Relationship of Serum Uric Acid Level with Acute Ischemic Stroke: A Single-Center, Hospital-Based Study from Bangladesh

The role of uric acid as a risk factor for cerebrovascular disease, particularly acute ischemic stroke, is controversial and there is little information about this in our setting. This cross-sectional study was conducted at the departments of Medicine and Neurology of a tertiary hospital in Bangladesh over one year, from January 2018 to December 2018, to estimate serum uric acid (SUA) levels and assess its risk factor potential in patients with acute ischemic stroke. Forty-five patients with acute ischemic stroke were enrolled and a similar number of age and sex-matched healthy individuals were recruited for comparison. All known risk factors for stroke were searched and SUA levels were measured. SUA was higher (6.66±2.33 vs. 5.23±1.81 mg/dL; p=0.002) and hyperuricemia was more frequent (64.4% vs. 24.4%, p<0.001) in stroke patients in comparison to the controls. Hypertension was more frequent among stroke patients. In multivariate analysis, hyperuricemia [OR 4.51 (95% CI 1.67-12.16; p<0.05)] and HTN [OR 6.31 (95% CI 2.26-17.61; p<0.001)] were found to be independent risk factors of acute ischemic stroke. The stroke and control groups had no differences in age, sex, residence, education, monthly income, occupation, fasting plasma glucose, triglyceride and high-density lipoprotein cholesterol levels. Total cholesterol and low-density lipoprotein cholesterol levels were higher in the stroke patients. SUA may be used as a marker for increased risk of ischemic stroke. However, larger-scale studies are needed to get more insight into our findings.

Management of Neglected Rupture of Tendoachilles with Long Gap by Flexor Hallucis Longus Tendon Transfer

The tendo achilles is one of most important tendon in human body which often injured through direct trauma or indirect stress on a weakened tendon. Longer the duration after injury the injured parts likely to move apart, fibrosis and degeneration leading to difficulty in repair or reconstruction. Usually a phase of 4 weeks or more without specific treatment is regarded as chronic or neglected rupture. Different authors described many management protocols about the tendo achilles rupture but there is no procedure of choice for neglected rupture with long gap. Prospective case series of 21 patients of neglected tendo achilles rupture with long gap treated with flexor hallucis longus tendon (FHLT) transfer was taken for study from January 2019 to December 2020 in Mymensingh Medical College Hospital, Bangladesh. Average age of patients was 39.47 years with range 22-65 years. Fifteen (15) cases of traumatic rupture in this study with average age 32.66 years and pathologic 6 cases with average age 56.5 years were recorded. We grafted FHLT from channel by incising Henry's knot. Krackow et al.'s technique was followed for tendon mobilization and bone fixation. We made procedure simpler and cheaper; instead of using interference screw the sutured tendon pulled through the heel and anchored over rubber tube or button by Cole method. Post-operative complications were less with one patient with superficial infection which eventually recovered 3 cases of mild pain and 2 cases of numbness. Questionnaire for surgical outcome measure are satisfactory in 19 patients (90.47%). Final follow up AOFAS score at 6 month (91.61±5.41) was highly significant (p<0.001) in comparison to preoperative score (38.71±9.78). These are comparable to other study. Above mentioned scores indicate the reliability of the surgical system. But our study is a prospective case series with minimum cases. To establish the best procedure for neglected tendo achilles rupture with long gap we recommend further study with larger group and Randomized Controlled Trial (RCT) study among different procedure.

Association of Aortic Valve Sclerosis with Angiographic Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome, Aged ≤65 Years

Aortic valve sclerosis (AVS) represents a degenerative process that progresses with advancing age. The study was intended to find out the association between aortic valve sclerosis and the severity of CAD in patient's age ≤65 years with acute coronary syndrome. This cross-sectional analytical study was carried out in the department of cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh during a period of October 2017 to September 2018. A total of 140 Acute coronary syndrome (ACS) patients undergoing coronary angiogram during index hospitalization were included in the study. Study patients were divided into two groups on the basis of echocardiographic presence or absence of Aortic valve sclerosis (AVS), with 70 patients in each group. Group I was patients with aortic valve sclerosis and Group II was patients without aortic valve sclerosis. All patients underwent transthoracic echocardiography before they underwent coronary angiography on different days. Severity of CAD was determined by Gensini score and Vessel score. Association of traditional risk factors (smoking habit, hypertension, diabetes mellitus, dyslipidaemia and family history of CAD) with severity of CAD was investigated. Coronary angiography showed that AVS group had a higher positive rate of CAD (82.9% vs. 54.3%, p<0.001) and incidence rate of triple vessel CAD (40% vs. 14.3%, p<0.001) than non-AVS group. Gensini score had higher in AVS group than non AVS group (37.9±27.8 vs. 12.5±14.2; p<0.001). Multivariate analysis showed that AVS (p=0.01) and age (p=0.04) were independent predictors of the presence of significant coronary artery disease. The study concluded that echocardiographically detected AVS is an independent predictor of coronary artery disease severity. There is positive correlation between severity of AVS and severity of CAD in patient's age ≤65 years with ACS.

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.

982 ARE POST FALL CT HEAD SCANS DONE ACCORDING TO TRUST GUIDELINES

Introduction

Falls are a major public health concern, which poses a high risk of injury and even death. Due to fears regarding increased morbidity and mortality post fall, we have noticed that there is a tendency for junior doctors to request computerized tomography (CT) head scans beyond clinical reasoning and indications that are not found in the trusts post falls protocol. In addition, we discovered significant delays in completion of inpatient CT head scans resulting in delayed management. We therefore embarked on an audit with the aim of improving post falls assessment. We assessed compliance with trust post fall protocol regarding suspected head injury and requesting of urgent CT head scans, if urgent CT had scan are done within 1 hour and carrying out neurological observations post fall. The initial audit outcomes demonstrated poor compliance with the audited standards. As a result we introduced a new comprehensive post falls assessment proforma.

Results

We re-audited after the introduction of the new falls proforma, assessing inpatient falls from 20th January to 27th February 2021 at the William Harvey Hospital. 69% of falls cases have CT head scans requested as per trust policy, an improvement of 77% from the initial audit. 50% of patients who met the criteria for urgent CT head scans had it done within one hour of the request being made, an improvement of 150%. 84% of patient’s had neurological observations recorded as part of post fall assessment, an improvement of 12% from the initial audit.

Conclusion

The improvements seen in the audited standards are indicative that the new post falls proforma improves compliance with the trusts post falls protocol. We recommend that the new post falls proforma be a part of the trusts post fall protocol and for it to be included in the trust induction to new doctors.

Energy Harvesting by Mesoporous Reduced Graphene Oxide Enhanced the Mediator-Free Glucose-Powered Enzymatic Biofuel Cell for Biomedical Applications

Harnessing electrochemical energy in an engineered electrical circuit from biochemical substrates in the human body using biofuel cells is gaining increasing research attention in the current decade due to the wide range of biomedical possibilities it creates for electronic devices. In this report, we describe and characterize the construction of just such an enzymatic biofuel cell (EBFC). It is simple, mediator-free, and glucose-powered, employing only biocompatible materials. A novel feature is the two-dimensional mesoporous thermally reduced graphene oxide (rGO) host electrode. An additionally novelty is that we explored the potential of using biocompatible, low-cost filter paper (FP) instead of carbon paper, a conductive polymer, or gold as support for the host electrode. Using glucose (C₆H₁₂O₆) and molecular oxygen (O₂) as the power-generating fuel, the cell consists of a pair of bioelectrodes incorporating immobilized enzymes, the bioanode modified by rGO-glucose oxidase (GOx/rGO), and the biocathode modified by rGO-laccase (Lac/rGO). Scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDX), transmission electron microscopy, and Raman spectroscopy techniques have been employed to investigate the surface morphology, defects, and chemical structure of rGO, GOx/rGO, and Lac/rGO. N₂ sorption, SEM/EDX, and powder X-ray diffraction revealed a high Brunauer-Emmett-Teller surface area (179 m² g^-1) mesoporous rGO structure with the high C/O ratio of 80:1 as well. Results from the Fourier transform infrared spectroscopy, UV-visible spectroscopy, and electrochemical impedance spectroscopy studies indicated that GOx remained in its native biochemical functional form upon being embedded onto the rGO matrix. Cyclic voltammetry studies showed that the presence of mesoporous rGO greatly enhanced the direct electrochemistry and electrocatalytic properties of the GOx/rGO and Lac/rGO nanocomposites. The electron transfer rate constant between GOx and rGO was estimated to be 2.14 s^-1. The fabricated EBFC (GOx/rGO/FP-Lac/rGO/FP) using a single GOx/rGO/FP bioanode and a single Lac/rGO/FP biocathode provides a maximum power density (P_max) of 4.0 nW cm^-2 with an open-circuit voltage (V_OC) of 0.04 V and remains stable for more than 15 days with a power output of ∼9.0 nW cm^-2 at a pH of 7.4 under ambient conditions.

Detection of L-Aspartic Acid with Ag-Doped ZnO Nanosheets Using Differential Pulse Voltammetry

Here, a sensitive voltametric electrochemical sensor probe was fabricated to reliably trace the detection of L-aspartic acid in phosphate-buffered medium using a glassy carbon electrode (GCE) layered with a film of wet-chemically prepared Ag₂O-doped ZnO nanosheets (NSs). EDS, FESEM, XPS, and X-ray diffraction analyses were implemented as characterizing tools of prepared NSs to confirm the structural and compositional morphology, binding energies of existing atoms, and the crystallinity of synthesized NSs. The differential pulse voltammetry (DPV) was applied to the trace detection of L-aspartic acid, and exhibited a wide detection range of 15.0~105.0 µM, a limit of detection (3.5 ± 0.15 µM), and good sensitivity (0.2689 µA µM^-1 cm^-2). Besides these the precious reproducibility, stability, and efficient responses were perceived from the voltametric analysis of aspartic acid. Moreover, the proposed aspartic acid was subjected to experiments to potentially detect aspartic acid in real biological samples. Therefore, the development of an enzyme-free sensor by applying this method will be a smart technical approach in the near future.

An Efficient Enzyme-Less Uric Acid Sensor Development Based on PbO-Doped NiO Nanocomposites

Here, the voltammetric electrochemical approach was applied to detect uric acid (UA) in a conductive sensing medium (phosphate buffer solution-PBS) by using PbO-doped NiO nanocomposites (NCs)-decorated glassy carbon electrode (GCE) performing as working electrode. The wet-chemically prepared PbO-doped NiO NCs were subjected to characterization by the implementation of XRD, FESEM, XPS, and EDS analysis. The modified GCE was used to detect uric acid (UA) in an enzyme-free conductive buffer (PBS) of pH = 7.0. As the outcomes of this study reveal, it exhibited good sensitivity of 0.2315 µAµM−1cm−2 and 0.2233 µAµM−1cm−2, corresponding to cyclic (CV) and differential pulse (DPV) voltammetric analysis of UA, respectively. Furthermore, the proposed UA sensor showed a wider detection (0.15~1.35 mM) range in both electrochemical analysis methods (CV & DPV). In addition, the investigated UA sensor displayed appreciable limit of detection (LOD) of 41.0 ± 2.05 µM by CV and 43.0 ± 2.14 µM by DPV. Good reproducibility performance, faster response time and long-time stability in detection of UA were perceived in both electrochemical analysis methods. Finally, successful analysis of the bio-samples was performed using the recovery method, and the results were found to be quite acceptable in terms of accuracy. Thus, the findings indicate a reliable approach for the development of 5th generation biosensors using metal-oxides as sensing substrate to fulfill the requirements of portable use for in situ detection.

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.

Effect of Vibrations, Displacement, Pressure, Temperature and Humidity on the Resistance and Impedance of the Shockproof Resistors Based on Rubber and Jelly (NiPc–CNT–Oil) Composites

Here, we present the design, fabrication and characterization of shockproof rubber–jelly (NiPc–CNT–oil) composite-based resistors. To fabricate the resistors, gels of CNT and NiPc with edible oil were prepared and deposited on a flexible rubber substrate using rubbing-in technique. The devices’ resistance and impedance were investigated under the effect of pressure, displacement, humidity, temperature and mechanical vibrations. The resistance and the impedance decreased, on average, by 1.08 times under the effect of pressure (up to 850 gf/cm2) and by 1.04 times under the effect of displacement (up to 50 µm). Accordingly, upon increasing the humidity from 60% to 90% RH, the resistance and impedance decreased by up to 1.04 times, while upon increasing the temperature from 25 °C to 43 °C, the resistance and impedances also decreased by up to 1.05 times. Moreover, under the effect of vibration, a decrease in resistance and impedance, by up to 1.03 times, was observed. The investigated samples can potentially be used as prototypes for the development of shockproof jelly electronic-based devices in particular resistors. The technological achievement in the fabrication of these devices is the use of edible organic oil, which allows for the fabrication of uniform jelly films of organic materials that cannot be realized simply by mixing “dry” ingredients. Especially, we highlight that edible organic oil is environmentally friendly, unlike some other inorganic oils that are used in practice.

Management of Choledocholithiasis: Should We Remove the Bile Duct?

Retrieval of stone by endoscopic papillotomy, laparoscopic choledochotomy or open choledochotomy is the treatment of choice for choledocholithiasis. Published literature shows that the recurrence rate is 4% to 24% with existing method of treatment. We have treated 8 patients who admitted with recurrent choledocholithiasis in the department of Hepato-Biliary-Pancreatic and Liver Transplant Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh in the period of January 2016 to December 2019. None had intrahepatic duct abnormality or stones. All patients underwent either ERCP stenting, open choledocholithotomy or both 16 to 84 months back. Management policy is designed and outcome is observed on these patients. There were 3 males and 5 females; age ranges 18 to 60 years. The common bile duct (CBD) diameter of all patient ranges from 15 to 24mm. The shape of CBD is different from normal variant; S shaped, saculated, grossly dilated with terminal narrowing. Considering the anatomical abnormality and recurrence of disease we have removed the abnormal part of common bile duct along with stones and the operation was completed by Roux-en-Y hepaticojejunostomy. All patients were completely symptom free for 6 to 48 months after surgery. Removal of abnormal part of common bile duct with reconstruction in the form of Roux-en-Y hepatico-jejunostomy may be considered for treating choledocholithiasis with abnormal CBD (abnormally dilated, abnormally shaped, angulated or sacculated) however, long-term follow up is required for final comment.

Simple Treadmill Score: Does It Have Better Predictability for Coronary Artery Disease?

Coronary artery disease is one of the most prevalent causes of increasing mortalitiy in current time. Early detection of such dreadful condition by a non-invasive test like exercise treadmill test, is a much-required option to prevent future complications like myocardial infarction. The aim of this study was to find out how different the predictability of simple treadmill score in comparison to other treadmill scores namely the well-known Duke treadmill score and Cleveland clinic score. In a cross-sectional analytical study of total 130 individuals with stable angina were included according to criteria set before the study. The treadmill scores of these patients were calculated and compared to coronary angiogram findings where coronary artery angiograms were done according to clinical need. Simple treadmill test had similar predictability for coronary artery disease when we compared it with much-applied Duke Treadmill Test and Cleveland Clinic Score- which is currently used for mortality prediction. Receiver Operator Characteristics (ROC) Curve showd all scores had around 0.7 area under the curve (AUC) which is highly statistically significant (p<0.0001) though simple treadmill score in females has higher sensitivity (92.3%). Simple treadmill score can be considered to exclude female patients from undergoing invasive investigation as it has higher sensitivity than other currently practiced treadmill scores i.e., Duke treadmill score.

Health Problems of Bangladeshi Tannery Workers

Tanners are exposed to raw hides as well as to various toxic chemicals. The study was intended to find out the health problems among tannery workers. This descriptive cross-sectional study was conducted in 2019 among 223 workers working with raw hides and chemicals selected by stratified random sampling in ten tanneries of Leather Industry Area, Hemayetpur, Savar, Dhaka, Bangladesh. Data were collected by the principal investigator after taking informed written consent from the tanners using a pre-tested interview schedule and a check-list. Data were cross-checked for consistency and accuracy. All relevant ethical issues including approval from Institutional Review Board (IRB), and data quality assurance issues were taken into consideration. Analysis of data was carried out by using computer software SPSS version 20.0 with anonymity. Descriptive statistics were used to describe the data, while Chi-square test was carried out to measure statistical association. As many as 97(43.5%) workers were in age group of 15 to 24 years with a mean age of 28.4±9.5 years. An overwhelming majority 204(91.5%) were males, three-fifths 134(60.1%) of the workers were married, while 213(95.5%) tanners had religion Islam. Majority 122(54.7%) tanners had primary level of education, whereas 56(25.1%) had secondary level and 44(19.7%) had no formal schooling. The mean monthly family income was 13744.4±3485.5 Taka. More than three-fourths 170(76.2%) workers had more than four family members with over half 114(51.1%) of the workers were smokers. Of 223, over half 124(55.6%) of the workers were affected with at least one health problem. Majority of the workers suffered from skin diseases (51.6%), musculoskeletal disorders (33.1%), gastrointestinal problems (22.6%), chronic headache (14.5%) and respiratory problems (14.5%). Only 9(4.0%) workers had pre-placement orientation, while 196(66.4%) workers did not notice the necessity for pre-placement training. Of ten tanneries, cent per cent had foul smell, 80.0% each had poor lighting and discomfort temperature, 60.0% had intolerable noise, 50.0% were with poor ventilation system, and only 30.0% had adequate waste management facilities. The tanneries did not have medical facilities even for emergency conditions. Health problems are significantly associated with job duration (p<0.01), working sections (p<0.05) and smoking status (p<0.001) of the workers. The overall environment of the tanneries is far from satisfactory. Skin diseases, musculoskeletal disorders, gastrointestinal problems, chronic headache and respiratory diseases are the common identified health problems. A considerable number of workers are unconcerned for the pre-placement orientation, and do not use Personal Protective Equipments (PPEs). As a rule, Personal Protective Equipments (PPEs) are not made available to workers by the tannery authorities, and lack of treatment facilities of the tanneries is a common place.

Knowledge and Preventive Practice on COVID-19 among Civil Employees Working In Selected Unit of Dhaka Cantonment

Corona viruses are a large group of viruses that are responsible for sickness starting from mild common cold to extremely severe form of diseases. Prevention is the best method to control COVID-19 pandemic. The World Health Organization recommended that generating awareness by enriching knowledge of people to rule out COVID-19. To find out the level of knowledge and status of preventive practice on COVID-19 among Civil employees of Central Ordnance Depot (COD) and Central Mechanical Transport Depot (CMTD) of Dhaka Cantonment. This descriptive cross-sectional study was conducted among 151 civil employees of COD (Central Ordnance Depot) and CMTD (Central Mechanical Transport Depot), Dhaka cantonment from July 2020 to June 2021. Systematic random sampling technique was used to select the respondents. Data collection was done by face to face interview with using semi-structured questionnaire. The mean age of the respondent was 37.94±10.12 years. Among the respondents 84.8% were male, rest 15.2% were female. Mean score of knowledge highest (17.73) in 18-29 years age group, in female (17.83), 2nd class employee (18.00) and those qualified in graduation and above (17.27). Regarding level of knowledge 77.48% respondents had excellent knowledge, of which most of them were doing practice. The association between knowledge and preventive practice of COVID-19 on hand washing (p=0.01), wearing face mask (p=0.000), maintaining social distance (p=0.002) were found statistically significant. In this study most of the respondents had 'excellent' and 'good' level of knowledge on COVID-19, of which most of them were doing practice. There are some, those who had knowledge but not doing practice. On the other hand some had no knowledge on particular event of COVID-19, but were doing practice unknowingly.

Post-Operative Severe Hyperbilirubinemia: A Case Report

Hyperbilirubinemia is commonly seen in medical practice. But what could be the highest level of bilirubin in an individual that is still an unanswered question. We came across to a 37 years old lady in October 2018 with hepaticolithiasis who underwent extended choledocholithotomy. Her preoperative serum bilirubin was within normal range. Post-operatively she developed cholangitis and from 3rd post-operative day onwards she developed severe hyperbilirubinemia, which was high as 70.47 mg/dl on the 6th post-operative day. Other causes of post-operative hyperbilirubinemia were excluded. She was managed conservatively for this hyperbilirubinemia and bilirubin level gradually reduced.

Optimisation and stability of Rh particles on noble metal films immobilised on H + conducting solid polymer electrolyte in attaining efficient nitrate removal

During the electrocatalytic reduction of nitrate, nitrite is often evolved as a product along with ammonia due to the sluggish nitrite to ammonia conversion process compared to the nitrate to nitrite conversion step. Rhodium metal has been proven to enhance nitrite to ammonia conversion rates, yielding ammonia as the only final product. In the present article, we have shown how effectively Rh nanoparticles immobilized on Pt and Pd films deposited on H +  conducting Nafion-117 membranes eliminate intermediate nitrite ions during the progress of the nitrate reduction reaction in a flow type reactor. In this research, we also demonstrated the optimization of Rh nanoparticles on the cathode surface to attain effective nitrate reduction along with a reproducibility check. The dissolution of loosely held Rh nanoparticles on the cathodic surface was observed, which tends to redeposit during cathodic electrolysis, causing stable performance. Finally, Tafel analysis was performed to show the relative kinetic feasibility of the Rh modified Pt and Pd electrodes in attaining nitrate reduction reactions in neutral medium.

Metal-Organic Frameworks Derived Electrocatalysts for Oxygen and Carbon Dioxide Reduction Reaction

The increasing demands of energy and environmental concerns have motivated researchers to cultivate renewable energy resources for replacing conventional fossil fuels. The modern energy conversion and storage devices required high efficient and stable electrocatalysts to fulfil the market demands. In previous years, we are witness for considerable developments of scientific attention in Metal-organic Frameworks (MOFs) and their derived nanomaterials in electrocatalysis. In current review article, we have discussed the progress of optimistic strategies and approaches for the manufacturing of MOF-derived functional materials and their presentation as electrocatalysts for significant energy related reactions. MOFs functioning as a self-sacrificing template bid different benefits for the preparation of metal nanostructures, metal oxides and carbon-abundant materials promoting through the porous structure, organic functionalities, abundance of metal sites and large surface area. Thorough study for the recent advancement in the MOF-derived materials, metal-coordinated N-doped carbons with single-atom active sites are emerging candidates for future commercial applications. However, there are some tasks that should be addressed, to attain improved, appreciative and controlled structural parameters for catalytic and chemical behavior.

Evaluation of outcome of Coronavirus disease 2019 patients receiving RAAS inhibitors (OCRAS study): a prospective observational study of Bangladeshi hypertensive patients

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Beximco Pharmaceutical Limited, Bangladesh

OnBehalf

Cardiology Study Group (Bangladesh)

Background

The fact that SAARS-Cov2 virus enters cells through ACE2 receptors and the Renin-Angiotensin-Aldosterone System Inhibitors (RAASi) upregulate the ACE2 receptors, there was speculation that use of RAASi may lead increased cellular entry of the virus.  There was a pause for a brief period of the use of RAASi in COVID 19 patients. But clinically the speculation has been found to be incorrect. Different professional societies come up with the assertion to continue to use RAASi. As the hesitancy among the clinicians appears to continue and there is no first hand data regarding the safety of the use of RAASi in Bangladeshi population, the study was undertaken to evaluate the safety of RAASi in COVID 19 patients.

Aims & Methods

This study was a prospective, observational multi-center study to evaluate the outcome of COVID-19 patients receiving RAAS inhibitors. Adult Hypertensive patients (age ≥18 years) with diagnosed COVID-19 confirmed by RT-PCR test who have a history of taking either ACE inhibitor/ARB or any other anti-hypertensive medication. Evaluation of outcome was assessed by rate of hospitalization, requirement of oxygen therapy, requirement of high flow nasal cannula, admission to ICU and mortality between two groups. All statistical analyses were performed using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA).

Results

We collected data from 147 Covid-19 positive patients confirmed by RT-PCR. Among them, 117 (79.6%) had a history of taking RAAS inhibitor and 30 had history of taking other antihypertensive medications. Of them, two-third patients had more than 50 years of age and more than half of the patients had overweight or obesity. Other than hypertension they had several comorbidities such as Diabetes Mellitus (45.4%), Ischemic Heart Diseases (35.4%), Asthma or COPD (15%) etc. Rate of hospitalization had no statistical difference between RAAS inhibitor group and other hypertensive group (48.7% vs 46.70% respectively; p-value - 0.841). There was no statistical difference between two groups in terms of requirement of oxygen therapy (p-value - 0.297), High Flow Nasal Cannula (p-value - 0.430), intensive care unit (p-value - 0.194) and death (p-value – 0.383) also. Almost half and one-third of the patients had persistence of symptoms even after 14 days and 28 days respectively. Fatigue, cough, breathlessness, loss of appetite and taste were the most common symptoms among those.

Conclusion

In our study we found that RAAS inhibitor treatment had no adverse effect on the outcome of COVID-19 patients compared with other antihypertensive drugs. Patients may continue receiving ACEIs and ARBs for the treatment of any indication for RAASi without an increased risk of worse outcomes.