A Case Report of Porphyria Cutanea Tarda with Hepatitis-C Virus Co-infection

Porphyria cutanea tarda is a rare disorder of heme metabolism due to deficiency of the enzyme uroporphyrinogen decarboxylase which is manifested as some typical dermatological features and hepatic dysfunction. The Hepatitis-C virus co-infection is common and it can be aggravated by other environmental factors. We report a case of porphyria cutanea tarda in a 37-year-old woman, who presented with recurrent skin blisters and has concomitant Hepatitis-C virus infection. She was taking oestrogen containing oral contraceptive pill for a long duration. The diagnosis of porphyria cutanea tarda was considered on the basis of clinical features and high level of urine porphyrin level. She was put on hydroxychloroquine and combination drugs for Hepatitis-C virus with significant improvement after 3 months of therapy.

Local and Nonlocal Transport Spectroscopy in Planar Josephson Junctions

We report simultaneously acquired local and nonlocal transport spectroscopy in a phase-biased planar Josephson junction based on an epitaxial InAs-Al hybrid two-dimensional heterostructure. Quantum point contacts at the junction ends allow measurement of the 2×2 matrix of local and nonlocal tunneling conductances as a function of magnetic field along the junction, phase difference across the junction, and carrier density. A closing and reopening of a gap was observed in both the local and nonlocal tunneling spectra as a function of magnetic field. For particular tunings of junction density, gap reopenings were accompanied by zero-bias conductance peaks (ZBCPs) in local conductances. End-to-end correlation of gap reopening was strong, while correlation of local ZBCPs was weak. A model of the device, with disorder treated phenomenologically, shows comparable conductance matrix behavior associated with a topological phase transition. Phase dependence helps distinguish possible origins of the ZBCPs.

Coenzyme Q10 ameliorates carbofuran induced hepatotoxicity and nephrotoxicity in wister rats

Carbofuran is a widely used poisonous pesticide around the world that helps to control insects during farming. Upon oral ingestion to humans, it exaggerates oxidative stress in various organs like the liver, brain, kidney, and heart. Several studies reported that oxidative stress in the liver initiates and propagates hepatic cell necrosis, ultimately resulting in hepatotoxicity. It also reported that coenzyme Q10 (CoQ10) can neutralize oxidative stress due to its antioxidant properties. However, the hepatoprotective and nephroprotective role of CoQ10 against carbofuran toxicity has not been investigated. Therefore, the present study aimed to evaluate the hepatoprotective and nephroprotective role of CoQ10 in carbofuran-induced hepatotoxicity and nephrotoxicity in a mouse model for the first time. We determined the blood serum diagnostic markers, oxidative stress parameters, antioxidant system, and histopathological characteristics of liver and kidney tissues. The administration of 100 mg/kg of CoQ10 in carbofuran-treated rats significantly attenuated AST, ALT, ALP, serum creatinine, and BUN levels. Moreover, CoQ10 (100 mg/kg) remarkably altered the level of NO, MDA, AOPP, GSH, SOD, and CAT in both the liver and kidney. The histopathological data also unveiled that CoQ10 treatment prevented inflammatory cell infiltration in carbofuran-exposed rats. Therefore, our findings infer that CoQ10 may effectively protect liver and kidney tissues against carbofuran-induced oxidative hepatotoxicity and nephrotoxicity.

Construction of copy number variation landscape and characterization of associated genes in a Bangladeshi cohort of neurodevelopmental disorders

Introduction: Copy number variations (CNVs) play a critical role in the pathogenesis of neurodevelopmental disorders (NDD) among children. In this study, we aim to identify clinically relevant CNVs, genes and their phenotypic characteristics in an ethnically underrepresented homogenous population of Bangladesh. Methods: We have conducted chromosomal microarray analysis (CMA) for 212 NDD patients with male to female ratio of 2.2:1.0 to identify rare CNVs. To identify candidate genes within the rare CNVs, gene constraint metrics [i.e., "Critical-Exon Genes (CEGs)"] were applied to the population data. Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) was followed in a subset of 95 NDD patients to assess the severity of autism and all statistical tests were performed using the R package. Results: Of all the samples assayed, 12.26% (26/212) and 57.08% (121/212) patients carried pathogenic and variant of uncertain significance (VOUS) CNVs, respectively. While 2.83% (6/212) patients' pathogenic CNVs were found to be located in the subtelomeric regions. Further burden test identified females are significant carriers of pathogenic CNVs compared to males (OR = 4.2; p = 0.0007). We have observed an increased number of Loss of heterozygosity (LOH) within cases with 23.85% (26/109) consanguineous parents. Our analyses on imprinting genes show, 36 LOH variants disrupting 69 unique imprinted genes and classified these variants as VOUS. ADOS-2 subset shows severe social communication deficit (p = 0.014) and overall ASD symptoms severity (p = 0.026) among the patients carrying duplication CNV compared to the CNV negative group. Candidate gene analysis identified 153 unique CEGs in pathogenic CNVs and 31 in VOUS. Of the unique genes, 18 genes were found to be in smaller (<1 MB) focal CNVs in our NDD cohort and we identified PSMC3 gene as a strong candidate gene for Autism Spectrum Disorder (ASD). Moreover, we hypothesized that KMT2B gene duplication might be associated with intellectual disability. Conclusion: Our results show the utility of CMA for precise genetic diagnosis and its integration into the diagnosis, therapy and management of NDD patients.

A 60-year-old Man Presented with Relapsing Polychondritis with Haemophagocytic Lymphohistiocytosis

Relapsing polychondritis is a rare autoimmune disorder of unknown etiology, which can affect multiple organs. It usually presents with involvement of elastic cartilage of ear and nose and involvement of other organs like kidney and central nervous system. Here, we report a case of 60-year-old man, who initially presented with fever, polyarthritis, erythema nodosum and painful swelling and redness of both external ears admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 13th December 2019. Two days after hospitalization, he developed sudden onset of proptosis with ophthalmoplegia. After evaluation, he was diagnosed as relapsing polychondritis with haemophagocytic lymphohistiocytosis and was treated with high dose prednisolone. His clinical condition and laboratory parameters significantly improved after treating with prednisolone during follow up.

Procalcitonin versus C-Reactive Protein as a Biomarker for Prediction of Bacterial Infection in Children with Febrile Neutropenia in Acute Leukemia

Febrile neutropenia (FN) is a frequently occurring treatment-related complication with significant morbidity and mortality for childhood acute leukemia. Early diagnosis and assessment of severity are essential steps for early comprehensive treatment to reduce FN-related morbidity and mortality. Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) can be used to assess and predict the bacterial infection in children with febrile neutropenia. The objective of the study was to determine the role of procalcitonin and CRP as a biomarker for prediction of bacterial infection in children with FN in acute leukemia. This prospective observational study was conducted in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from August 2020 to July 2021. Total 58 Children with acute leukemia aged 1 to <18 years with FN were analyzed in this study. A proper history and thorough physical examination were carried out. The blood sample was sent for biomarkers (Procalcitonin and CRP) within 24 hours of the onset of FN and other investigations, such as Complete blood count, Blood C/S, Urine R/E and C/S. Metabolic workup (SGPT, Serum Creatinine, Serum Electrolytes, Serum Ca+) was also done in every patient. Stool R/E & C/S, Chest X-ray, Wound swab for C/S were done when the patient presented with diarrhoea, cough, respiratory distress and focal sepsis respectively. In this study, the mean age of the patients was 6.62±4.07 years (1.10-16.0 years) and 34 patients (58.6%) were male. In 65.5% of patients, localizing signs of infection were not identified. Of the 58 patients, 12 patients (20.7%) showed positive blood culture and 2 patients (3.4%) showed positive urine culture. Klebsiella spp (41.0%) was the most frequent organism isolated followed by Acinetobacter (17.0%), Pseudomonas (17.0%) and E. coli (17.0%). The median PCT levels were significantly higher in patients with bacterial infection than patients without bacteremia (26.10μg/l versus 0.78μg/l, p=0.002) and PCT level >2μg/l was significantly associated with bacteremia. The median CRP levels in the bacteremia and without-bacteremia patients were 137.4mg/L and 54.17mg/L, respectively (p=0.036). In direct comparisons, PCT showed better overall performance than CRP with the AUC being 0.797 (95% CI 0.651-0.943) for PCT and 0.697 (95% CI 0.54-0.855) for CRP in predicting the bacterial infection. PCT and CRP both are useful biomarkers for the prediction of bacteremia, but PCT may be a superior early biomarker as compared to CRP to predict bacterial infection in children with febrile neutropenia in acute leukemia.

Paroxysmal Nocturnal Hemoglobinuria in Systemic Lupus Erythematosus: A Rare Manifestation

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare disorder of hematopoietic stem cells. The occurrence of PNH in a patient with systemic lupus erythematosus (SLE) is even rarer. One such presentation was seen in a 19 years old woman who presented with fever, multiple joint pain, photosensitivity, oral ulcer, hair loss and was diagnosed as a case of SLE and was admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 7th February 2019. Subsequently she developed progressive anaemia and passing of dark colored urine. Flow cytometry analysis showed PNH clone within red cells. We report this case so that clinicians are aware about this association between PNH and SLE. Informed written consent was obtained from the patient for the publication of this case report, the copy of which is available with the authors.

Health Related Quality of Life in Patients with Pulmonary Tuberculosis

Tuberculosis (TB) is one of the major public health issues in many developing nations especially in Bangladesh. Though most focus is being directed towards mortality and incidence rate, the changes in morbidity and other health status parameters are not been well considered. The aim of the study was a comprehensive assessment of patients with pulmonary tuberculosis by measuring patient's quality of life which may lead to better outcome in patients' health, infection surveillance and prevention programs. This prospective study was conducted in the department of Respiratory and Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2015 to March 2017. The quality of life scores of 61 smear positive pulmonary tuberculosis cases were measured by validated Bangla version of SF-36 questionnaire before or at the starting of treatment, after the initial phase and at the end of treatment. Then the score was compared with those of 75 healthy matched controls. The changes of the quality of life with the stage of treatment and with socio-demographic variables were assessed. Before treatment, all domains of HRQoL of the pulmonary TB patients were significantly lower than those of the control group (p<0.001). At the end of six-month treatment period, HRQoL of the pulmonary TB patient had significantly increased compared to before treatment (p<0.001). There was no significant difference of scores after six months of treatment with that of control (p>0.05). The lowest score in tuberculosis patients was related to general health perception and vitality. Patients with low socio economic status, low educational level, prolonged disease duration and increased number of symptoms had lower HRQoL scores.

Problematic internet use and depressive symptoms among the school-going adolescents in Bangladesh during the COVID-19 pandemic: A cross-sectional study findings

Background and Aims

Problematic internet use (PIU) by children and adolescents is a concern for many parents. Several factors, including students' education level, the method of instruction, the dependence on the internet, and their intended use of the internet, could all be contributing factors to PIU and depression. Disturbed mental health may be attributed to the cancellation of physical education classes because of the COVID-19 outbreak. This study aimed to assess the association of COVID-19 pandemic with PIU and depressive symptoms in adolescent students.

Methods

We performed this cross-sectional study among 491 school-going adolescents of 10 to 16 years. Self-administered questionnaires were applied to collect sociodemographic information and the internet usage pattern of the participants. We measured the prevalence of PIU and depressive symptoms using the PIU questionnaire (PIUQ-SF-6) and patient health questionnaire-9 (PHQ-9).

Results

The estimations of the risk group for PIU and depressive symptoms among school-going adolescents were 80.04% and 77.80%, respectively. The latent profiling of PIU scores for obsession, neglect, and control sub-groups were 5.82, 6.12, and 6.35, respectively. Moreover, we observed mild, moderate, and severe depressive symptoms in 48.68%, 27.70%, and 1.43% of cases. Age, education level, medium of education, financial impression, internet connection, the device used, the purpose for internet use, and the living status of respondents were significantly associated with the PIU. Reported mental health issues was associated with education level, medium of education, financial impression, and internet connection.

Conclusion

The present study revealed an association of PIU and depressive symptoms with sociodemographic factors and internet usage patterns. Therefore, these results might have practical implications in clinical psychology, psychiatry, and psychotherapy. The healthcare professional can develop a context-specific comprehensive clinical intervention plan for children and adolescents.

Rehabilitation of Persons with Spinal Cord Injury in Bangladesh

There is a knowledge gap about the rehabilitation system for the persons with spinal cord injury (SCI). A rehabilitation scenario is necessary to conduct a national community survey in conjunction with the International Spinal Cord Injury Community Survey (InSCI) in order to gather data on the lived experiences of people with SCI, to map out the health and rehabilitation system of Bangladesh, it's demographic characteristics, accessible resources and rehabilitation challenges. Information for this narrative report was acquired through a structured questionnaire, which was supplemented by an online search of agencies, government websites, rehabilitation-related organizations and published papers during the period of March 2020 to April 2021. Bangladesh is a developing country with a vast population and a developing health care system. Representative government and non-government rehabilitative care settings a total of sixteen survey replies (n=16) were obtained. During the year 2019, a total of 1035 people with SCI were seen. The majority of patients with SCI were hospitalized by a non-government facility (38.65%), whereas the two main public general hospitals consulted roughly 30.0% of people with SCI. The rehabilitation team leader in the majority of the facilities (93.75%) was a physiatrist, but just a few had a full complement of rehabilitation professionals and only 12.5% of settings provide community care. Indoor rehabilitation facilities, equipment and a competent rehabilitation staff are not available at many of the tertiary care facilities including National Trauma Institute (NITOR), where most of the SCI report first after the trauma. A consistent and nationwide data source is unavailable and the majority of the available SCI research publications are hospital-based demographic studies in Bangladesh. SCI was commonly due to work-related trauma in young male manual laborers due to fall from height or road traffic accidents. The country faces multiple challenges in rehabilitation of people with SCI regarding triage, a referral system development, infrastructure and shortage of expert human resources in addition, currently there is no three-tier rehabilitation care continuum available. Keeping pace with the transition to a developed country by 2041, the Bangladesh health sector also has to be oriented to face the focused challenge of caring for people with SCI. As recommended by WHO Rehabilitation 2030 initiatives, establishment of an SCI dedicated national institute and escalation of number of related specialists such as trauma and orthopedic surgery, spinal neurosurgery and physical rehabilitation medicine, skilled professionals such as rehabilitation nurses, therapists, case managers and social workers to work in a team required for specialized care of SCI.

Repositioning potentials of smallpox vaccines and antiviral agents in monkeypox outbreak: A rapid review on comparative benefits and risks

Background and aims

There is a sought for vaccines and antiviral agents as countermeasures for the recent monkeypox outbreak. Here, we aimed to review and discuss the repurposing potentials of smallpox vaccines and drugs in monkeypox outbreaks based on their comparative benefits and risks. Therefore, we conducted this rapid review and discussed the repurposing potentials of smallpox vaccines and drugs in monkeypox infection.

Methods

Here, we searched Google Scholar and PubMed for relevant information and data. We found many articles that have suggested the use of smallpox vaccines and antiviral drugs in monkeypox outbreaks according to the study findings. We read the relevant articles to extract information.

Results

According to the available documents, we found two replication‐competent and one replication‐deficient vaccinia vaccines were effective against Orthopoxvirus. However, the healthcare authorities have authorized second‐generation live vaccina virus vaccines against Orthopoxvirus in many countries. Smallpox vaccine is almost 85% effective in preventing monkeypox infection as monkeypox virus, variola virus, and vaccinia virus are similar. The United States and Canada have approved a replication‐deficient third‐generation smallpox vaccine for the prevention of monkeypox infection. However, the widely used second‐generation smallpox vaccines contain a live virus and replicate it into the human cell. Therefore, there is a chance to cause virus‐induced complications among the vaccinated subjects. In those circumstances, the available Orthopoxvirus inhibitors might be a good choice for treating monkeypox infections as they showed similar efficacy in monkeypox infection in different animal model clinical trials. Also, the combined use of antiviral drugs and vaccinia immune globulin can enhance significant effectiveness in immunocompromised subjects.

Conclusion

Repurposing of these smallpox vaccines and antiviral agents might be weapons to fight monkeypox infection. Also, we recommend further investigations of smallpox vaccines and Orthopoxvirus inhibitors in a human model study to explore their exact role in human monkeypox infections.

Pharmaceutical quality evaluation of marketed vildagliptin tablets in Bangladesh based on the United States Pharmacopeia specifications

Continuous monitoring of pharmaceutical products is vital because it matters to human health. Here we aimed to assess the quality parameters of commercially available vildagliptin tablets in Bangladesh. We tested the tablets for the content uniformity, hardness, friability, disintegration, dissolution, and potency. Then, we fitted the dissolution data with kinetic models to investigate the release pattern of the studied brands. Moreover, we applied a mathematical model-independent approach to compare the dissolution profiles of the brands. The interchangeability was determined using difference and similarity factors. Weight variation, friability, and hardness were between 150.35±1.26 to 230.8±1.98 mg, 0 to 0.88%, and 47.3±5.09 to 108.1±1.92 N, respectively. All tablets disintegrated within 0.54±2.85 to 7.69±2.14 min in distilled water. The potency of tablets in 0.1 N HCl and PBS (pH 6.8) were between 97.67±2.58 to 105±0.95% and 99±4.63 to 105±1.65%, respectively. The drug release (%) in 0.1 N HCl and phosphate-buffered saline (PBS) (pH 6.8) after 60 min were between 99.37±1.80 to 111.09±0.64% and 96.59±3.52 to 109.57±0.53%, respectively. All the brands complied with the United States Pharmacopeia (USP) specification for physicochemical properties. Also, we observed the drug release patterns of vildagliptin tablets matched with different kinetic models. We found only one substitutable brand with the standard product regardless of the dissolution medium. In-vitro chemical equivalence is not always consistent with bioequivalence. Therefore, continuous evaluation of marketed products is essential to ensure the desired quality.

Curcumin improves D-galactose and normal-aging associated memory impairment in mice: In vivo and in silico-based studies

Aging-induced memory impairment is closely associated with oxidative stress. D-Galactose (D-gal) evokes severe oxidative stress and mimics normal aging in animals. Curcumin, a natural flavonoid, has potent antioxidant and anti-aging properties. There are several proteins like glutathione S-transferase A1 (GSTA1), glutathione S-transferase omega-1 (GSTO1), kelch-like ECH-associated protein 1 (KEAP1), beta-secretase 1 (BACE1), and amine oxidase [flavin-containing] A (MAOA) are commonly involved in oxidative stress and aging. This study aimed to investigate the interaction of curcumin to these proteins and their subsequent effect on aging-associated memory impairment in two robust animal models: D-Gal and normal aged (NA) mice. The aging mice model was developed by administering D-gal intraperitoneally (i.p). Mice (n = 64) were divided into the eight groups (8 mice in each group): Vehicle, Curcumin-Control, D-gal (100mg/kg; i.p), Curcumin + D-gal, Astaxanthin (Ast) + D-gal, Normal Aged (NA), Curcumin (30mg/kg Orally) + NA, Ast (20mg/kg Orally) + NA. Retention and freezing memories were assessed by passive avoidance (PA) and contextual fear conditioning (CFC). Molecular docking was performed to predict curcumin binding with potential molecular targets. Curcumin significantly increased retention time (p < 0.05) and freezing response (p < 0.05) in PA and CFC, respectively. Curcumin profoundly ameliorated the levels of glutathione, superoxide dismutase, catalase, advanced oxidation protein products, nitric oxide, and lipid peroxidation in mice hippocampi. In silico studies revealed favorable binding energies of curcumin with GSTA1, GSTO1, KEAP1, BACE1, and MAOA. Curcumin improves retention and freezing memory in D-gal and nature-induced aging mice. Curcumin ameliorates the levels of oxidative stress biomarkers in mice. Anti-aging effects of curcumin could be attributed to, at least partially, the upregulation of antioxidant enzymes through binding with GSTA1, GSTO1, KEAP1, and inhibition of oxidative damage through binding with BACE1 and MAOA.

Quality of Life Assessment by SF-36 among the Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) patients have substantial functional disability which poses a significant impact on the quality of life (QoL). So, this study aims to assess the QoL of RA patients by the Short Form Health Survey-36 (SF-36) questionnaire. Total sixty-two (62) rheumatoid arthritis patients were included in this cross-sectional observational study and were performed in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from August 2018 to September 2019 according to selection criteria. A Bengali validated version of Medical Outcomes Study-36: Item Short Form Health Survey (SF-36) questionnaire was used to assess QoL. Among the sixty-two (62) patients, mean age was 44.18±12.14 years with female preponderance (77.4%). About one-fifth of the patients (19.4%, n=12) were illiterate and the majority (71.0%, n=44) were housewives. Amongst all, 53.2% (n=33) had monthly family income >20,000 taka. Forty percent (n=25) had a disease duration of 1 to 5 years. According to Disease Activity Score Sheet 28 (DAS-28), 36(58.1%) patients had moderate disease activity and 26(41.9%) patients had high disease activity. Among the 8 domains, the mental health domain had the highest score (42.77±13.78) and the role physical domain had the lowest (35.89±15.43). Male, literate patients with higher income had relatively better QoL. Patients with prolonged disease, high disease activity and irregular taking of Disease Modifying Anti-Rheumatic Drugs (DMARDs) had poor quality of life. A significant negative correlation was present between SF-36 scores and the DAS-28 scores (r = -0.803, p<0.001). Rheumatoid arthritis had a relatively poor quality of life regarding both physical and mental health components, but the physical health component was predominantly affected.

Association of Diastolic Dysfunction with Angiographic Severity of Coronary Artery Disease in patients with Non-ST Elevation Myocardial Infarction

In recent years, diastolic dysfunction is an evolving context. Presence of left ventricular diastolic dysfunction (LVDD) indicates a poor prognosis in patients with an ACS and chronic coronary artery diseases. This study evaluated the association of LVDD and angiographic severity of CAD in patients with non-ST elevation myocardial infarction (NSTEMI). This cross-sectional analytical study was carried out in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh, during the period of April 2017 to March 2018. A total of 120 NSTEMI patients undergoing coronary angiogram (CAG) during index hospitalization were included in the study. All patients underwent transthoracic echocardiography before they underwent CAG on different days. Presence (Group I, n=65) and absence of LVDD (Group II, n=55) was established by echocardiography. Severity of CAD was assessed by Vessel score and Leaman score. Association of traditional risk factors (smoking habit, hypertension, diabetes mellitus, dyslipidemia and family history of CAD) with severity of CAD was investigated. Vessel score showed coronary artery obstruction (CAO) was present in 62(95.4%) patients in Group I and 35(63.6%) patients in Group II, single vessel was involved in 17(27.4%) patients while multi vessel in 45(72.6%) patients was found in Group I. On the contrary 27(77.1%) single vessel patients and 8(22.9%) multi vessel patients were found in Group II. Positive Leaman score was significantly higher in Group I, 62(95.4%) than that of Group II, 35(63.6%) which is statistically significant (p<0.001). This study showed a positive correlation between LVDD and CAD severity in terms of vessel score and Leamanscore. This study also demonstrates that the severity of vessel score and Leaman score was higher in the higher grade of diastolic dysfunction. The present study concludes that LVDD is associated with angiographically severe CAD in patients with NSTEMI.

Prevalence and associated risk factors for mental health problems among patients with polycystic ovary syndrome in Bangladesh: A nationwide cross-Sectional study

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common female reproductive endocrine problem worldwide. The prevalence of mental disorder is increasing among PCOS patients due to various physical, psychological, and social issues. Here we aimed to evaluate the mental health and associated factors among women suffering from PCOS in Bangladesh.

METHODS

We performed an online cross-sectional survey among 409 participants with PCOS using Google Forms. We used structured questionnaires to collect socio-demographic information and lifestyle-related factors. Also, we applied patient health questionnaire (PHQ-9), generalized anxiety disorder (GAD-7) scale, and UCLA loneliness (UCLA-3) scale for psychometric assessment of the participants. Finally, we applied several statistical tools and performed data interpretations to evaluate the prevalence of mental health disorders and associated factors among patients with PCOS in Bangladesh.

RESULTS

Prevalence of loneliness, generalized anxiety disorder and depressive illness among the women with PCOS were 71%, 88%, and 60%, respectively. Among the mental illness, mild, moderate, and severe cases were 39%, 18%, and 14% for loneliness; 39%, 23% and 26% for generalized anxiety disorder; and 35%, 18%, and 7% for depressive disorder. According to the present findings, obesity, financial condition, physical exercise, mealtime, food habit, daily water consumption, birth control method, and long-term oral contraceptive pills contribute to developing mental health disorders among females with PCOS in Bangladesh.

CONCLUSION

According to present study results, high proportion of women suffering from PCOS experience several mental disorders in Bangladesh. Although several socio-demographic and lifestyle-related factors were found to be associated with the poor mental health of women with PCOS; however, PCOS itself is a condition that favors poor physical and psychological health. Therefore, we recommend proper treatment, public awareness, and a healthy lifestyle to promote the good mental health of women suffering from PCOS.

Effect of telephone-monitored home-based cardiac rehabilitation exercise on functional capacity and quality of life in heart failure patients in a lower-middle-income country

Funding Acknowledgements

Type of funding sources: None.

Introduction

Chronic heart failure (CHF) prevails as one of the major cardiovascular diseases in lower-middle-income countries (LMICs) like Bangladesh. Home-Based Cardiac Rehabilitation (HBCR) is a cost-effective method of secondary prevention of chronic heart failure which, if provided, might not only improve the health status of the patients but might also reduce the financial and hospitalization burden on the health care system of these countries. The study aims to assess the scope and benefits of HBCR in such low resource settings.

Purpose

The study evaluates the effect of telephone-monitored HBCR exercise programme in improving the functional capacity and quality of life (QoL) in patients of CHF with reduced ejection fraction due to ischemic heart disease (IHD).

Method

This self-controlled interventional study was conducted from August 2019 to July 2020 at a heart failure clinic, a tertiary healthcare centre in Bangladesh. A total of 115 patients of CHF with ejection fraction &lt;40% and in NYHA class II and III were included in the study according to selection criteria. The functional capacity of the patients was evaluated by NYHA classification and 6-minute walk test. The quality of life of the patients was evaluated by Minnesota Living with Heart Failure Questionnaire (MLHFQ). All patients were advised to perform HBCR exercise as per recommended guideline and were telephone-monitored 2-weekly. After the 3-months study period, the participants were divided into compliant and partial compliant groups based on their adherence to the guideline. Repeat evaluation of patients' condition was carried out. Results were then compared within the groups and data was analyzed through appropriate statistical methods.

Results

Significant improvement of NYHA class (p&lt;0.05), and 6-minute walk test distance (6MWTD) (1102.01±215.90 feet vs 1243.30±217.86 feet; p&lt;0.001) were noticed after the rehabilitation programme. Improvement of total MLHFQ score was also observed (35.53±14 vs 28.22±12.84; p&lt;0.001) at 3-months follow up. The functional capacity and quality of life of the patients in both the compliant and partially compliant groups showed significant improvement after the rehabilitation programme (p&lt;0.001); though no difference was found in the indicators when compared between compliant vs partially compliant groups after rehabilitation except for 6MWTD (1302.86±219.61 feet vs 1230.71±212.284 feet, p&lt;0.001).

Conclusion

From the results, it can be concluded that any amount of routine exercise tends to improve quality of life and symptoms in patients of chronic heart failure with reduced ejection fraction. However, to achieve the best effect in functional capacity and overall health status, the addition of a structured exercise programme like HBCR can be beneficial for proper rehabilitation in low resource settings. Further validation of the results is recommended through randomized control trials in larger study groups.

Physician's Perception about the Use of PPE, COVID-19 Prevention and Management in Bangladesh

This study aims to explore physician's perceptions about the use of Personal Protective Equipment (PPE), COVID prevention, and management during the COVID pandemic since knowledge on these might explain the reason behind infection and death of physicians in Bangladesh at an unexpected rate. This cross-sectional study was conducted based on an online questionnaire on 346 physicians (n=346) by the Department of Gastroenterology of Mymensingh Medical College Hospital, Bangladesh from 15th July 2020 to 14th September 2020. Physicians of different health care facilities across Bangladesh were invited to take part. Knowledge on specific points of the questionnaire was evaluated, scored, and compared between different groups by Independent sample t-test. Mean knowledge score between the respondents working up to 8 hours and beyond 8 hours per day was 17.28±1.28, 16.90±1.40 respectively (p=0.03). Mean knowledge score observed between graduate and post-graduate physicians and work experience of 5 years and beyond 5 years were 17.26±1.36 vs. 17.16±1.27; (p=0.40), 16.87±1.75 vs. 17.27±1.21; (p=0.11) respectively. Physician's safety should be first concern that is highlighted through proper use of PPE and prevention of COVID. Patient management skills would be better if physicians are trained well on infection prevention and control which in turn will reduce infection and death of physicians.

Adverse In-Hospital Outcome of Transradial PCI in Comparison to Transfemoral PCI in NSTEMI Patients during Index Hospitalization: A Single Center Study in Bangladesh

NSTEMI patients, in comparison to STEMI patients, are more at risk of bleeding, access site complication and MACE after PCI during index hospitalization. Because they get, multiple adjuvant anti-thrombotic agents before PCI than do the STEMI patients undergoing primary PCI. Transradial access (TRA) is proven to decrease those adverse in-hospital outcomes compared to transfemoral access (TFA) in STEMI patients. But very few studies were conducted in this regard considering NSTEMI patients. We observed prospectively the adverse in-hospital outcomes of total 180 NSTEMI patients who had undergone PCI through TRA (Group I = 80) and TFA (Group II = 100) during index hospitalization between October 2017 to September 2018 in National Institute of Cardiovascular Disease (NICVD), Dhaka, Bangladesh. Samples were selected purposively. Patients were followed up 2 hours after PCI and thereafter every day until discharge. Demographic and risk factor variables were almost same in both groups. TRA, compared with TFA, yielded less major bleeding (0% versus 3%, p=0.12) which was statistically non-significant. Minor bleeding was significantly less in Group I (2.5% versus 13.0%, p=0.04). Overall bleeding was also significantly less in Group I (2.5% and 10.0%; p=0.002). Access site complication was non-significantly less in Group I (0% versus 1%, p=0.91). TRA caused non-significant reduction in MACE (2.5% versus 5%; p=0.38) but significant reduction of total adverse in-hospital outcome (5% versus 20%, p=0.006%). In this study TRA seems to have less adverse in-hospital outcome than TFA in NSTEMI patients undergoing PCI during index hospitalization.

Predictors of Malignancy in Thyroid Nodules

Thyroid swellings are common clinical problem throughout the world and also in Bangladesh. Most of thyroid swellings are multinodular, but a good percentage is solitary thyroid nodule. There is no robust, feasible method for malignancy differentiation has not been well established. The study evaluated thyroid nodules for risk of malignancy and compared history, clinical, sonographic features and FNAC findings with histopathology. This was a cross sectional study on 160 consecutive subjects of thyroid nodules done in the department of ENT and Head Neck Surgery of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh during from July 2018 to December 2019. All patients were admitted and diagnosed by detail history, clinical examination, investigations and underwent thyroidectomy. Detailed history, clinical examination, ultrasonographic finding and FNAC variables were documented retrospectively and a mathematical model was established for malignancy prediction. In this study mean age of the patients of thyroid nodules was 37.54±11.49 years and majority of the patients were within 21-40 years of age. Frequency of thyroid nodules is more in female with male female ratio 1:7. Most of the thyroid nodules appeared in this study within 0-2 years (61.9%). In this series of thyroid nodules constituted 88.1% firm, 8.8% hard, 3.1% cystic. Among the patients 89(55.6%) cases have solitary thyroid nodule and 71(44.4%) cases have multinodular goitre Majority of the nodules were warm 57.5% followed by cold 42.5%. FNAC showed nodular goitre 72.5%, Follicular neoplasm 1.3%, Papillary carcinoma of thyroid 7.5%, colloid goitre 9.4%, suspicious papillary carcinoma 3.8% and lymphocytic thyroiditis 1.3%. In this study out of 85 solid nodule, 69(81.18%) were benign and 16(18.82%) was malignant and out of 3 cystic nodule 3(100%) were benign. In this study most of the benign and malignant nodules were predominantly solid. Study showed the malignancy is significantly (p=0.001) more in solid than cystic nodules. Final diagnosis in this study was done on the basis of histopathological reports. Out of 160 patients, histopathologically benign lesion was 120(75%) and malignant was 40(25%). Among malignant cases 36(22.5%) cases were papillary carcinoma, 1 case was medullary carcinoma and 3 cases were follicular carcinoma.

Positivity of COVID -19 Cases among the Patients Attending Flu Corner of Emergency and Casualty Department of Mymensingh Medical College Hospital

Recent COVID-19 pandemic has changed health resource disposal plan and urged relocation of work force to defend the world from devastation of this emerging disease. This cross-sectional observational study aims to categorize and rationalize COVID-19 testing of all patients attending flu corner of One Stop Service (OSS) in the department of Emergency and Casualty (E&C) in Mymensingh Medical College Hospital (MMCH) during 15th April 2021 to 14th May 2021 on 2627 patients as per inclusion and exclusion criteria. Out of 2627 patients 920(35%) were symptomatic cases and 1707(65%) attended for testing without symptom. Out of 920 symptomatic cases 175(19%) were confirmed COVID-19 cases. Among the confirmed cases 38(21.71%) was admitted whereas, from suspected cases 100(13.42%) got admitted, remaining patients from both categories were advised for home isolation. Coverage and justification of COVID-19 testing should be done precisely to ensure proper disease control and COVID care during this pandemic.

Efficacy and Safety of the Awake Prone Positioning in Patients with COVID-19 Related Respiratory Distress: A Scoping Review

Prone positioning (PP) is becoming an important treatment modality for the management of COVID-19 related respiratory distress syndrome. The aim of this scoping review was to evaluate effectiveness and safety of awake PP in non-intubated patients with COVID-19 related acute respiratory distress at different care settings. The study was conducted during December 1, 2019 to August 30, 2020 using health science electronic databases and grey literature. A PRISMA flow diagram was used and finally 06 studies with 187 patients were included for review. Male patients were predominating with the mean age of approximately 55 years. Oxygenation was improved in 79.14% patients. One hundred fifty seven (83.95%) patients with COVID-19-related hypoxemic respiratory distress tolerated the procedure. Intubations required 25.41% of the patients or mechanical ventilation and 6(3.2%) patients expired. Number of patients in the reported studies could tolerate more than 3 hours of PP without a major side effect. Awake proning improved oxygenation of the patients suffering from COVID-19 related respiratory hypoxia in different care settings. Early instituted prone positioning may be an effective alternative method of treating COVID-19 related respiratory distress. Patient compliance and small size cohort studies are the limitations of this review. Multicenter controlled studies are warranted before conclusions are made about safety and the settings.

Factors Associated with Delayed Hospital Arrival of Patients Presenting with Acute Myocardial Infarction: A Cross-Sectional Study in Bangladesh

Delay in seeking medical care of the patients with acute myocardial infarction (AMI) could affect the outcome. Therefore, it is important to recognize and reduce pre-hospital in initiating treatment of these patients. The objective of the study was to evaluate the factors associated with delayed hospital arrival of patients with AMI. This cross-sectional study was carried out among 385 patients with AMI attended in the Department of Cardiology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. The delay in arrival to the hospital was recorded along with socio-demographic data, conditions of the patients during onset and other relevant data. The mean age of the patients 59.7±9.9 years with a male-female ratio of 2.4:1. About 22% of patients with AMI arrived at the hospital within 6 hours of symptoms onset and only around 13% arrived within 2 hours of onset of symptoms. Comparatively younger (p=0.037), unmarried (p=0.008) and Muslim (p=0.008) patients were more likely to present for hospital care sooner (p=0.037). Patients coming from upper middle class of socioeconomic status (p<0.001) and those with college or post college level of education (p<0.001) were more likely to present earlier for hospital care. Prehospital delay was larger in non-manual worker patients (p<0.001) as well as in patients with onset of chest pain during rest period (p<0.001) and while at home (p<0.001). Pre-hospital delay was shorter in patients with onset of chest pain from 12am to 6am and 6am to 12pm (p<0.001). Lack of awareness of AMI symptoms and benefits of its early treatment, long distance and mode of transport were shown as the most common causes of delayed arrival of patients at hospital (p<0.001). This study has identified the factors associated with AMI in context of Bangladesh. Effective measures including increasing awareness of AMI symptoms should be taken for better outcome of the patients.