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Background: Corona Virus Disease (COVID -19) patients present mainly with respiratory manifestations and viral pneumonia. The cardiovascular presentation includes early signs of acute myocardial injury. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or nonspecific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities and mortality. Methods and materials: It was a prospective observational study, conducted in four tertiary care Private Hospitals of Chattogram City of Bangladesh. The study enrolled 181 consecutive patients admitted to hospital from June 01, 2020 to December 31, 2020 due to Covid-19 disease on the basis of presentation of signs and symptoms severity. Upon admission, routine investigations cTnI and ECG were carried out. Results: Mean age of the patients was 54.3±7.3 years with 63.5% male. Hypertension was the most common comorbidity followed by diabetes and obesity. 57.1% of the patients had abnormal ECG. Abnormal axis deviation [26 % (left axis deviation 23.9% vs right axis deviation 2.0%)], Poor R wave progression (22.9%), T inversion (14.5%), left ventricular hypertrophy (LVH) (11.4%) followed by ST segment depression (8.3%) were major findings observed in the study population. Presence of LVH (p=0.008), ST segment elevation (p≤0.001), ST segment depression (p≤0.001) and T inversion (p=0.003) showed statistically significant association with Severe COVID-19 disease. 48.2% had raised cTnI level. Thirteen (7.2%) patients expired in hospital. The mortality rate increased with incrementally higher troponin group: 12/18 than mildly elevated troponin 1/63 (p < 0.01). The presence of an abnormal ECG finding resulted in significant in the intermediate Troponin elevation group (0.05-1 ng/ml) but not in the low ( 1 ng/ml) Troponin elevation groups. There were statistically significant association between between cTnI level and death; and between ECG findings and death. Conclusion: Study conclude that Troponin-I level and ECG are a prognostic factor for mortality in hospitalized COVID-19 patients. Bangladesh Heart Journal 2021; 36(2): 105-112

Background: Febrile seizures are the most common type of seizures in children. It is prevalent in children aged between 6 months and 60 months, with an incidence of 2-5%. On the other hand, iron deficiency anemia is the most common hematologic disease of infancy and childhood with a period of incidence that coincides with the time of developing febrile seizures. Therefore, it is hypothesized that there is a possible association between this two conditions. The relationship between iron deficiency anemia and febrile seizures had been examined in several studies with conflicting results. This study was designed to elucidate this association. The purpose of this study was to determine the association between Iron deficiency anemia and febrile seizures in children. Materials and methods: In this case-control study 80 children with a diagnosis of febrile seizures, aged between 6 months and 60 months who were visited Pediatric ward and Pediatric outpatient department of Chattogram Medical College Hospital, Chattogram, during June 2012 to may 2013 were enrolled as cases. The control group consisted of 80 febrile children without seizure and were matched to the cases by gender and age. Iron deficiency anemia was diagnosed by hematologic investigations of hemoglobin value 15%. Results: A total 36 out of 80(45%) seizure cases had iron deficiency anemia whereas, 08 out of 80(10%) controls were found to have iron deficiency anemia. There was statistical significance of difference observed in two groups (p

Background: Transmission risk of coronavirus disease 2019 (COVID-19) to close contacts and at different exposure settings are yet to be fully understood for the evaluation of effective control measures. Methods: We traced 1171 close contact cases who were linked to 291 index cases between July 3, 2020 and September 3, 2020. Clinical and epidemiological characteristics of all index cases, close contacts, and secondary contact cases were collected and analyzed the secondary attack rate and risk of transmission at different exposure settings. Results: Median age of 291 index cases were 43.0 years (range 18.5-82.3) including 213 male and 78 females. Among all 1171 close contact cases, 39(3.3%) cases were identified as secondary infected cases. Among 39 secondary cases, 33(84.62%) cases were symptomatic and 3 (7.69%) cases were asymptomatic. Of the 33 symptomatic cases, 31(86.1%) male and 5(13.9%) female. Of these 36 symptomatic cases, 24(66.7%) cases between age 20-59 and remaining 12(33.3%) cases were age 60 and over. Of the 36 symptomatic cases, 11(30.6%) cases were identified as severe, 19(52.8%) as moderate and 6(16.7%) as mild. The overall secondary clinical attack rate was 3.07% (95% CI 2.49-3.64). The attack rate was higher among those aged between 50 to 69 years and shows higher risk of transmission than age below 50 years. The attack rate was higher among household contact (6.17%(95%CI 4.7-7.6; risk ratio 2.44[95%CI1.5-3.4]), and lower in hospital facility (2.29%,95%CI0.58-3.40; [risk ratio 0.91,95%CI 0.17-1.9]), funeral ceremony (2.53%,95%CI 0.32-4.73), work places (3.95%,95% CI2.5-5.42 [risk ratio 1.56,95%CI 0.63-2.5]), family contacts (3.87%,95%CI 2.4-5.3; risk ratio 1.53,95%CI 0.61-2.45]). Conclusions: Among all exposure settings analyzed, household contact exposure setting remained the highest transmission probability and risk of transmission of COVID-19 with the increase of age and disease severity.

Emerging evidence suggests that patients with cancer are at increased risk of detrimental Covid-19 outcome. The relationship between SARS-CoV-2 viral load and risk factors and outcome of SARS-CoV-2 positive cancer patients remains largely unexplored. We assessed the outcomes of Covid-19 infection in 64 cancer patients and 120 non-cancer and measured SARS-CoV-2 viral load from nasopharyngeal swab samples using cycle threshold (Ct) values who were admitted to two geographically distinct hospitals. We also assessed the incubation period and serial interval time differences between the non-cancer and cancer groups. Our results indicated that the overall mortality rate was higher among cancer patients with a high SARS-CoV-2 viral load. Covid-19 positive cancer patients with higher viral load are more prone to severe outcomes compared to non-cancer and low viral load patients. In addition, patients with lung and hematologic cancer have higher tendencies of severe events in proportion to high viral load. Higher attributable mortality and severity were directly proportional to high viral load particularly patients who are receiving anticancer treatment. Importantly, we found that the incubation period and serial interval time is fairly shorter in cancer patients compared with non-cancer cases. Our report suggests that high SARS-CoV-2 viral loads may play significant role in the overall mortality and severity of Covid-19 positive cancer patients and warranted further study to explore the disease pathogenesis and their use as prognostic tools.

Background: To determine the Validity of Immunochromatographic Test (ICT) in diagnosis of typhoid fever in children admitted in a tertiary care hospital.Methods: This cross sectional study was carried out the in Pediatric & Medicine wards of Chittagong Medical College Hospital (CMCH), Chittagong during the period July 2012 to June 2013. A total number of 150 clinically suspected cases of typhoid fever (Age >6 months to18 years) were enrolled in this study. After taking informed written consent, detailed history & clinical examination were completed. A blood culture sample was taken on the day of admission before starting antibiotic. On the 5th day onwards of appearance of fever, blood sample was taken to perform ICT. Patients received standard medical treatment of the admitting wards.Results: Blood C/S for Salmonella typhi was found positive in 16(10.7%) cases. Positive ICT for typhoid fever was found in 37(24.7%) cases. Among then, IgM was 18(12.0%) IgM+IgG were 8(5.3%) and IgG was 11(7.3%). ICT found true positive in 14, false positive in 23, false negative in 2 and true negative in 111 cases, where blood culture considered as gold standard. The difference was statistically significant (p

Mucopolysaccharidoses (MPS) are hereditary progressive metabolic disorder caused by the absence or malfunctioning of lysosomal enzyme needed to breakdown molecule called glycosaminoglycan (GAGS) [1]. The major GAGS are chondrotin 4 sulfate, heparin sulfate, dermaten sulfate and hyaluranan. People with mucopolysacaride disease either do not produce enough one of the enzyme required to break down these sugar chain into simple molecule or they produce enzyme that don't work [2]. Morquio disease (MPS IV) is caused by a deficiency of Nacetylgalactosamine-6-sulfatase (MPS IV-A) or of B-galactosidase (MPS IV-B). Both result in the defective degradation of keratan sulfate [2,3]. The incidence of MPS is between 3.5 to 4.5/100000. The most common subtype is MPS III. Our case is a 8 month old son of a non-consanguineous parents from Sandwip, Chittagong, admitted to the Department of Paediatrics, Chittagong Medical College Hospital with a history of gibbus at thoracolumber region for last two months. But on examination he was found to be macrochphalic, stunted and wasted. Skeletal survey had shown some consistent findings of Morquio disease and his urine for Mucopolysaccharidoses screening test is also positive. We have reported this case of MPS as it is rarer and among the MPS, Morquio disease is also not a commoner one [4,5). It is also necessary for early differentiation of MPS IV from some treatable clinical entity like congenital hypothroidism. JCMCTA 2013 ; 24 (2): 48-50

Objective To determine the diagnostic accuracy of three rapid diagnostic tests (RDTs) for typhoid fever in febrile hospitalised patients in Bangladesh. Methods Febrile adults and children admitted to Chittagong Medical College Hospital, Bangladesh, were investigated with Bact/Alert® blood cultures and real‐time PCR to detect Salmonella enterica Typhi and Paratyphi A and assays for Rickettsia, leptospirosis and dengue fever. Acute serum samples were examined with the LifeAssay (LA) Test‐it™ Typhoid IgM lateral flow assay detecting IgM antibodies against S. Typhi O antigen, CTKBiotech Onsite Typhoid IgG/IgM Combo Rapid‐test cassette lateral flow assay detecting IgG and IgM antibodies against S. Typhi O and H antigens and SD Bioline line assay for IgG and IgM antibodies against S. Typhi proteins. Results In 300 malaria smear‐negative febrile patients [median (IQR) age of 13.5 (5–31) years], 34 (11.3%) had confirmed typhoid fever: 19 positive by blood culture for S. Typhi (three blood PCR positive) and 15 blood culture negative but PCR positive for S. Typhi in blood. The respective sensitivity and specificity of the three RDTs in patients using a composite reference standard of blood culture and/or PCR‐confirmed typhoid fever were 59% and 61% for LifeAssay, 59% and 74% for the CTK IgM and/or IgG, and 24% and 96% for the SD Bioline RDT IgM and/or IgG. The LifeAssay RDT had a sensitivity of 63% and a specificity of 91% when modified with a positive cut‐off of ≥2+ and analysed using a Bayesian latent class model. Conclusions These typhoid RDTs demonstrated moderate diagnostic accuracies, and better tests are needed.

Dextran solutions are widely used as sieving medium in protein analysis by capillary electrophoresis in the presence of sodium dodecyl sulfate. We studied the effect of dextran molecular weight on the separation efficiency using different dextran preparations with wide and very narrow molecular weight distributions, in the range between 1270 and 2 000 000. Migration times and band broadening of proteins were significantly affected by the molecular weight of dextran. Migration times of proteins decreased as molecular weights of the dextrans decreased. Satisfactory separation of all the proteins was possible with all dextrans except those with molecular weights of 70 000 and 23 800 where bovine serum albumin and phosphorylase b failed to be separated. Unexpectedly rapid separation of all the proteins with enhanced resolution could be observed using two dextrans with a narrow molecular weight distribution, with molecular weights of 1270 and 5220. Clearly the use of dextran with higher molecular weight is not the only way to achieve efficient sreparation of proteins. The separation-mechanism in the presence of the low molecular weight dextrans remains to be made clear in a future study.

Many researchers have discussed the effects of heavy-tailedness in network traffic patterns and shown that Internet traffic flows exhibit characteristics of self-similarity that can be explained by the heavy-tailedness of the various distributions involved. Self-similarity and heavy-tailedness are of great importance for network capacity planning purposes in which researchers are interested in developing analytical methods for analysing traffic characteristics. Designers of computing and telecommunication systems are increasingly interested in employing heavy-tailed distributions to generate workloads for use in simulation - although simulations employing such workloads may show unusual characteristics. Congested Internet situations, where TCP/IP buffers start to fill, show long-range dependent (LRD) self-similar chaotic behaviour. Such chaotic behaviour has been found to be present in Internet traffic by many researchers. In this context, the 'Hurst exponent', H, is used as a measure of the degree of long-range dependence. Having a reliable estimator can yield a good insight into traffic behaviour and may eventually lead to improved traffic engineering. In this paper, we describe some of the most useful mechanisms for estimating the tail index of Internet traffic, particularly for distributions having the power law observed in different contexts, and also the performance of the estimators for measuring the intensity of LRD traffic in terms of their accuracy and reliability.

The rapid development of network technologies has widened the scope of Internet applications and, in turn, increased both Internet traffic and the need for its accurate measurement, modelling and control. Various researchers have reported that traffic measurements demonstrate considerable burstiness on several time scales, with properties of self-similarity. The self-similar nature of this data traffic may exhibit spikiness and burstiness on large scales with such behaviour being caused by strong dependence characteristics in data: that is, large values tend to come in clusters and clusters of clusters and so on. Several studies have shown that TCP, the dominant network (Internet) transport protocol, contributes to the propagation of self-similarity. Bursty traffic can affect the Quality of Service of all traffic on the network by introducing inconsistent latency. It is easier to manage the workloads under less bursty (i.e. smoother) conditions. In this paper, we examine the use of a novel algorithm, the Bursty Packet Traffic Shaper (BPTraSha), for traffic shaping, which can smooth out the traffic burstiness. Experimental results show that this approach allows significant traffic control by smoothing the incoming traffic. BPTraSha can be implemented on the distribution router buffer so that the traffic’s bursty nature can be modified before it is transmitted over the core network.

This paper surveys techniques for the recognition and treatment of self-similar network or internetwork traffic. Various researchers have reported traffic measurements that demonstrate considerable burstiness on a range of time scales with properties of self-similarity. Rapid technological development has widened the scope of network and Internet applications and, in turn, increased traffic volume. The exponential growth of the number of servers, as well as the number of users, causes Internet performance to be problematic as a result of the significant impact that long-range dependent traffic has on buffer requirements. Consequently, accurate and reliable measurement, analysis and control of Internet traffic are vital. The most significant techniques for performance evaluation include theoretical analysis, simulation, and empirical study based on measurement. In this research, we discuss existing and recent developments in performance evaluation and control tools used in network traffic engineering.

For over a decade researchers have been reporting the impact of self-similar long-range dependent network traffic. Long-range dependence (LRD) is of great significance in traffic engineering problems such as measurement, queuing strategy, buffer sizing and admission and congestion control. In this research, in order to determine the existence of LRD, we apply three different robust versions of the autocorrelation function (ACF), namely weighted ACF (WACF), trimmed ACF (TACF) and variance-ratio of differences and sums, known as the D/S variance estimator (DACF), in conjunction with the sample ACF (which is moment based). Here we define the moment based ACF as MACF. In telecommunications, LRD traffic defines that a similar pattern of traffic persists for a longer span of time. Through ACF, it is possible to detect how long the traffic lasts. The aim of this research is to investigate the performance of ACF in identifying the existence of LRD traffic.