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Background: In Bangladesh, preventive chemotherapy targeting soil-transmitted helminth (STH) infections in school-age children has been implemented since 2008. To evaluate the success of this strategy, surveys were conducted between 2017 and 2020 in 10 out of 64 districts. We estimate the geographic distribution of STH infections by species at high spatial resolution, identify risk factors, and estimate treatment needs at different population subgroups. Methodology: Bayesian geostatistical models were fitted to prevalence data of each STH species. Climatic, environmental, and socioeconomic predictors were extracted from satellite images, open-access, model-based databases, and demographic household surveys, and used to predict the prevalence of infection over a gridded surface at 1 x 1 km spatial resolution across the country, via Bayesian kriging. These estimates were combined with gridded population data to estimate the number of required treatments for different risk groups. Principal findings: The population-adjusted prevalence of Ascaris lumbricoides, Trichuris trichiura, and hookworm across all ages is estimated at 9.9% (95% Bayesian credible interval: 8.0-13.0%), 4.3% (3.0-7.3%), and 0.6% (0.4-0.9%), respectively. There were 24 out of 64 districts with an estimated population-adjusted STH infection prevalence above 20%. The proportion of households with improved sanitation showed a statistically important, protective association for both, A. lumbricoides and T. trichiura prevalence. Precipitation in the driest month of the year was negatively associated with A. lumbricoides prevalence. High organic carbon concentration in the soil's fine earth fraction was related to a high hookworm prevalence. Furthermore, we estimated that 30.5 (27.2; 36.0) million dosages of anthelmintic treatments for school-age children were required per year in Bangladesh. Conclusions/Significance: For each of the STH species, the prevalence was reduced by at least 80% since treatment was scaled up more than a decade ago. The current number of deworming dosages could be reduced by up to 61% if the treatment strategy was adapted to the local prevalence. Author summary: Bangladesh was in 2003 one of the world's countries that was most the affected by soil-transmitted helminthiasis, an infection of parasitic intestinal worms, with prevalence estimates as high as 55%. Following recommendations put forth by the World Health Organization (WHO), Bangladesh initiated a national deworming program based on school mass drug administration at six-month intervals, which started in 2008. Data collected between 2017 and 2020 showed that this program has lead to a striking decrease in prevalence, which was now between 10.5% and 1% depending on the species. Entering a close to elimination setting, the disease's control strategy can be refined according to local endemicity to reduce overtreatment. To inform such a shift, we predict the prevalence across Bangladesh at high spatial resolution and highlight zones of different endemicity. We also show the potential reduction of overtreatment and financial resources that could be achieved by treating according to WHO recommendations at the predicted endemicity levels. [ABSTRACT FROM AUTHOR]

There is increasing evidence of the post-COVID-19 suffering and decreased quality of life in the COVID-19 patients. This study aimed to assess the quality of life and associated factors of COVID-19 patients at one month after discharge from the hospital. This was a cross-sectional study that was conducted at the post-covid clinic of Dhaka Medical College Hospital (DMCH) where RT–PCR-confirmed adult COVID-19 recovered patients were enrolled one month after discharge from the same hospital. They were consecutively selected from January 01 to May 30. A pretested semi-structured questionnaire was used for the data collection for clinical variables. The generic multi-attributable utility instrument EQ-5D-5L was used for assessing health-related quality of life (HRQoL). A total of 563 patients were enrolled in the study. The patients had a mean age with standard deviation (±SD) of 51.18 (±13.49) years and 55.95% were male. The mean (SD) EQ-5D-5L index score and EQ-VAS scores were 0.78 (±0.19) and 70.26 (±11.13), respectively. Overall, 45.77%, 50.99%, 52.79%, 55.14% and 62.16% had problems (slight to extreme) in the mobility, self-care, usual activities, pain/discomfort and anxiety/depression dimensions, respectively. Patients aged ≥60 years had significant problem in mobility (odds ratio [OR] 3.24, 95% confidence interval [CI]: 1.07–9.77). Female participants were 5.50 times (95% CI: 2.22–13.62) more likely to have problems in their usual activities. In comparison to urban area, living in a peri-urban setting was significantly associated with problems in mobility (OR 1.89, 95% CI: 1.13–3.20), pain/discomfort (OR 1.82, 95% CI: 1.04–3.12) and anxiety/depression (OR 2.16, 95% CI: 1.22–3.84). Comorbid patients were 1.75 times (95% CI: 1.07–2.85) more likely to report problems in the pain/discomfort dimension. Presence of symptom(s) was associated with problems in self-care (OR 3.27, 95%CI: 1.31–8.18), usual-activity (OR 3.08, 95%CI: 1.21–7.87), pain/discomfort dimensions (OR 2.75, 95%CI: 1.09–6.96) and anxiety/depression (OR 3.35, 95%CI: 1.35–8.30). Specific management strategies should be planned to address the factors associated with low health-related quality of life in post-acute care of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) is well known for its varying presentations and poor outcomes, but little is evident about its distribution and characteristics among the Bangladeshi population. This study aimed to assess the pattern and prevalence of neuropsychiatric symptoms in female systemic lupus erythematosus (SLE) patients of Bangladesh. A retrospective study was conducted at a tertiary care hospital in Dhaka, Bangladesh, between January and December 2018. One hundred female SLE patients were included in the study purposively. Data were collected on sociodemographic and clinical characteristics of diagnosed SLE cases visiting the SLE clinic and indoor medicine department. Neuropsychiatric (NP) syndromes were defined according to the widely accepted American College of Rheumatology (ACR) nomenclature and case definitions. Results: A total of 244 NP events were identified in fifty-five patients. Headache was the most frequent symptom (55%), followed by cognitive dysfunction (50%), anxiety (49%), psychosis (43%), seizure (23%), depression (17%), and cerebrovascular disease (ischemic type, 7%). The NP manifestations were more prevalent among urban residents (58.2%), younger patients (41.8%), and patients with graduate-level education (34.5%). Besides, young age at diagnosis (p = 0.038), Raynaud's phenomenon (p = 0.015), other organ involvement (p < 0.001), and time of NPSLE development (p < 0.001) were found to be significantly associated with the development of these manifestations. Conclusion: NP damage is prevalent among Bangladeshi female SLE patients (55%) with headache and cognitive dysfunction being the most common symptoms. Routine screening for neuropsychiatric symptoms among suspected SLE cases and further evaluation with a larger population are warranted. [ABSTRACT FROM AUTHOR]

Background: Post-coronavirus disease (COVID-19) syndrome includes persistence of symptoms beyond viral clearance and fresh development of symptoms or exaggeration of chronic diseases within a month after initial clinical and virological cure of the disease with a viral etiology. We aimed to determine the incidence, association, and risk factors associated with development of the post-COVID-19 syndrome. Methods: We conducted a prospective cohort study at Dhaka Medical College Hospital between June 01, 2020 and August 10, 2020. All the enrolled patients were followed up for a month after clinical improvement, which was defined according the World Health Organization and Bangladesh guidelines as normal body temperature for successive 3 days, significant improvement in respiratory symptoms (respiratory rate <25/breath/minute with no dyspnea), and oxygen saturation >93% without assisted oxygen inhalation. Findings: Among the 400 recruited patients, 355 patients were analyzed. In total, 46% patients developed post-COVID-19 symptoms, with post-viral fatigue being the most prevalent symptom in 70% cases. The post-COVID-19 syndrome was associated with female gender (relative risk [RR]: 1.2, 95% confidence interval [CI]: 1.02–1.48, p = 0.03), those who required a prolonged time for clinical improvement (p<0.001), and those showing COVID-19 positivity after 14 days (RR: 1.09, 95% CI: 1.00–1.19, p<0.001) of initial positivity. Patients with severe COVID-19 at presentation developed post-COVID-19 syndrome (p = 0.02). Patients with fever (RR: 1.5, 95% CI: 1.05–2.27, p = 0.03), cough (RR: 1.36, 95% CI: 1.02–1.81, p = 0.04), respiratory distress (RR: 1.3, 95% CI: 1.4–1.56, p = 0.001), and lethargy (RR: 1.2, 95% CI: 1.06–1.35, p = 0.003) as the presenting features were associated with the development of the more susceptible to develop post COVID-19 syndrome than the others. Logistic regression analysis revealed female sex, respiratory distress, lethargy, and long duration of the disease as risk factors. Conclusion: Female sex, respiratory distress, lethargy, and long disease duration are critical risk factors for the development of post-COVID-19 syndrome. [ABSTRACT FROM AUTHOR]

Background: Globally, studies have shown conflicting results regarding the association of blood groups with SARS CoV-2 infection. Objective: To observe the association between ABO blood groups and the presentation and outcomes of confirmed COVID-19 cases. Design, setting, and participants: This was a prospective cohort study of patients with mild-to-moderately severe COVID-19 infections who presented in the COVID-19 unit of Dhaka Medical College Hospital and were enrolled between 01 June and 25 August, 2020. Patients were followed up for at least 30 days after disease onset. We grouped participants with A-positive and A-negative blood groups into group I and participants with other blood groups into group II. Results: The cohort included 438 patients; 52 patients were lost to follow-up, five died, and 381 completed the study. The prevalence of blood group A [144 (32.9%)] was significantly higher among COVID-19 patients than in the general population (p < 0.001). The presenting age [mean (SD)] of group I [42.1 (14.5)] was higher than that of group II [38.8 (12.4), p = 0.014]. Sex (p = 0.23) and co-morbidity (hypertension, p = 0.34; diabetes, p = 0.13) did not differ between the patients in groups I and II. No differences were observed regarding important presenting symptoms, including fever (p = 0.72), cough (p = 0.69), and respiratory distress (p = 0.09). There was no significant difference in the median duration of symptoms in the two group (12 days), and conversion to the next level of severity was observed in 26 (20.6%) and 36 patients (13.8%) in group I and II, respectively. However, persistent positivity of RT-PCR at 14 days of initial positivity was more frequent among the patients in group I [24 (19%)] than among those in group II [29 (11.1%)]. Conclusions: The prevalence of blood group A was higher among COVID-19 patients. Although ABO blood groups were not associated with the presentation or recovery period of COVID-19, patients with blood group A had delayed seroconversion. [ABSTRACT FROM AUTHOR]

Background: Snakebite is a neglected public health problem in many countries of the world. Being a tropical country Bangladesh is also facing this problem. In this case series we have tried to focus the illiteracy, prejudice and mismanagement happen in snake bite cases from primary to tertiary level and how effective management can save life of snake bite victim. Case presentation: Among the 29 snake bite cases admitted in a medicine ward of tertiary care hospital four were venomous bites-two male and two female. Our patients came from around Dhaka city. Though victim failed to bring the snake, by studying clinical features and syndromic approaches we suspected Kraits as the culprit in three cases and Cobra in one case. Time period between bite and attend to hospital ranged from 4 hr to 16.30 hours. All victims had inappropriate application of tourniquet to their limbs as a first aid management. Most of them first visit OZHA (traditional healer). Two of them developed respiratory failure. All cases were managed in ICU with polyvalent ASV. One developed anaphylaxis which was managed with adrenaline. All patients recovered completely. Conclusion: Arrival to hospital without delay, facilities for management with trained physicians and proper supply of ASV may reduce death from snake bite and reduce financial burden to the patient. Developing public awareness to remove prejudice about snakes and identifying venomous snake bite is also necessary. [ABSTRACT FROM AUTHOR]

Background: We report relationship of wealth indices with self-reported diabetes data in Bangladeshi people. As a secondary objective we examine whether educational achievement can be used as a proxy of wealth indices. Methods: We have analyzed data of a nationally representative STEPS survey (STEPwise Surveillance of NCD risk factors) done in 2010 in 8808 adults selected at their households using a multistage cluster sampling approach to describe association of socioeconomic status with diabetes mellitus. We created wealth indices using principal component analysis based on a 20-item household asset items; and then divided subjects in to quartiles. Results: Prevalence of documented diabetes was 3.9% but it was more than 11 times (9.3%) in the fourth quartile (richest) compared to the first quartile (0.8%). This may either mean that the detection rate is higher among the higher socioeconomic group or there are some intervening factors accompanied by the economic achievements that favors occurrence or detection of diabetes in Bangladeshi adults. Conclusion: Future studies need to identify the factor(s) that provides such a putative effect. Educational achievement also has shown similar trend. Therefore, education might be a proxy variable to determine socioeconomic status instead of a long list of household asset items. [ABSTRACT FROM AUTHOR]

Bangladesh has achieved remarkable success in reducing the prevalence of open defecation to almost zero, from as high as 34 per cent in 1990. However, significant disparity exists in sanitation coverage, with relatively low coverage and poor quality sanitation in poor communities. In addition, poor management of faecal sludge is leading to serious environmental degradation and is becoming a major public health concern. Local government institutions (LGIs) (i.e. city corporations and municipalities) are responsible for sanitation services in urban areas. In this study, the Burke-Litwin model of organizational capacity has been used for capacity assessment of three city corporations (Dhaka North, Chattogram, and Rangpur) in Bangladesh with regard to sanitation. Analysis based on the model clearly identified a number of 'external' factors such as existing rules and regulations, public opinion, political commitment, and role of support organizations that have very strong influence on the attitude and performance of the city corporations. The analysis also identified a number of 'internal' factors (e.g. leadership, organization culture, structure, management practice, individual skills and motivation) affecting organizational capacity and performance. Currently all three city corporations studied have very limited capacity in sanitation/pro-poor sanitation planning, investment, and management. Based on the analysis, a number of recommendations aimed at improving capacities of the city corporations in addressing inclusive sanitation planning, investment, and management are made. Lessons learned from this study could be useful in assessing and improving sanitation service delivery by LGIs in cities and towns in Bangladesh and elsewhere. [ABSTRACT FROM AUTHOR]

This study aimed to investigate factors affecting fruit and vegetables (FAVs) intake among Bangladeshi adults. Dietary data of 9275 adults from the Bangladesh Noncommunicable Disease Risk Factor Survey 2010 were analyzed. The mean age of the respondents was 42.4 (±13.5) years. Multistage cluster sampling was applied to identify samples. Demographics, personal habits, physical activity, diet, and anthropometric data were collected using the WHO-STEPs questionnaire. Average daily intake of <5 servings of FAVs combined was considered to be low FAV consumption, and its prevalence was 82.8%. A mixed-effect logistic regression model was fitted to assess association of factors with low FAV intake. Higher educational attainment, greater wealth, female sex, low physical activity, body mass index >25 kg/m2, and smokeless tobacco consumption were significantly associated with higher FAV consumption. Frequency of low FAV intake increased with increasing age and decreased with increasing educational attainment. Programs targeting people at risk of low FAV consumption are needed to promote consumption. [ABSTRACT FROM AUTHOR]

Introduction Chikungunya is an arthropod-borne virus endemic to Africa, Southeast Asia and India that causes acute febrile polyarthralgia and arthritis. In this short case series, we discuss six Bangladeshi patients with chikungunya fever. Though Bangladesh is in endemic zone, it is not common here, hence it demands attention for proper diagnosis and management. Case presentation The six cases of chikungunya we report occurred in native Bangladeshi women with ages ranging from 20 to 50 years and all having a middle class family background. Three women had severe incapacitating arthralgia as well as a maculo-papular rash and a high fever. The other three had a high grade fever and arthralgia only, but no rash. They were tested for chikungunya immunoglobulin M antibody and found to be positive in all cases. They were treated symptomatically with non-steroidal anti-inflammatory drugs and found responsive in most cases. Conclusion From this case series, it is evident that chikungunya is not that uncommon in Bangladesh. But the concomitant presence of other arthropod-borne infections with similar courses of illness makes most physicians less aware of this infection. An awareness and clinical knowledge are necessary to diagnose chikungunya infection properly. [ABSTRACT FROM AUTHOR]

Background: Psoriatic Arthritis (PsA) is a complex seronegative inflammatory arthritis associated with psoriasis, characterized by a wide range of clinical manifestations. This study aimed to explore the prevalence of PsA in arthritic patients along with associated demographic and clinical characteristics in a tertiary care setting in Bangladesh. Methods: This cross-sectional study was conducted at the Rheumatology Clinic of Dhaka Medical College Hospital over a period of 6 months from March 2018 to August 2018. A total of 600 arthritis patients underwent screening for PsA, with subsequent evaluations of confirmed cases based on the CASPAR criteria. Demographic and clinical characteristics were documented through face-to-face interviews and physical examination. For data collection, a pre-structured questionnaire was used. Disease activity was assessed using the DAPSA score. The study was conducted according to the 'Declaration of Helsinki'. The statistical analysis was done with SPSS v-21. Results: The prevalence of PsA in arthritis patients was 5%. Age distribution of PsA showed a majority in between 30-39 years age group with a mean of 36.33±11.86 (SD). Slight female predominance was reported with a percentage of 53.3%.Almost three-fourths of study patients presented with a current diagnosis of psoriasis while the rest had a personal history or family history. A higher incidence (67.7%) of plaque psoriasis was observed followed by sebopsoriasis (20%) and for the rest of the patients, the type of psoriasis was unknown. The disease mostly involved multiple joints (90%), with ankle and metacarpal joints being the most commonly affected at 43.3% and 33.3%, respectively. Disease activity was high in the majority of the patients according to the DAPSA score, representing 53.34% of the patients, with the remainder exhibiting moderate to low disease activity. Conclusion: The study revealed a significant incidence of PsA among the arthritic population which indicates a pressing need for further extensive research on PsA across diverse populations. [ABSTRACT FROM AUTHOR]

The death toll of the coronavirus disease 2019 (COVID-19) has been considerable. Several risk factors have been linked to mortality due to COVID-19 in hospitals. This study aimed to describe the clinical characteristics of patients who either died from COVID-19 at Dhaka Medical College Hospital in Bangladesh. In this retrospective study, we reviewed the hospital records of patients who died or recovered and tested positive for COVID-19 from May 3 to August 31, 2020.All patients who died during the study period were included in the analysis. A comparison group of patients who survived COVID-19 at the same hospital during the same period was systematically sampled.All available information was retrieved from the records, including demographic, clinical, and laboratory variables. Of the 3115 patients with confirmed COVID-19 during the study period, 282 died.The mean age of patients who died was higher than that of those who survived (56.7 vs 52.6 years).Approximately three-fourths of deceased patients were male. History of smoking (risk ratio 2.3; 95% confidence interval: 1.6–3.4), comorbidities (risk ratio: 1.5; 95% confidence interal:1.1–2.1), chronic kidney disease (risk ratio: 3.2; 95% confidence interval: 1.7–6.25), and ischemic heart disease (risk ratio:1.8; 95% confidence interval: 1.1–2.9) were higher among the deceased than among those who survived. Mean C-reactive protein and D-dimer levels [mean (interquartile range), 34 (21–56) vs. 24 (12–48); and D-dimer [1.43 (1–2.4) vs. 0.8 (0.44–1.55)] were higher among those who died than among those who recovered. Older age, male sex, rural residence, history of smoking, and chronic kidney disease were found to be important predictors of mortality. Early hospitalization should be considered for patients with COVID-19 who are older, male, and have chronic kidney disease. Rapid referral to tertiary care facilities is necessary for high-risk patients in rural settings. [ABSTRACT FROM AUTHOR]

Background: The health care workers'(HCWs) are working 24/7 in managing devastating pandemic Corona virus disease19(COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) as front liner which leads them to be at highest risk for contacting infection. In Bangladesh, being a lower middle-income country and densely populated, the burden is much more on HCWs. Methods: We did a cross-sectional study with an aim to identify the prevalence, risk factors, and outcomes of SARS-CoV-2 infection among the HCWs in a COVID-19 dedicated tertiary care hospital. Statistical analysis was done in SPSS version-26. Multivariate regression analysis was done to evaluate risk factors responsible for COVID-19 infection and the severity of the COVID-19 disease. We expressed odds ratio with 95% CI, and considered the p-value of <0.05 as significant in the two-tailed test. Results: A total of 864 HCWs had participated with mean age of 34.16 ± 6.77 and 426 (49.31%) males. Among them 143 (16.55%) were tested RT-PCR positive for SARS-COV-2. Bronchial asthma/COPD and Hypertension were the most common co-morbidities with 23 (16.08%) for each. About 102 (71.33%) of the RT-PCR positive HCWs became symptomatic. Fever, cough and myalgia were the most common symptoms 84(82.35%), 67(65.69%) and 52(50.98%) respectively. Multivariate regression analysis revealed hypertension, gout, and working in the COVID-19 confirmed ward had a significant odds ratio for getting infected with SARS-CoV-2 [95% CI, p-value 1.91 (1.08 - 3.41), 0.027; 5.85 (1.33 - 25.74), 0.020; and 1.83 (1.10 - 3.03), 0.019]. Bronchial asthma/COPD and gout found to be risk factors for moderate to severe COVID-19 disease [95% CI, p-value 3.04 (1.01 - 9.21), 0.049 and 23.38 (3.42 - 159.72), 0.001]. Hospitalization rate was 12(85.7%), and 3(100%) and median hospital stays were 11 (5.5 - 15), and 20 (7 - 30) days for moderate and severe diseases respectively. Outcome was uneventful without any ICU admission and death. Conclusion: HCWs working in the COVID-19 confirmed ward are at increased risk of infection with SARS-COV-2. Some co-morbidities like hypertension and gout are important risk factors for contacting SARS-COV-2 infection. Bronchial asthma/COPD and gout favors disease severity. [ABSTRACT FROM AUTHOR]

Background: A large number of kala-azar cases from a particular village in Debigonj upazila of Panchaghar, a remote district of Bangladesh, led us to carry out the study of the situation. Materials & methods: This cross-sectional study was done among clinically screened people at the health camp in two days in Dararhat in Debigonj upazila of Panchaghar. Results: Around 700 people were screened at the health camp and 51 (7.2%) were suspected to have either Kala-azar or related disorders where 42 (82%) were rk-39 test positive. The disease was more prevalent among adult (59.6%) and children (23.8%) under the age of 10 years. However, there was no clear linear relationship between the prevalence of the disease and age group. Kala-azar occurred in both male and female, and its prevalence did not correlate significantly with income. A history of fever (73.8%) and splenomegaly (45.2%) was noted in most of the kala-azar cases. A significant number of PKDL (26.2%) cases were also found in that area. Conclusions: Since there are a significant proportion of PKDL cases, eradication will be very tough unless the health authority take adequate measure to identify and treat them properly. [ABSTRACT FROM AUTHOR]

This study proposes a community rainwater harvesting (RWH) system as an alternative water supply solution for Paikgacha, a water-scarce coastal urban area in Bangladesh. Although individual household-based RWH systems have been implemented in many areas in Bangladesh, to date, no study has been conducted designing a community RWH system and assessing its reliability and financial feasibility. This study employs historical observed and available climate model predicted future rainfall data into stormwater management model (SWMM) for rainfall-runoff simulation of the community RWH, and compares SWMM's performance with rational formula based estimation. We then calculate volumetric and time reliability of the proposed system and assess its financial viability. We observe good agreement in reliability curves generated by SWMM and rational formula-based model. Under the historical rainfall scenario, our proposed community RWH shows up to 99% reliability for 100 L per day household demand, given that proper community size and storage tank size are chosen. Predicted rainfall pattern of 2041–2070 period shows similar reliability-tank size relation to that of historical observed rainfall; however, predicted high precipitation intensity during 2021–2040 and 2071–2100 seem to assist the system in attaining higher reliability. Cost-benefit analysis indicates the financial viability of the proposed system. Finally, we develop a nomograph incorporating interactive factors of RWH, which would ease decision making by the policymakers regarding the implementation of community RWH. [Display omitted] • Designing and modeling a community rainwater harvesting (RWH) system. • Estimation of climate change impacts on reliability and financial feasibility. • Up to 99% reliability can be achieved for certain community water demand scenario. • Community RWH is financially viable in the study area. • A decision making nomograph is developed for implementing community RWH. [ABSTRACT FROM AUTHOR]

Objective: We aimed to describe clinical and laboratory characteristics and determine the predictors of outcome in patients with cerebral venous sinus thrombosis., Methods: This prospective study was conducted over 2 years among hospitalized patients with cerebral venous sinus thrombosis. Patient outcome was assessed using the Modified Rankin Scale (mRS) score at 3 months. Outcome predictors were identified using logistic regression analysis., Results: Eighty-one patients were included in this study. The median mRS outcome at 3 months was 1 (interquartile range 1-3). Poor outcomes were observed in 27.2% of patients, and the mortality rate was 9.8%. Factors associated with poor outcomes were age >60 years (relative risk [RR] 5.1), hemiparesis (RR 5.4), altered level of consciousness (RR 7.1), and transverse sinus involvement (RR 1.1). In general, mRS scores were not associated with D-dimer levels (RR 2.4). However, older patients with elevated D-dimer levels showed a significant association with poor outcomes (1.6) according to mRS scores., Conclusion: Older age, hemiparesis, and altered consciousness levels were independent predictors of poor outcomes in patients with cerebral venous sinus thrombosis. High D-dimer level showed no association with functional disability, except in older patients., Competing Interests: Declaration of conflicting interestThe authors declare that there is no conflict of interest.

Introduction: COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic., Methods: We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI)., Results: Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p<0.01). Anxiety, depression and burnout scores were statistically worse in COVID-19 active staff compared with those not working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although mean burnout scores were within the normal range for each institution, a high proportion of staff (almost 20% in some instances) were shown to be classified as experiencing burnout by their EE, DP and PA scores., Conclusion: We identified a high prevalence of perceived anxiety, depression and burnout among doctors and nurses during the COVID-19 pandemic. This was worse in staff engaged in COVID-19-related activities. These findings could help healthcare organisations to plan for future similar events., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background Objectives: Bangladesh is afflicted with periodic dengue outbreak every few years and one of the worst upsurges was recorded in 2019 during which there was an increasing trend of dengue with unusual symptoms which were not so common before. This study aims to describe the experience of three tertiary care centres of Dhaka regarding the clinical and laboratory, hospital outcome and management profile of the Expanded Dengue Syndrome (EDS) cases admitted from the 2019 outbreak., Methods: The current work was a cross-sectional observational study which took place from August 1 to December 31 2019 at three major tertiary care centres in Dhaka, Bangladesh. Out of total 2017 screened dengue cases, 49 met the inclusion criteria and 39 were enrolled after taking informed written consent. Data was analysed using Microsoft Excel and Graph pad prism 9.3.1. A probability value of p<0.05 was considered statistically significant., Results: Out of the 39 cases, majority were male (79.49%) with median (±IQR) age of 33(±9) years. Hypertension (4; 10.26%) was the most commonly associated co-morbidity. Among the systemic manifestations, most prevalent was hepatitis (38.49%) followed by encephalopathy (12.82%). Majority of the patients were suffering from primary infection (85%). Case fatality rate was 15.38%. Hepatitis and meningoencephalitis were the predominant cause of death. This study records the only known case report of Acute respiratory dress syndrome (ARDS) complicating dengue from Bangladesh. None of the patients from our cohort were managed by steroids. Only two (5.13%) out of 39 cases received antibiotics., Interpretation Conclusion: In the year 2019, an unusual rise in EDS cases with about 15.4% fatalities were observed in this study. Hepatitis was the most common presentation and cause of death. Here, we report the first ARDS case encountered in Bangladesh. Despite the multifaceted presentation of EDS, indiscriminate use of antibiotics and steroid was minimal. Early recognition of multifarious features of EDS is important for choosing the targeted treatment option which can avert many deaths. The results of this study underline the necessity for more in-depth research into the risk factors that are contributing to mortality in EDS cases., (Copyright © 2024 Copyright: © 2024 Journal of Vector Borne Diseases.)

Background: Dengue-COVID-19 coinfection is one of the greatest emerging challenges in dengue-endemic areas during the continuing pandemic. With coinciding clinical and laboratory pictures, early diagnosis becomes burdensome, with management discrepancy., Methods: A descriptive study was performed on dengue-COVID-19 coinfected patients during July-August 2021 for an overview of disease progression, severity and outcome. A total of 11 patients who were positive for dengue NS1 and/or antidengue IgM were included in this study., Results: In total, 45.5% patients developed severe COVID-19 disease, 45.5% patients developed group B dengue fever and 9% patients developed group C dengue fever. Concurrent severity of both diseases was seen to be rare, except for in one patient., Conclusion: Early diagnosis and compatible management still stand as basic principles to prevent fatality and morbidity., (© The Author(s) 2022. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may cause severe life-threatening diseases called acute respiratory distress syndrome (ARDS) owing to cytokine storms. The mortality rate of COVID-19-related ARDS is as high as 40% to 50%. However, effective treatment for the extensive release of acute inflammatory mediators induced by hyperactive and inappropriate immune responses is very limited. Many anti-inflammatory drugs with variable efficacies have been investigated. Colchicine inhibits interleukin 1 beta (IL-1β) and its subsequent inflammatory cascade by primarily blocking pyrin and nucleotide-binding domain leucine-rich repeat and pyrin domain containing receptor 3 (NLRP3) activation. Therefore, this cheap, widely available, oral drug might provide an added benefit in combating the cytokine storm in COVID-19. Here, we sought to determine whether adding colchicine to other standards of care could be beneficial for moderate COVID-19 pneumonia in terms of the requirement for advanced respiratory support and mortality., Methods and Findings: This blinded placebo-controlled drug trial was conducted at the Dhaka Medical College Hospital, Dhaka, Bangladesh. A total of 300 patients with moderate COVID-19 based on a positive RT-PCR result were enrolled based on strict selection criteria from June 2020 to November 2020. Patients were randomly assigned to either treatment group in a 1:1 ratio. Patients were administered 1.2 mg of colchicine on day 1 followed by daily treatment with 0.6 mg of colchicine for 13 days or placebo along with the standard of care. The primary outcome was the time to clinical deterioration from randomization to two or more points on a seven-category ordinal scale within the 14 days post-randomization. Clinical outcomes were also recorded on day 28. The primary endpoint was met by 9 (6.2%) patients in the placebo group and 4 (2.7%) patients in the colchicine group (P = 0.171), which corresponds to a hazard ratio (95% CI) of 0.44 (0.13-1.43). Additional analysis of the outcomes on day 28 revealed significantly lower clinical deterioration (defined as a decrease by two or more points) in the colchicine group, with a hazard ratio [95%CI] of 0.29 [0.098-0.917], (P = 0.035). Despite a 56% reduction in the need for mechanical ventilation and death with colchicine treatment on day 14, the reduction was not statistically significant. On day 28, colchicine significantly reduced clinical deterioration measured as the need for mechanical ventilation and all-cause mortality., Conclusion: Colchicine was not found to have a significant beneficial effect on reducing mortality and the need for mechanical ventilation. However, a delayed beneficial effect was observed. Therefore, further studies should be conducted to evaluate the late benefits of colchicine., Clinical Trial Registration: Clinical trial registration no: ClinicalTrials.gov Identifier: NCT04527562 https://www.google.com/search?client=firefox-b-d&q=NCT04527562., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Rahman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Wearing masks or personal protective equipment (PPE) has become an integral part of the occupational life of physicians due to the coronavirus disease 2019 (COVID-19) pandemic. Most physicians have been developing various health hazards related to the use of different protective gears. This study aimed to determine the burden and spectrum of various health hazards associated with using masks or PPE and their associated risk factors., Methods: This cross-sectional survey was conducted in Dhaka Medical College from March 01-May 30, 2021, among physicians from different public hospitals in Dhaka, Bangladesh. We analyzed the responses of 506 physicians who completed case record forms through Google forms or hard copies., Findings: The mean (SD) age of the respondents was 35.4 [7.7], and 69.4% were men. Approximately 40% were using full PPE, and 55% were using N-95 masks. A total of 489 (96.6%) patients experienced at least one health hazard. The reported severe health hazards were syncope, severe dyspnea, severe chest pain, and anaphylaxis. Headache, dizziness, mood irritation, chest pain, excessive sweating, panic attack, and permanent facial disfigurement were the minor health hazards reported. Extended periods of work in the COVID-19-unit, reuse of masks, diabetes, obesity, and mental stress were risk factors for dyspnea. The risk factors for headaches were female sex, diabetes, and previous primary headaches. Furthermore, female sex and reusing masks for an extended period (> 6 h) were risk factors for facial disfigurement. The risk factors for excessive sweating were female sex and additional evening office practice for an extended period., Conclusions: Healthcare workers experienced several occupational hazards after using masks and PPE. Therefore, an appropriate policy is required to reduce such risks., Competing Interests: The authors have declared that no competing interests exist.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder in which the body's defense system wrongly attacks healthy body tissues. The objective of this current setup was to quantify and compare the serum concentration of ascorbic acid (Vit-C), malondialdehyde (MDA), c-reactive protein (CRP) and trace elements (Cu, Fe, Mn and Zn) in SLE and normal subjects., Methods: The proposed case-control study was performed with 25 SLE patients and 25 healthy subjects as case and control, respectively. The serum level of malondialdehyde (MDA) and vitamin C was evaluated by UV spectrophotometric method. For the determination of CRP, the latex agglutination method was used, whereas serum trace elements were estimated by atomic absorption spectroscopy (AAS)., Results: This analysis demonstrated that patients with SLE possessed a significant (p < 0.001) higher level of MDA and lower level of vitamin C compared to control subjects. Pearson's correlation analysis found negative correlation between the serum level of MDA and vitamin C (r= -0.023, p = 0.887) for patients while control group also possessed similar result (r= -0.157, p = 0.453). The current findings have also revealed that serum level of Zn and Cu in SLE patients was significantly (p < 0.05) lowered to that of the control group, while serum level of Mn also showed a similar scenario. During Pearson's correlation analysis a significantly (p < 0.05) negative correlation was found between Zn and Mn (r= -0.410, p = 0.042) in patients' group., Conclusion: Although our study was limited to a small sample size and confined to a particular area of the country, the study results support a significant role of antioxidants, CRP, and trace elements in the generation of SLE and, therefore, recommends a large spectrum study of the associations between SLE and these biochemical parameters., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Objectives: To determine the national prevalence of risk factors of non-communicable diseases (NCD) in the adult population of Bangladesh., Design: The study was a population-based national cross-sectional study., Setting: This study used 496 primary sampling units (PSUs) developed by the Bangladesh Bureau of Statistics. The PSUs were equally allocated to each division and urban and rural stratum within each division., Participants: The participants were adults aged 18 to 69 years, who were usual residents of the households for at least 6 months and stayed the night before the survey. Out of 9900 participants, 8185 (82.7%) completed STEP-1 and STEP-2, and 7208 took part in STEP-3., Primary and Secondary Outcome: The prevalence of behavioural, physical and biochemical risk factors of NCD. Data were weighted to generate national estimates., Results: Tobacco use was significantly (p<0.05) higher in the rural (45.2%) than the urban (38.8%) population. Inadequate fruit/vegetable intake was significantly (p<0.05) higher in the urban (92.1%) than in the rural (88.9%) population. The mean salt intake per day was higher in the rural (9.0 g) than urban (8.9 g) population. Among all, 3.0% had no, 70.9% had 1 to 2 and 26.2% had ≥3 NCD risk factors. The urban population was more likely to have insufficient physical activity (adjusted OR (AOR): 1.2, 95% CI: 1.2 to 1.2), obesity (AOR: 1.5, 95% CI: 1.5 to 1.5), hypertension (AOR: 1.3, 95% CI: 1.3 to 1.3), diabetes (AOR: 1.6, 95% CI: 1.6 to 1.6) and hyperglycaemia (AOR: 1.1, 95% CI: 1.1 to 1.1)., Conclusions: Considering the high prevalence of the behavioural, physical and biochemical risk factors, diverse population and high-risk group targeted interventions are essential to combat the rising burden of NCDs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

From April to September 2017, Bangladesh experienced a huge outbreak of acute Chikungunya virus infection in Dhaka. This series describes the clinical and laboratory features of a large number of cases (690; 399 confirmed and 291 probable) suffered during that period. This observational study was carried out at Dhaka Medical College Hospital, Bangladesh. The median age of the patients at presentation was 38 years (IQR 30-50) with a male (57.3%) predominance. Hypertension and diabetes were the most common comorbidities. The mean (±SD) duration of fever was 3.7 (±1.4) days. Other common manifestations were arthralgia (99.2%), maculopapular rash (50.2%), morning stiffness (49.7%), joint swelling (48.5%), and headache (37.6%). Cases were confirmed by anti-chikungunya IgG (173; 43.3%), IgM (165; 42.3%), and reverse transcription polymerase chain reaction (44; 11.0%). Important laboratory findings include high erythrocyte sedimentation rate (156; 22.6%), raised serum glutamic pyruvic transaminase (73; 10.5%), random blood sugar (54; 7.8%), leukopenia (72; 10.4%), thrombocytopenia (41; 5.9%), and others. The oligo-articular (453; 66.1%) variety of joint involvement was significantly more common compared with the poly-articular (237; 34.5%) variety. Commonly involved joints were the wrist (371; 54.1%), small joints of the hand (321; 46.8%), ankle (251; 36.6%), knee (240; 35.0%), and elbow (228; 33.2%). Eleven cases were found to be complicated with neurological involvement and two of them died. Another patient died due to myocarditis. Public health experts, clinicians, and policymakers could use the results of this study to construct the future strategy tackling chikungunya in Bangladesh and other epidemic countries.

Background: Nationally representative data on noncommunicable disease (NCD) risk factors are lacking in Bangladesh. This study was done to determine the prevalence of common risk factors for major NCDs among men and women of rural and urban areas of Bangladesh., Materials and Methods: This survey was done with 9,275 individuals aged 25 years or older randomly drawn from all over the country. Information on diet, physical activity, tobacco and alcohol, and treatment history for hypertension and diabetes were collected. Height, weight, waist circumference, and blood pressure (BP) were measured., Results: There were 4,312 men and 4,963 women with the mean age of 42 years (standard deviation 13 years). Half of them (54%) used tobacco in some form, <1% consumed alcohol within the past 30 days, 92% did not consume adequate fruit and vegetables (five servings or more), and 35% had low physical activity level [<600 metabolic equivalent (MET) min per week]. Documented diabetes was found in 4% of the participants. Seventeen percent were overweight [body mass index (BMI) ≥25 kg/m 2 and 21% had abdominal obesity (men ≥94, women ≥80 cm). Overall, 21% people had hypertension (blood pressure ≥140/90 mmHg or medication). Physical inactivity, alcohol intake, hypertension, obesity, and diabetes were more prevalent in urban areas, as opposed to tobacco. Tobacco intake showed a decreasing gradient, but hypertension, obesity, diabetes, and low physical activity showed an increasing gradient across the wealth quartiles., Conclusion: Risk factors are widely prevalent in Bangladeshi people across sexes and across both rural and urban areas of residences. NCD prevention through risk factor control, and early detection and treatment of hypertension and diabetes are warranted.