The Association of Cytokines IL-2, IL-6, TNF-α, IFN-γ, and IL-10 With the Disease Severity of COVID-19: A Study From Bangladesh

Introduction Clinically, the early prediction of the severity of COVID-19 is often challenging, as a dramatic change in severity can occur without warning. The severity of COVID-19 disease is associated with an increased level of inflammatory mediators, including cytokines. This study aimed to evaluate the association of the levels of cytokines interleukin (IL)-2, IL-6, tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), and IL-10 with the severity of COVID-19 in Bangladesh. Materials and methods This cross-sectional study included a total of 60 confirmed cases of COVID-19, comprising 30 severe cases (Group A) and 30 non-severe cases (Group B), and 10 healthy individuals (Group C) attending Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2021 to February 2022. The cytokine assay was performed using the human Th1/Th2/Th17 cytokine kit BD cytometric bead array (CBA) on the BD Accuri C6 Plus flow cytometer. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York). Results The mean ages of the patients in Groups A, B, and C were 60.73±5.97, 57.13±7.68, and 48.10±9.13 years, respectively, with a male predominance in all groups. The mean IL-2, IL-6, IL-10, and TNF-α levels had a positive correlation with the increased age group and male gender, although it was not statistically significant. The mean IL-6 and IFN-γ levels were significantly higher among severe cases (216.95±147.78 and 0.98±0.95 pg/mL, respectively) compared to non-severe cases (94.29±128.79 and 0.41±0.61 pg/mL, respectively) and healthy individuals (1.08±1.97 and 0.15±0.28 pg/mL, respectively). Furthermore, the anti-inflammatory cytokine IL-10 was also significantly higher among severe cases (17.92±21.87 pg/mL) compared to non-severe cases (5.38±6.73 pg/mL) and healthy individuals (1.62±1.65 pg/mL). Conclusion IL-6, IFN-γ, and IL-10 have a significant association with the severity of COVID-19 disease. Clinicians treating patients with COVID-19 can consider the level of these cytokines as biomarkers of severity.

Assessment of Kidney Function among the Employees of Sylhet MAG Osmani Medical College and Hospital

The kidney carries out a variety of physiological processes, including the excretion of nitrogenous waste products, maintenance of fluid, electrolyte, acid-base, and mineral homeostasis, regulation of blood pressure, as well as the synthesis and release of erythropoietin and other endocrine substances. Chronic kidney disease (CKD) can lead to end-stage renal disease (ESRD) and increased cardiovascular morbidity and mortality. CKD has a long period of asymptomatic stage. The symptoms of CKD usually present at the advanced stage of the disease. Chronic kidney disease (CKD) is a potentially fatal that impacts various physiological systems. This cross-sectional observational study was conducted in the Department of Physiology in collaboration with the Department of Nephrology, Sylhet MAG Osmani Medical College Hospital (SMAGOMC&H), from July 2022 to June 2023 to observe the status of kidney function among the employees of SMAGOMC&H, Bangladesh. The study population consisted of all willingly participating volunteers working at SMAGOMC&H between the ages of 18 and 59 years. Participants with acute illness, malignancy, pregnancy, diagnosed case of CKD, and history of kidney transplant were excluded from the study. A thorough history was taken, and a physical examination was done. Serum creatinine, and spot urine albumin creatinine ratio (ACR) of each participant were measured. eGFR (estimated glomerular filtration rate) was estimated by using NKF (National Kidney Foundation) eGFR calculator app. A Semi-structured questionnaire was used for data collection. Most of the participants were between 50-59 years (46.0%). The mean age of these study subjects was 45.25±10.08 years. The mean serum creatinine level was 0.85±0.18 mg/dl, the mean eGFR was 102.92±16.21 ml/min/1.73m² and the mean urinary ACR was 27.44±12.48 mg/gm found in this study. Out of the total participants, 16.5% were at stage 1 CKD, 6.5% were at stage 2 CKD and 2.5% were at stage 3 CKD, according to eGFR by CKD-EPI (Chronic kidney disease epidemiology collaboration) equation. Seventy five percent (75.0%) of the participants had normal to mildly increased ACR and 25.0% had moderately increased ACR. Pearson's correlation test revealed a significant negative correlation of eGFR with age, serum creatinine, and urinary ACR (p<0.001). This study revealed that 16.5%, 6.5% and 2.5% of the study participants were at CKD stage 1, stage 2, and stage 3, respectively. Assessment of renal function can help early identification of CKD in apparently healthy asymptomatic subjects.

Evaluation of Hemoglobin Concentration in Male Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a major public health problem. This study was done to evaluate the changes of hemoglobin concentration in COPD patients in comparison to healthy person. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh from July 2018 to June 2019. A total number of 160 male subjects, ages ranged from 30-70 years were included in this study. Among them, eighty (80) male COPD subjects were taken as study group (Group II) and eighty (80) age matched male healthy subjects were taken as control group (Group I). Hemoglobin concentration was estimated by cyanmethemoglobin method. Data were expressed as mean (±SD) and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean±SD of hemoglobin concentration of Group I and Group II were 13.79±1.08gm/dl and 11.63±1.33gm/dl respectively. The mean ±SD of hemoglobin concentration significantly lower in study group in comparison with control group. Patients with COPD with greater changes in hemoglobin concentration causes more frequent hospitalization and increased mortality and morbidity due to COPD related complications. So, assessment of this parameter is important for early detection and prevention of complication related to COPD for leading a healthy life.

Status of Serum Calcium in Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) remains a major public health problem with relatively high prevalence rates worldwide (5-13%). COPD is a major cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. The purpose of the study was to explore the alteration of serum calcium in patients with COPD. This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh from January 2021 to December 2021. Data was collected from Medicine Department of Mymensingh Medical College Hospital, Mymensingh. A total number of 120 subjects participated in this study. Out of them, 60 apparently normal healthy individuals were selected as Group I and another 60 diagnosed COPD patients were selected as Group II. Serum calcium was measured by colorimetric method using the test kit. The results were calculated and analyzed by using statistical package for social science (SPSS), windows package version 21.0. Data were expressed in mean ±SD and statistical significance was done by Student's unpaired 't' test. In this study, the mean ±SD values of serum calcium were 9.21±1.06mg/dl and 8.26±0.95mg/dl in Group I and Group II respectively. The results were highly significant (p<0.001). The result suggested that there was significant relation between COPD and alteration of serum calcium. So, by this study we recommended that routine evaluation of serum calcium is important for prevention of exacerbations, reduction of morbidity and mortality in patients with COPD.

Study of Body Mass Index, Fasting Serum Glucose and Glycated Hemoglobin in Type 2 Diabetic Female Patients

Type 2 diabetes mellitus is a serious public health concern because it produces considerable impact on human life and health expenditures. Overweight and obesity plays a major role in the pathogenesis of type 2 diabetes. Fasting blood sugar is the diagnostic marker for type 2 diabetes mellitus. Glycated hemoglobin is widely used as an index of mean glycemia. The aim of this study was to find out the effect of body mass index, fasting serum glucose, glycated hemoglobin in type 2 diabetic female patients in Mymensingh locality. This cross-sectional analytical type of study was carried out in the department of Physiology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh from July 2022 to June 2023. A total 200 subjects age ranged between 30-59 years were selected and were grouped as control group, Group I (100, non-diabetic female) and study group, Group II (100, female diabetic patients). SPSS was used to calculate and analyzed the result. Anthropometric measurements such as height and weight taken in meter and kilogram respectively, laboratory analysis of fasting serum glucose was determined by GOD- POD method, glycated hemoglobin by fluorescence immunoassay method. Results were expressed as mean (± SD) and by unpaired Student's 't' test. The mean (± SD) of BMI of control group (non-diabetic female) and study group (female diabetic patients) were 22.01±1.50 and 26.86±2.00 kg/m² respectively. In study group BMI was increased in comparison to control group. The mean (± SD) of fasting serum glucose of control group (non-diabetic female) and study group (female diabetic patients) were 4.36±0.84 and 8.25±2.52 mmol/L respectively. In study group fasting serum glucose was increased in comparison to control group. The mean (± SD) of glycated hemoglobin of control group (non-diabetic female) and study group (female diabetic patients) were 5.07±0.47 and 7.45±1.34 % respectively. In study group glycated hemoglobin was increased in comparison to control group. In this study we found that body mass index, fasting serum glucose, glycated hemoglobin was significant in study group (female type 2 diabetic patients) in comparison to control group (healthy female adults of same age group). Therefore, by this study we recommended that for prevention of complications related to type 2 diabetes mellitus routine estimation of these parameters is important.

Status of Hemoglobin Concentration and Serum Total Iron Binding Capacity among Iron Deficiency Anemic Adolescent Girls

Adolescence may be defined as the period from 10 to 19 years of age. Adolescence is a significant period of human growth and maturation when various changes occur and requirement of nutrients is increased in girls due to increase demands for growth. This prospective type of analytical cross-sectional study was carried out to observe the status of Hb concentration and serum total iron binding capacity (TIBC) levels among iron deficiency anemic adolescent girl. This study was conducted in the Department of Physiology, Mymensingh Medical College, Bangladesh from July 2019 to December 2020. For this purpose, 140 adolescent girl's age ranged from 10-19 years were selected in this study, among them, 70 healthy adolescent girls as control group (Group I) and 70 girls selected as study group (Group II) and they are iron deficiency anemic adolescent girls. Estimation of hemoglobin by cyanmethaemoglobin method and estimation of serum total iron binding capacity (TIBC) was determined by Ferrozine method using Globals iron and TIBC kit, UK. All data were expressed as mean ±SD and statistical significance of difference among the Group I and Group II were calculated by unpaired students''t' test. Hemoglobin (Hb) concentration significantly lowers in study group (Group II) in comparison with control group (Group I), Result is highly significant (p<0.001). Total iron binding capacity (TIBC) significantly higher in study group (Group II) in comparison with control group (Group I), Result is highly significant p<0.001). Immediate, long term and sustainable public health intervention would require for overcome the situation.

M gene targeted qRT-PCR approach for SARS-CoV-2 virus detection

Quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) is the gold standard method for SARS-CoV-2 detection, and several qRT-PCR kits have been established targeting different genes of the virus. Due to the high mutation rate of these genes, false negative results arise thus complicating the interpretation of the diagnosis and increasing the need of alternative targets. In this study, an alternative approach for the detection of SARS-CoV-2 viral RNA targeting the membrane (M) gene of the virus using qRT-PCR was described. Performance evaluation of this newly developed in-house assay against commercial qRT-PCR kits was done using clinical oropharyngeal specimens of COVID-19 positive patients. The limit of detection was determined using successive dilutions of known copies of SARS-CoV-2 pseudovirus. The M gene based assay was able to detect a minimum of 100 copies of virus/mL indicating its capacity to detect low viral load. The assay showed comparable accuracy, sensitivity and specificity with commercially available kits while detecting all the variants efficiently. The study concluded that the in-house M gene based assay might be an effective alternative for the currently available commercial qRT-PCR kits.

Status of Serum Magnesium and Uric Acid in Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) remains a major public health problem with relatively high prevalence rates worldwide (5.0-13.0%). COPD is a major cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. The purpose of the study was to explore the relationship of biochemical alterations of serum magnesium and uric acid with frequent exacerbations, hypoxia, increase hospital stay, morbidity and mortality in patients with COPD. This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh from January 2021 to December 2021. Data was collected from Medicine Department of Mymensingh Medical College Hospital, Bangladesh. A total number of 120 subjects participated in this study. Out of them, 60 apparently normal healthy individuals were selected as Group I and another 60 diagnosed COPD patients were selected as Group II. The results were calculated and analyzed by using statistical package for social science (SPSS), windows package version 21.0. Serum magnesium was measured by photoelectric colorimetric method using the test kit and serum uric acid was measured by enzymatic colorimetric method using the test kit. Data were expressed in mean±SD and statistical significance of different parameter was done by Pearson's correlation co-efficient test. The mean±SD values of serum magnesium were 2.15±0.29mg/dl and 1.54±0.30mg/dl in Group I and Group II respectively. Result was statistically highly significant (p<0.001). The mean±SD values of serum uric acid were 5.43±2.05mg/dl and 6.86±1.61mg/dl in Group I and Group II respectively. Result was statistically highly significant (p<0.001). Pearson's correlation coefficient test showed that there was significant (p=0.001) negative correlation (r= -0.415) found between serum magnesium and serum uric acid in study group. In this study, the result suggested that there was significant relation between COPD exacerbations and alteration of these biochemical parameters. So, by this study we recommended that routine evaluation of these parameters is important for prevention of exacerbations, reduction of morbidity and mortality in patients with COPD.

Status of Serum Iron and Fasting Serum Glucose in Reproductive Aged Women Taking Combined Oral Contraceptive Pill

The oral contraceptive pill, 'the pill', was introduced in the beginning of the 1960s. Presently, worldwide about 100 million women are current users of combined oral hormonal contraceptives (COC) most frequently used in the western world. Oral contraceptive use has been associated with decreased menstrual blood losses; thus, can independently reduce the risk of anemia and iron deficiency in women. Manufacturers have recently started to include supplemental iron in the non-hormonal placebo tablets of some contraceptives. This study was done to evaluate the status of serum iron and fasting serum glucose in combined oral contraceptive pill users in comparison to non-users. This cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh from July 2021 to June 2022. A total number of 120 reproductive aged women, age ranged from 15-55 years was included in this study. Among them, sixty (60) combined oral contraceptive pill users subjects were taken as study group (Group II) and sixty (60) age matched oral pill non users subjects were taken as control group (Group I). Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean±SD of serum iron of control group (Group I) and study group (Group II) were 93.22±17.19μg/dl and 181.57±22.06μg/dl respectively. The mean±SD of fasting serum glucose of control group (Group I) and study group (Group II) were 4.67±0.61mmol/L and 6.61±0.61mmol/L respectively. Serum iron and fasting serum glucose increased in study group in comparison to control group. Result is statistically highly significant (p<0.001). So there from this study it can be concluded that there is significant association of serum iron and fasting serum glucose with oral contraceptives.

Study on Blood Pressure, e-GFR, Serum Albumin, C-reactive Protein in Normal Subjects and Patients with CKD

In general, Kidney diseases are silent with no apparent early symptoms and chronic kidney disease (CKD) is marked by gradual loss of kidney function over time. High rate of inflammation is common in CKD and it causes high CRP level. High CRP levels are associated with low e-GFR and low serum albumin level. This study was conducted to determine the changes of blood pressure, estimated glomerular filtration rate, serum albumin and C-reactive protein in chronic kidney diseased patients and compared with healthy subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh from July 2021 to June 2022. A total number of 140 subjects, age range between 25-70 years were included in this study. Among them, 70 healthy subjects were taken as control group (Group I) with 35 male (IA) and 35 female (IB) and 70 chronic kidney diseased patients were taken as study group (Group II) with 35 male (IIA) and 35 female (IIB). Calculation of estimated glomerular filtration rate (eGFR) was done by chronic kidney disease epidemiology collaboration (CKD-EPI) equation. Data were expressed as mean±SD and statistical significance difference among the group were calculated by unpaired t-test. In this study, we found that eGFR (in IIA 29.83±0.73 ml/min and in IIB 30.80±0.73ml/min) and serum albumin (in IIA 2.96±0.04g/dl in IIB 2.07±0.02g/dl) were significantly decreased in study group in comparison to control group. Blood pressure (SBP in IIA 150.57±1.70 mm of Hg, in IIB 143.71±1.32 mm of Hg and DBP in IIA 94.40±0.70 and in IIB 91.20±0.70 mm of Hg) and C-reactive protein (CRP) (in IIA 12.14±0.90mg/l and in IIB 21.80±2.58mg/l) were significantly increased in study group in comparison to control group. CKD is associated with increased risks of several co-morbidities including cardiovascular complications and chronic renal failure. Detection of CKD at an early stage helps to reduce the progression of renal disease and burden of end stage renal disease.

Community Based Rehabilitation for Accessibility of Disable Person in a Low and Middle-income Country like Bangladesh

Not Available.

Study on Body Mass Index and Fasting Serum Glucose in Postmenopausal Women

Menopause is a normal physiological period that is characterized by the completely stoppage of endometrial cycles in women between the age of 45-55 years due to lack of ovarian follicular function. Several postmenopausal syndromes such as hot flushes, night sweats, vaginal dryness, depression, irritability, headache, and sleep disturbance can occur more frequently in this period which hampers the standard of life. This study was done to assess body mass index and fasting serum glucose changes in postmenopausal women in contrast with reproductive women. This cross-sectional analytical type of study was conducted in the Department of Physiology, Mymensingh Medical College, Bangladesh from January 2021 to December 2021. Total 140 women subject's age ranged between 25-65 years were involved in this study. Among them 25-45 years aged 70 (Seventy) reproductive women were involved as control group (Group I) and 45-65 years aged 70 (Seventy) postmenopausal women were taken as study group (Group II). By Anthropometric measurements, Body Mass Index (BMI) such as height and weight were taken in meter and kilogram respectively and fasting serum glucose was measured by GOD-PAP method. Results were expressed as mean (±SD) and by unpaired Student's 't' test, statistical significance of difference among the group was calculated. The mean±SD of BMI of Group I and Group II were 23.05±4.43kg/m² and 29.01±3.12kg/m² respectively. The mean±SD of body mass index is notably increase in study group in contrast with control group. The mean±SD of fasting serum glucose of control Group I and study Group II were 4.77±2.04mmol/l and 6.11±1.61mmol/l respectively. In study Group II fasting serum glucose was increased. Due to increased fasting serum glucose caused by lower level of female sex hormones specially estrogen hormone increased chance of cardiovascular diseases in postmenopausal women. Assessment of these parameters are important for early detection and prevention of complication related to high BMI and fasting serum glucose level for leading a better life.

Study on Body Mass Index and Fasting Serum Glucose in Patient with Chronic Kidney Disease

The BMI and fasting serum glucose was estimated in chronic kidney diseased patient to observe low body mass and the frequency of high in fasting serum glucose level in chronic kidney diseased patient (CKD). BMI fluctuations may indicate other serious comorbid conditions. Wasting is prevalent among patients with chronic kidney disease. It is to be distinguished from chronic inflammation and malnutrition, which is defined as the consequence of insufficient food intake. Diabetes is the most common cause of kidney disease. The chronic hyperglycemia of diabetes mellitus is associated with long-term damage, dysfunction and failure of kidneys, blood vessels, nerves, heart. This cross sectional study was carried out in the department of Physiology of Mymensingh Medical College, Mymensingh from July 2014 to June 2015. In this study total 200 subjects were selected with age ranged from 25 to 60 years and divided into 100 healthy persons as control group and 100 CKD patients as study group. Both control and study group were further divided into 50 male and 50 female. Unpaired student's t test was used for Statistical data analysis. The mean±SE BMI of control group male and study group male were 25.04±0.13 and 23.87±0.41 kg/m² respectively. In study group male, mean±SE BMI was decreased. Result was statistically significant (p<0.05). The mean±SE BMI of control group female and study group female were 24.13±0.43 and 22.90±0.27 kg/m² respectively. In study group female, mean±SE BMI was decreased and result was significant (p<0.05). BMI was decreased in study group than in control group. The results were statistically significant. Fasting serum glucose was evaluated by the Enzymatic, colorimetric, GOD-PAP method. The results showed that the mean±SE fasting serum glucose of control group male & study group male were 5.31±0.17mmol/L and 7.56±0.37mmol/L respectively. In study group male, mean±SE FSG was increased. Result was statistically highly significant (p<0.0001). The mean±SE FSG of control group female & study group female were 5.11±0.11mmol/L and 7.37±0.33mmol/L respectively. In study group female, mean±SE FSG was increased & result was highly significant (p<0.0001). According to the above result, FSG was increased in study group than in control group. The results were statistically significant. Fasting serum glucose levels increased significantly in chronic kidney disease patients than the normal healthy persons. The increasing frequency of blood glucose level in CKD may predispose the patients to diabetes and increasing the other complications.

Status of Body Mass Index and Blood Pressure in Post-Menopausal Women

Menopause, in between the age of 45-55 years every woman faces it, that means completely stoppage of menstruation because the decrease level of estrogen from the normal level. In this period the quality life is disturbed due to hormonal imbalance specially estrogen. This study was done to evaluate the changes of body mass index and blood pressure in post-menopausal women in comparison to reproductive women. This cross-sectional analytical type of study was done in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh and the period is from January 2021 to December 2021. Total 140 women subjects age ranged between 25-65 years were involved in this study. Among them 70 post-menopausal women (45-65 years) were involved as study group (Group II) and 70 (seventy) reproductive women (25-45 years) were taken as control group (Group I). By anthropometric measurements, Body Mass Index (BMI) such as height and weight were taken in meter and kilogram respectively and systolic and diastolic blood pressure by aneroid sphygmomanometer (ALPK2, Japan). Findings were expressed as mean±SD and by unpaired student's 't' test, analytical significance of difference among the group was calculated. The mean±SD of BMI of Group I and Group II were 23.05±4.43kg/m² and 29.01±3.12kg/m² respectively. The mean±SD of body mass index is significantly higher in study group in comparison with control group. The average (±SD) of systolic blood pressure of control group I and study group II were 118.29±10.00 mm of Hg & 134.00±11.91 mm of Hg respectively. The mean±SD of systolic blood pressure was significantly higher in study group in comparison with control group. The mean±SD of diastolic blood pressure of control group I and study Group II were 79.21±6.46 mm of Hg and 89.00±6.23 mm of Hg respectively. The mean±SD of diastolic blood pressure was significantly higher in study group in comparison with control group. Post-menopausal women with high systolic and diastolic pressure have a chance of development of cardiovascular diseases, stroke. So assessment of these parameters are important for early detection and prevention of complication related to high BMI and Blood Pressure for leading a healthy life.

Assessment of Serum Total Cholesterol in Adult Male Hypertensive Bangladeshi People

Hypertension is a most common health problem worldwide and its incidence seems to be increasing on global scale. The objective of the study was to assess the relationship of serum Total Cholesterol with hypertensive patients in order to compare this parameter with normotensive subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2017 to June 2018. A total number of 120 male subjects, age ranged from 30-65 years was included in this study. Among them, sixty (60) hypertensive subjects were taken as study group (Group II) and sixty (60) age matched normotensive male subjects were taken as control group (Group I). Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. In this study we found that serum total cholesterol was significant in study group (229.62±17.49mg/dl) in comparison with control group (166.32±18.04mg/dl). Therefore, by this study we recommended that routine estimation of these parameters is important for prevention of complication related to hypertension for leading a healthy life.

Study of Body Mass Index, Blood Pressure, Serum Sodium in Newly Diagnosed Hypertensive Patients

Hypertension 'The sustained elevation of systemic arterial pressure' is a significant risk factor for heart disease, stroke and other cardiovascular diseases and an estimated 970 million people worldwide suffer from the disease resulting in significant morbidity, mortality and financial burden globally. It is the leading modifiable risk factor for morbidity and mortality worldwide. Worldwide an estimated 1.28 billion adults aged 30-79 years have hypertension, the majority (two-thirds) living with low and middle income countries. One of the global targets for non-communicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030.Sodium plays an important role in blood pressure regulation with a reduced sodium intake being associated with a reduction in systolic and diastolic blood pressure. This study was done to evaluate the differences in body mass index (BMI) and serum sodium in hypertensive and normotensive subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh between the periods from January 2022 to December 2022. A total number of 140 male subjects, age ranged from (30-59) years were included in this study. Among them, seventy (70) hypertensive subjects were taken as study group (Group II) and seventy (70) age matched normotensive subjects were taken as control group (Group I). The results were calculated and analyzed by using Statistical Package for Social Science (SPSS) version 26.0. Anthropometric measurements like height and weight taken in meter and kilogram respectively. Systolic and diastolic blood pressure was performed by aneroid sphygmomanometer (ALPK2, Japan), laboratory analysis of serum sodium by colorimetric method. In this study we found that body mass index in control group 23.59±1.29 kg/m² and study group 26.81±2.31kg/m²; blood pressure (systolic pressure in control group 113.21±6.76 mm Hg and in study group 149.14±5.03 mm Hg, diastolic pressure in control group 75.57±4.55 mm Hg and in study group 100.21±5.28 mm Hg) and serum sodium in control group 138.84±2.12 & in study group was 147.94±1.41 which were significant in study group in comparison with control group. In study group parameters were significantly increased in comparison to control male group. Therefore, by this study we recommended that routine estimation of these parameters is important for prevention of complication related to hypertension for leading a healthy life.

A Comparative Study of Body Mass Index and Blood Pressure between Sedentary and Non-Sedentary Workers

Sedentary lifestyle are spreading worldwide because of lack of available spaces for exercise, increased occupational sedentary behaviors such as office work and the increased prevalence of television and video devices. Increased incidence of sedentary lifestyle and obesity in developed and developing countries is one of the major risk factors for the development of cardiovascular diseases. This study was undertaken to analyze the differences in anthropometric and cardiovascular parameters in sedentary and non-sedentary male subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2021 to June 2022. This study consisted 50 male employees of 25-60 years who worked in an office were study group (Group II) and control group Group-I) consisted of 50 male age matched physical laborers. BMI was calculated as weight in kilogram divided by the height in meter square i.e. kg/m². Blood Pressure was measured by indirect auscultatory method with an aneroid sphygmomanometer. Statistical analysis was done by using Student's un-paired 't' test. Values expressed as mean ± standard deviation. P value was taken as significant at 5 percent confidence level. The mean±SD BMI in kg/m² of Group I and Group II were 21.90±2.22 and 29.32±3.13 respectively. The mean±SD systolic blood pressure of Group I and Group II were 112.20±6.79 and 145.10±8.11 and mean±SD diastolic blood pressure of Group I and Group II were 72.80±5.73 and 91.00±5.05 respectively. The BMI and blood pressure were increased in sedentary group compared to non-sedentary group. From the study, it appears that the risk for cardiovascular disease is increased in sedentary workers.

Evaluate the Changes of Body Mass Index and Blood Pressure in Combined Oral Contraceptive Pill Users

The oral contraceptive pill, 'the pill', was introduced in the starting of the 1960s. Presently, worldwide about 100 million women are current users of combined hormonal contraceptives (COC) most frequently used in the western world. The most frequently used agents are a combination of drugs containing both the estrogen and progesterone. This combination is considered to be highly efficacious, generally considered 99.9% and a use effectiveness of 97.0% to 98.0%. This study was done to evaluate the changes of Body Mass Index (BMI) and Blood pressure ( BP) in combined oral contraceptive pill users in comparison to non- users. This cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2021 to June 2022. Total number of 120 reproductive aged women, age ranged from 15-55 years was included in this study. Among them, sixty (60) combined oral contraceptive pill users subjects were taken as study group (Group II) and sixty (60) age matched oral pill non users subjects were taken as control group (Group I). Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test and Pearson's correlation coefficient test. The mean±SD of BMI of control group (Group I) and study group (Group II) were 22.50±1.50 kg/m² and 27.64±1.28 kg/m² respectively. In study group (Group II) BMI was increased. Result is statistically highly significant (p<0.001). The mean±SD of systolic blood pressure of control group (Group I) and study group (Group II) were 111.17±8.51 mm of Hg and 127.50±6.14 mm of Hg respectively. In this study the mean±SD of diastolic blood pressure of control group (Group I and study group (Group II) were 75.58±5.05mm of Hg and 87.00±4.89 mm of Hg respectively. In study group (Group II) diastolic blood pressure was increased. Result is statistically highly significant (p<0.001). So the assessment of this parameter is important for early detection and prevention of complication related to combined oral contraceptive pill use for leading a healthy life.

Study on Body Mass Index, Serum Total Cholesterol and Serum Triglycerides in Adult Male Hypertensive Patients

Hypertension or elevated blood pressure is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases. An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. An estimated 46.0% of adults with hypertension are unaware that they have the condition. In Bangladesh, 21.3 million of the adult population has hypertension and that is 21.0% of total population. About half of them (48.7%) with hypertension are diagnosed and 34.9% are under treatment. One of the global targets for non communicable diseases is to reduce the prevalence of hypertension by 33.0% between 2010 and 2030. This study was done to evaluate the effects of hypertension and to find out the major complications occurring due to hypertension. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2021 to December 2021. A total number of 120 male subjects, age ranged from 20-59 years was included in this study. Among them, sixty (60) hypertensive subjects were taken as study group (Group II) and sixty (60) ages matched normotensive adult male subjects were taken as control group (Group I). The results were calculated and analyzed by using Statistical package for social science (SPSS). Anthropometric measurements such as height and weight were taken in meter and kilogram respectively. Systolic and diastolic blood pressure were measured by Aneroid Sphygmomanometer (ALPK2, Japan), laboratory analysis of fasting serum total cholesterol by CHOD-POD method, fasting serum triglycerides by GPO-POD method. In this study we found that in study group Mean±SD of body mass index (29.36±2.60, p<0.001), fasting serum total cholesterol (232.05±11.18, p<0.001) and fasting serum triglycerides (180.67±19.44, p<0.001) which were significantly increased with comparison to control group. It's concluded from this study we recommended that routine estimation of these parameters is important for prevention of complication related to hypertension for leading a healthy life.

Study on Serum Calcium Level in Patients with Chronic Kidney Disease

Patients often present with chronic kidney disease (CKD) complicated with hypocalcaemia. Lower serum calcium is independently associated with chronic kidney disease. Aim of this study was to assess of serum calcium level in chronic kidney diseased patients in order to compare this parameter with healthy subjects. This analytical type of cross-sectional study was carried out in the Physiology department, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 200 subjects, age range 30-70 year were included in this study. Among 200 subjects, 100 healthy were taken as control group (Group I) and 100 chronic kidney diseased patients were taken as study group (Group II). Control group (Group I) subdivided into male healthy subject (Group IA) and female healthy subject (Group IB). Also study group (Group II) subdivided into male chronic kidney diseased patient (Group IIA) and female chronic kidney diseased patient (Group IIB). The results were calculated and analyzed by using SPSS version-21. Expression of data as mean±SE and statistical significance of difference among the group was calculated by unpaired student's 't' test. In this study we found that mean±SE serum calcium of Group IA and Group IIA were 9.60±0.09mg/dl & 8.04±0.03mg/dl respectively. The mean±SE serum calcium of Group IB and Group IIB were 9.38±0.096mg/dl & 8.19±0.05mg/dl respectively. Serum calcium was significantly decreased in study groups in comparison with control groups (p<0.001). By this study we therefore recommended that routine estimation of this parameter is important for prevention of complication related to chronic kidney disease for leading a healthy life.

Status of Serum Ferritin Level among Iron Deficiency Anemic Adolescent Girls in Bangladesh

Adolescence explained as a period of age between 10 to 19 years. This is a major contributing period to build up the health of girls. Ferritin is an intracellular protein that contains iron and releases it in a controlled fashion and it reflects body iron stores and systemic inflammation during adolescent period. It is considered the best single test for the diagnosis of iron deficiency anemia during adolescent because its concentration is directly proportional to total body iron stores in adolescent period. This study was done in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh to evaluate the changes of serum ferritin levels among iron deficient anemic adolescent girls in comparison to healthy adolescent girls in Bangladesh. This was a cross sectional, prospective, analytical type of study. This study ranged from 10-19 years of adolescent girls. Seventy (70) healthy adolescent girls, as control group (Group I). Seventy (70) iron deficiency anemic adolescent girls as study group (Group II). Serum ferritin was estimated by Micro-particle Enzyme Immunoassay Test Kit. Data were expressed as mean (±SD). Statistical significance of difference among the Group I and Group II were calculated by unpaired students 't' test. The mean±SD level of serum ferritin among Group I and Group II were 26.22±4.03μg/L and 13.33±3.18μg/L respectively. Mean values ±SD of serum ferritin significantly lower in (Group II) in comparison with (Group I). Higher numbers of adolescent girls are still suffering from anemia along with low level of serum ferritin in Bangladesh. For combat this situation, immediate, sustainable and long term public health intervention and nutritional supplementation must be required.

283 Delayed Discharge-a Pitfall for NHS; Can We Improve?

Aim

Identify reasons for discharge delays in a tertiary care hospital and find areas of improvement.

Method

Data were collected for seven days, and all inpatients (Elective and Emergency) admissions were included. Patient's demographic data, length of hospital stay, and discharge data were entered on Microsoft Excel and analysed using SPSS.

Results

Out of 102 total patients, 48 (47.1%) were male and 54 (52.9%) females. Mean age was 60.5 years (min 20 max 91). Clinical frailty score (CFS) was not calculated in more than half of the patients (n=55, 57.4%). 47(46.5%) patients had polypharmacy. 61(59.80%) patients did not have a documented Expected date of Discharge (EDD). Median hospital stay was 10 days (1–161 days).

27(26.47%) patients had delayed discharge (mean 4.93 days, median 1 day). Reasons for delay included unavailability of rehab bed (n=5, 4.9%), stoma nurse review (n=6, 5.88%), and awaiting bloods, diabetic control or discharge hub planning (n=3, 2.94%). Delayed discharges do not seem to be affected by polypharmacy (p=0.067), DNACPR (p=0.926), frailty score (p=0.761) or gender (p=0.518). However, Patients aged 65 or above were more likely to have delayed discharge (p=0.037).

Conclusions

Delayed discharge is more likely in over 65years. We recommend early identification of at-risk patients. Possible interventions to avoid discharge delays are EDD, pre-emptive preparation of discharge letters, early morning bloods and training of ward nurses for stoma care.

Study of Serum Troponin-I Level in Non-diabetic Hyperglycemic ST Elevation Myocardial Infarction Patients

The most common cause of premature death in developing countries like Bangladesh is ischaemic heart disease. Cardiac troponin-I (cTnI) is 100 percent tissue specific for the myocardium which has been shown to be a very sensitive and specific biomarker for acute myocardial infarction. As acute myocardial infarction is a stressful condition so, plasma glucose level may also increase in this condition which is stress hyperglycemia and also plasma glucose level may be used for prediction of outcome as it is a cheap and easy available test. The aim of the study is to investigate the impact of the elevation of troponin-I level with plasma glucose level of non-diabetic patients in ST-elevation myocardial infarction. This study which was comparative type of analytical and cross- sectional study carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2021 to December 2021. Data was collected from Cardiology Department of Mymensingh Medical College Hospital, Mymensingh. A total number of 70 subjects participated in this study and were grouped as normoglycemic ST elevation myocardial infarction- Control group (Group I) and non-diabetic hyperglycemic ST elevation myocardial infarction- Study group (Group II). The results were calculated and analyzed by using SPSS. Serum troponin-I was measured by Fluorescence Immunoassay (FIA) and plasma glucose estimated by GOD-PAP method. Data were expressed in mean±SD and statistical significance of difference among the groups were calculated by unpaired Student's 't' test. The correlation between different parameter was done by Pearson's correlation coefficient test. In this study, the result suggests that there is significant positive association between serum troponin-I and plasma glucose level in study group (hyperglycemic non-diabetic STEMI) in comparison to control group (normoglycemic STEMI). So, by this study we recommend that routine estimation of these parameters is important for prevention of complications related to acute myocardial infarction.

Relationship between Body Mass Index and Serum Alanine Transaminase Concentration in Obese Female

The serum Alanine Transaminase (ALT) activity has been regarded as a reliable and sensitive marker of liver disease. In the context of obesity ALT may also be a good indicator of overall health. Obesity has been reported as a risk factor associated with elevation of ALT, which is a surrogate marker of Non-alcoholic fatty liver disease (NAFLD). Elevated ALT may correlate with the severity of NAFLD in obese female. This study was done to evaluate the changes of serum ALT in obese female age ranged 30-60 years in comparison to normal healthy female of same age. At the same time we can know the relationship between body mass index and serum ALT concentration in obese female. This analytical cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2020 to December 2020. A total number of 100 female subjects were included in this study. Among them fifty (50) normal healthy female were taken as control group (Group I) and fifty (50) obese female were taken as study group (Group II). The level of serum ALT was determined by Ultra violet (UV) method. Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired Student's 't' test. Pearson's correlation coefficient test was done to find the correlation of serum ALT with BMI by using SPSS (version 21.0). During interpretation of results, p values of <0.001 were considered as statistically highly significant. In this study, serum level of ALT was significantly higher (p<0.001) in obese female compared to those of healthy control female. In addition, there is a positive correlation of serum ALT with BMI. From the results of the present study, it can be concluded that, elevated ALT was significantly associated with high BMI as well as with other feature of NAFLD.

Study on Body Mass Index and Serum Calcium Level in Postmenopausal Women

Menopause is one of the natural parts of women's life when menstrual cycle stops due to lack of estrogen, which occurs in middle age. Various health problems occur in this period which hampers quality of life. This study was done to evaluate the changes of body mass index and serum calcium level in post-menopausal women in comparison to reproductive women. This cross-sectional analytical type of study was done in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2021 to December 2021. A total number of 140 female subjects age ranged from 25-65 years were included in this study. Among them 70 (seventy) postmenopausal woman (45-65 years) were taken as study group (Group II) and 70 (seventy) reproductive women (25-45 years) were taken as control group (Group I). Body mass index was measured by Anthropometric measurements such as height and weight taken in meter and kilogram respectively and Serum calcium level was measured by colorimetric method with O-Cresolftalein-complexone (OCC). Data were expressed as mean (±SD) and statistical significance of difference among the group was calculated by unpaired Student's 't' test. The mean±SD of BMI of Group I and Group II were 23.05±4.43 kg/m² and 29.01±3.12 kg/m² respectively. The mean±SD of body mass index is significantly higher in study group in comparison with control group. Serum calcium of Group I and Group II were 10.95±0.77 mg/dl and 7.99±0.55 mg/dl respectively. The mean±SD of serum calcium level was significantly lower in study group in comparison with control group. Post-menopausal women with low serum calcium level have a chance of development of osteoporosis. So, assessment of this parameter is important for early detection and prevention of complication related to low serum calcium level for leading a sound life.

Evaluation of the Status of Glycated Haemoglobin in Male type 2 Diabetic Patients

The incidence of type 2 diabetes mellitus is increasing in Bangladesh with its attendant complications. Glycated haemoglobin (HbA1c) is broadly used as an index of mean glycaemia. This study was planned to evaluate the status of glycated haemoglobin (HbA1c) in male type 2 diabetic patients. This cross-sectional analytical study was executed in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2019 to June 2020. This study included in total 200 male subjects who are above 40 years in age. Among them, one hundred (100) male type 2 diabetic patients were taken as study group (Group I) and one hundred (100) age matched healthy male subjects were taken as control group (Group II). Glycated haemoglobin was assessed by ion-exchange high performance liquid chromatography (HPLC) method. Mean±SD was used to express data and unpaired Student's 't' test was used to calculate the statistical significance of difference amongst the groups. Pearson's correlation coefficient test was done to correlate the relationship between serum fasting glucose and glycated haemoglobin. The mean±SD of fasting serum glucose of Group I and Group II were 9.79±2.88mmol/L and 5.23±0.48mmol/L respectively. The mean±SD of glycated haemoglobin of Group I and Group II were 8.38±1.28mmol/L and 5.19±0.46mmol/L respectively. The mean±SD of glycated haemoglobin is found to be significantly higher in the study group compared to the control group and there is a positive correlation between fasting serum glucose and glycated haemoglobin. So, routine estimation of this parameter (HbA1c) is important for prevention of complications related to type 2 diabetes mellitus for leading healthy life.

Study on Serum Total Cholesterol in Patient with Chronic Kidney Disease

In the present study serum total cholesterol were estimated in chronic kidney diseased patient to observe the frequency of high serum total cholesterol in chronic kidney diseased patient (CKD) and to assess the incidence of hyper-cholesterolemia. This cross-sectional study was carried out in the department of Physiology of Mymensingh Medical College, Mymensingh from July 2014 to June 2015. For this purpose, total 200 subjects with age ranged from 25 to 60 years were selected and divided into 100 healthy persons as control group and 100 CKD patients as study group. Serum total cholesterol (TC) was evaluated by the Enzymatic, Liquid, Colorimetric test - CHOD/PAP method. Statistical analysis of data was done by unpaired student's t test. The results showed that serum total cholesterol the Mean±SE of control group male and study group male were 164±3.20mg/dl and 220±5.96mg/dl respectively. In study group male, mean±SE serum TC was increased. Result was statistically highly significant (p<0.0001). The Mean±SE serum TC of control group female and study group female were 158±3.13mg/dl and 213±5.49mg/dl respectively. In study group female, Mean±SE serum TC was increased & result was highly significant (p<0.0001). The mean serum total cholesterol level was increased in study group than in control group. The results were statistically significant. From this study, it may be concluded that the increasing frequency of Serum total cholesterol level in CKD may predispose the patients to hypercholesterolemia accelerates development of atherosclerosis, increases risk of cardiovascular disease (CVD) and the other complications.

Challenges in the establishment of a biosafety testing laboratory for COVID-19 in Bangladesh

At the beginning of the coronavirus disease 2019 (COVID-19) pandemic in Bangladesh, there was a scarcity of ideal biocontainment facilities to detect the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a risk group of 3 organisms. Molecular detection of SARS-CoV-2 must be performed in a BSL-2 laboratory with BSL-3-equivalent infection prevention and control practices. Establishing these facilities within a short timeframe proved to be an enormous challenge, including locating a remote space distant from the university campus to establish a laboratory, motivating the laboratory staff to work with a novel pathogen without any prior experience, allocation of funds for essential equipment and accessories, and arrangement of a safe waste management system for environmental hazard reduction. This report also highlights several limitations, such as the facility's architectural design that did not follow the biosafety guidelines, lack of continuous flow of funds, and an inadequate number of laboratory personnel. This article describes various efforts taken to overcome the challenges during the establishment of this facility that may be adopted to create similar facilities in other regions of the country. Establishing a BSL-2 laboratory with BSL-3-equivalent infection prevention and control practices will aid in the early detection of a large number of cases, thereby isolating persons with COVID-19, limiting the transmission of SARS-CoV-2, and promoting a robust public health response to contain the pandemic.

288 Impact of Trainee Surgeons Performing Thyroid Procedure on Patient Safety

Introduction

Impact of trainee surgeons performing thyroid procedure on patient safety

Aim

The primary aim was to evaluate the impact of trainee as the principal operator on patient safety in thyroid surgery.

Method

The data was extracted from a single consultant’s data from 2009 to 2020 in the British Association of Endocrine and Thyroid Surgeons (BAETS) National audit. Multivariable analysis of predictive factors (including trainee primary operator) for temporary and permanent hypocalcaemia was performed.

Results

There were 507 thyroid cases. After excluding cases with missing data in variables analysed 378 (74.5%) cases were analysed. Vocal cord palsy occurred in 5/378 (1.3%), postoperative bleeding 3/378 (0.8%), temporary hypocalcaemia 68/378 (18.0%) and permanent hypocalcaemia 20/378 (5.3%). Predictive factors analysed included hyperthyroidism 117/378 (31%), retrosternal goitre 33/378 (8%), reoperation, 43/378 (11%), total thyroidectomy 184/378 (49%), nodal dissection 21/378 (6%) and trainee principal operator 15/378 (4%). Multivariable analyses of temporary and permanent hypocalcaemia found only two variables significantly affected incidence of temporary hypocalcaemia were total thyroidectomy (OR 7.82, 95% CI 3.41-17.92, p &lt; 0.001) and nodal dissection (OR 3.53, 95% CI 1.20-10.38, p = 0.02), and for permanent hypocalcaemia these were reoperation (OR 5.05, 95% CI 1.09-23.25, p = 0.04) and total thyroidectomy (OR 5.76, 95% CI 1.35-24.54, p = 0.018).

Conclusions

There was no evidence that trainee principal operator adversely affected the outcome of thyroidectomy; it is worth noting that only 4% of operations were done by trainees and so this study would support trainees undertaking more thyroidectomies as principal surgeon.

Level of Serum Creatinine and Creatinine Clearance Rate in Obese Female

The prevalence of obesity continues to increase worldwide day by day causing a serious health problem and impose a significant impact on the National Health Service (NHS) budget. Obesity usually arises from the interactions of multiple genes and lifestyle factors. This study was done to evaluate changes of serum creatinine and creatinine clearance rate in obese female age ranged 30-60 years in comparison to normal healthy female of same age. This study, a cross-sectional analytical type, was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh between the period from January 2020 to December 2020. A total number of 100 female subjects were included in this study. Among them fifty (50) normal healthy female were taken as control group (Group I) and fifty (50) obese female were taken as study group (Group II). To see the level of serum creatinine determined by Kinetic Colorimetric method and creatinine clearance rate was calculated from serum creatinine by Cockcroft-Gault equation. Data was calculated by unpaired Student's't' test and were expressed as mean (±SD). Pearson's correlation coefficient test was done to find the correlation of serum creatinine and creatinine clearance rate with BMI. In this study we found that mean serum Creatinine and Creatinine clearance rate were higher in obese female in comparison to normal healthy female. Again, serum Creatinine and Creatinine clearance rate were positively correlated with BMI. Therefore, to prevent obesity related complications and leading a healthy life we suggest estimations of these parameters routinely.

Correlation between Fasting Serum Glucose and Serum Zinc Level in Patients with Type-2 Diabetes Mellitus

Type-2 diabetes mellitus accounts for 90-95% of all diabetes. There is a Correlation between Fasting Serum Glucose and Serum Zinc level in patients with Type-2 Diabetes Mellitus. This study was done to assess the relationship of Fasting Serum Glucose and Serum Zinc in type-2 diabetic patients in order to compare this parameter with healthy subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 140 subjects, age ranged from 35-65 years was included in this study. Among them, seventy (70) type-2 diabetic patients were taken as study group (Group II) and seventy (70) ages matched healthy subjects were taken as control group (Group I). Group I again subdivided into control group male (Group IA) and control group female (Group IB). Group II also subdivided into study group male (Group IIA) and study group female (Group IIB). Pearson correlation coefficient test is done to correlate the relationship between fasting serum glucose (FSG) and serum zinc. In this study we found that serum zinc level was decreased in study groups in comparison with control groups. Therefore, by this study we recommended that routine estimation of this parameter is important for prevention of complication related to diabetes for leading a healthy life.

Experience in establishing a high-risk biocontainment facility in response to COVID-19 pandemic under resource constrain settings

The health care systems in resource limited countries are facing major challenges in dealing with Coronavirus disease (COVID-19). In Bangladesh, a steady increase in the number of COVID-19 cases since its first report on March 8, 2020, has led to an increased demand for COVID-19 detection facilities throughout the country. The detection of severe acute respiratory syndrome (SARS-CoV-2), the causative organism of COVID-19 and a highly infectious group 3(three) organism, requires a high biocontainment laboratory with a certain standard prerequisite infrastructure. This study describes the necessary steps for establishing and running a COVID-19 laboratory under resource constraint settings. Our experience indicates that, with collaborative efforts, funding, and technical support from locally available expertise, it is feasible to set up an optimally functional biocontainment facility with an acceptable quality performance despite several short comings. BSMMU J 2021; 14 (COVID -19 Supplement): 45-50

Vaccination against COVID-19 in Bangladesh: Perception and Attitude of Healthcare Workers in COVID-dedicated Hospitals

Healthcare professionals are the crucial and influencing source of information for vaccines and their communication among patients and communities that can accelerate successful vaccination in a country. This cross-sectional study was one of the first and foremost ones in Bangladesh to observe the basic perception and attitudes towards vaccination against COVID-19 among the healthcare workers (HCWs) - doctors, interns, nurses, ward boys, cleaners, and medical technologists of major COVID-dedicated hospitals. The cross-sectional questionnaire-based study was conducted in February 2021 among 550 HCWs to assess the perception and attitude towards vaccination against COVID-19. The study participants were targeted as the priority group for COVID-19 vaccination, working in two major COVID-dedicated hospitals, Holy Family Red Crescent Medical College Hospital (HF-center), and Sheikh Russel National Gastro-liver Institute and Hospital (SR-center) in Dhaka, Bangladesh during the pandemic. The questionnaire was structured with a three-point scale of responses from 'true', 'false', and 'do not know'. The responses were calculated on point-score as +1 for the correct response, -1 for the wrong response, and 0 for 'do not know' with an overall highest and the lowest possible score of +5 to -5. Absolute (n) and relative frequencies (%) were presented for qualitative variables, while quantitative variables were presented as mean (± standard deviation). Chi-square test was done for univariate analysis of qualitative variables and Student's t-test for quantitative variables. With the 95.27% response rate, including 204 males and 320 were female and the male: female ratio was 1: 1.56. The majority of the participants were doctors (45.8%) followed by nurses (27.9%), and MLSS (26.3%) respectively. The respondents were between 18 to 64 years of age with a mean of 36.17±10.94 years. Most of the respondents (95.99%) responded correctly about the cost-free availability of a vaccine against COVID-19 in the country, 87.40% preferred vaccination as safe and effective. Again 29.77% HCWs think the vaccine might not be safe or effective due to emergency authorization. Only 38.93% of respondents could respond correctly about the necessity of vaccines for children, 31.10% think the vaccination was not required instead of natural immunity. The positive perception and attitude of the frontline HCWs in COVID-dedicated hospitals in Bangladesh are crucial which will positively influence motivation and wide acceptance among the general population for the attainment of the nationwide vaccination program, and adopt effective strategic modification to minimize the gaps for a low-middle income country like Bangladesh with its resource constrain.

Association of Hypertension and Hypercholesterolemia in Patients with Type-2 Diabetes Mellitus

The present cross-sectional analytical study was carried out to observe blood pressure and serum total cholesterol in patients with type-2 diabetes mellitus. This observational study was carried out in the department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2016 to December 2016. For this purpose, 200 subjects of both sexes and age ranged from 30-60 years were selected; among them 100 were type-2 diabetic person and 100 were apparently healthy. Blood pressure and serum total cholesterol was significantly higher (p<0.0001) in both male and female of the study group in comparison to healthy control group. From this study, it may conclude that type-2 persons are considered to have significant positive relation for formation of hypertension, hypercholesterolemia and metabolic abnormalities that have high morbidity and mortality. So, prevention of type-2 diabetes mellitus by taking necessary steps like regular physical exercise, intake of healthy diet and behavior therapy may help in prevention of type-2 diabetes mellitus related complication.

Association of Body Mass Index and Blood Pressure with Age: A Cross Sectional Study in Elderly Male

The aim of the study was to assess the status of body mass index (BMI) and blood pressure in elderly male in comparison to younger male and to study the association of BMI and blood pressure with age. This analytical type of cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2019 to December 2019. A total number of 140 male subjects were included in this study. Among them seventy (70) younger males were taken as control group (Group I) and seventy (70) elderly males were taken as study group (Group II). Body mass index (BMI) was calculated as the weight in kilograms divided by the square of the height in meters (kg/m²). Systolic and diastolic blood pressure was measured by aneroid sphygmomanometer (ALPK2, Japan). Data were expressed as Mean±SD and statistical significance of difference among the group was calculated by unpaired student's 't' test. Pearson's correlation coefficient test was done to find the correlation of BMI, systolic blood pressure (SBP) & diastolic blood pressure (DBP) with age. In this study we found that mean BMI, systolic blood pressure & diastolic blood pressure were significantly higher in elderly male persons in comparison to younger male. Although the magnitude of correlation differed, we found that BMI, systolic blood pressure & diastolic blood pressure were positively correlated with age of the subjects. Based on the study carried out it can be concluded that due to aging process geriatric populations are more prone to development of hypertension and other cardiovascular complications than younger individuals.

Pulmonary Rehabilitation: A Weapon to Fight against COVID-19

No Abstract.

Relation of Serum Iron Level with Serum Zinc Level among Adolescent Girls with Iron Deficiency Anaemia in Bangladesh

Adolescent girls are vulnerable in underdeveloped and developing countries due to having public health problems regarding iron deficiency anaemia. As zinc acts as a cofactor in iron metabolism, so the deficiency of this trace element is associated with iron deficiency anaemia. This study was done to evaluate the changes of serum iron and serum zinc levels among iron deficient anaemic adolescent girls in comparison to healthy adolescent girls in Bangladesh. This prospective type of analytical cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2019 to December 2020. Total number of 140 adolescent girl's age ranged from10-19 years included in this study. Among them, 70 healthy adolescent girls, were taken as control group (Group I). Remaining 70 Adolescent girls with iron deficiency anaemia (IDA) were taken as study group (Group II). Estimation of serum iron was determined by Ferrozine method using Globals iron kit, UK. Serum zinc levels were determined by colorimetric method with reagents. All data were expressed as mean (±SD) and statistical significance of difference among the group I ( healthy adolescent girls) and group II (adolescent girls with iron deficiency anaemia) were calculated by unpaired students' 't' test. Correlation of serum iron with serum zinc was done by Pearson's correlation coefficient test. The mean values (±SD) of serum iron level of Group I and Group II were 69.06±18.11μg/dl & 15.61±9.12μg/dl respectively. Mean values (±SD) of serum iron significantly lower in study group (Group II) in comparison with control group (Group I). The mean (±SD) of serum zinc level of Group I and Group II were 75.48±14.26μg/dl & 33.27±12.94μg/dl respectively. Mean value (±SD) of serum zinc levels were significantly lower in study group (Group II) in comparison with control group (Group I). Serum zinc level was positively correlated with serum iron and that was statistically significant. The deficiency of iron does not occur alone; rather it is typically associated and developed with hypozincemia. The study suggests on supplementing iron along with zinc to correct the deficiency especially in adolescent girls when their metabolic demand is high.

Neonatal COVID-19 Infection: Is Neonate Safe?

No Abstract.

Evaluation of Change of Peak Expiratory Flow Rate (PEFR) in Male Chronic Obstructive Pulmonary Diseased (COPD) Patients

Chronic obstructive pulmonary disease (COPD) is a major public health problem which causes high health care utilizations, poor health-related quality of life, and substantial cost burden and deaths in worldwide. This study was done to evaluate the changes of peak expiratory flow rate (PEFR) in COPD patients in comparison to healthy person. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 160 male subjects, age ranged from 30-70 years was included in this study. Among them, eighty (80) male COPD subjects were taken as study group (Group II) and eighty (80) age matched male healthy subjects were taken as control group (Group I). PEFR was assessed by peak flow meter. Data were expressed as mean ±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean ±SD of PEFR of Group I and Group II were 432.75±30.23 L/min & 203.5±20.81 L/min respectively. The mean ±SD of PEFR significantly lower in study group in comparison with control group. Patients with COPD with greater changes in PEFR causes more frequent hospitalization and increased mortality and morbidity due to COPD related complications. So, assessment of this parameter is important for early detection and prevention of complications related to COPD for leading a healthy life.

Study on Body Mass Index, Serum C-Reactive Protein and Their Association with Cardiovascular Risk Factors in Postmenopausal Women

Menopause is the natural process of ageing when women pass from reproductive to non -reproductive phase with the cessation of cyclical ovarian functions. After menopause women are usually troubled by increasing weight and waist circumference caused by obesity and androidal fat redistribution. With the increase in life expectancy resulting in women living one half to one third of their lives after menopause, the high incidence of overweight and obesity in women have become important public health concerns. In postmenopausal women, elevated C-reactive protein (CRP) is one of the most significant predictors of cardiovascular disease and heart attack risk. In middle aged women, the risk of a coronary event rises dramatically after onset of menopause corresponding to decreased levels of circulating endogenous estrogens. Both body mass index (BMI) and serum CRP are significantly higher among postmenopausal women as compared with reproductive aged women. To assess the BMI and serum CRP level changes in healthy postmenopausal women in order to compare this parameter with healthy reproductive aged women. This comparative study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July, 2018 to June, 2019. Two hundred healthy women (100 female were postmenopausal as study group and 100 female were reproductive aged women as control group) aged between 25 to 65 years were enrolled in this study. BMI was calculated as weight in kilogram divided by the height in meter square. Serum CRP by CRP-Latex Test (Slide agglutination procedure). Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean value ±SD of BMI and serum CRP level was higher in postmenopausal group in comparison to the reproductive women group. This study concludes, BMI and Serum C-Reactive protein level increased in postmenopausal women.

Serum Copper Level and Its Relation with Blood Pressure and Urinary Protein Level in Preeclampsia

Preeclampsia is a multifactorial disease of unknown etiology and is associated with oxidative stress. Some studies observed that alteration of essential trace element may contribute to the development of preeclampsia. The aim of the study was to assess the serum copper (Cu) level and its relation with blood pressure and urinary protein level in preeclampsia. This cross sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from July 2016 to June 2017. Thirty subjects with preeclampsia age ranging from 18 to 40 years were considered as the study group and 30 aged matched healthy pregnant women were considered as control group for comparison. The subjects were selected from Department of Obstetrics and Gynecology of Dhaka Medical College hospital, Dhaka. Serum copper (Cu) level was estimated in the Department of Soil, Water and Environment of University of Dhaka. For statistical analysis, unpaired Students "t" test and Pearson's correlation coefficient (r) test were performed. In this study serum Copper level was significantly (p<0.001) higher in preeclampsia patients as compared to controls. Serum copper level showed positive correlations with systolic & diastolic blood pressure and urinary protein level. This study concluded that serum copper level increases and is positively related with blood pressure and urinary protein level. Therefore, estimation of serum copper level in early pregnancy might be useful for prediction of future risk of developing preeclampsia.

Relationship between Pack Year and Lung Function Parameters in Asymptomatic Smokers

Smoking has extensive effects on respiratory function. The rate of cigarette smoking among young people has continued to increase steadily. Exposure to cigarette smoking is usually measured in terms of 'Pack-Year'. The aim of the study was to observe the effect of pack years on pulmonary functions in apparently healthy asymptomatic smokers by measuring FVC, FEV₁, FEV₁/FVC ratio and PEFR value by digital spirometer. This cross-sectional observational study was conducted in the department of Physiology, Sylhet MAG Osmani Medical College in collaboration with department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from July 2016 to June 2017. A total number of 100 male smokers, age ranging from 18-60 years and BMI within normal limit (18.5-24.9kg/m²) were included in this study. Their pulmonary functions were studied by measuring FVC, FEV₁, FEV₁/FVC ratio and PEFR. Relationship between pack-year and pulmonary function test parameters was established by one way ANOVA test. In this study we found that lung function parameters shared an inverse relationship with pack year of smoking. The percentage of predicted values of FEV₁, FEV₁/FVC ratio and PEFR were significantly lower (p<0.001) in heavy smokers who smoked more than 30 pack years. Therefore, by this study we inferred that those who smoked more than 10 pack years are associated with accelerated decline in lung function.

Relationship of BMI and Fasting Serum Glucose with Hypertension

Hypertension is an important worldwide public-health challenge because of its high frequency and concomitant risks of cardiovascular and kidney disease. It is recognized as a major contributor to the disease burden globally. Aim of the study was to evaluate body mass index and fasting serum glucose level in male hypertensive patients in order to compare these parameters with male normotensive subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh from July 2018 to June 2019. Total 200 male subjects, age range was from 30-65 years were included in this study. Among them, 100 hypertensive subjects were taken as study group (Group II) and 100 ages matched normotensive male subjects were taken as control group (Group I). Quantitative data were expressed as mean (±SD) and statistical significance of difference among the group was calculated by unpaired student's 't' test. In this study we found that body mass index was significantly (p<0.001) increased in study group (29.52±2.46) in comparison with control group (22.91±1.04). Fasting serum glucose level was also significantly (p<0.001) increased in study group (6.35±0.47) in comparison with control group (4.52±0.50). Based on the study carried out it is concluded that there is definite relationship of body mass index and fasting serum glucose level with hypertension. Therefore, basic measurement of weight and height to determine the body mass index and fasting serum glucose level as routine assessment during hospital visitation with appropriate lifestyle modification would help in controlling hypertension as well as its devastating consequences.

Body Mass Index and Serum Thyroid Stimulating Hormone in Third Trimester of Pregnancy

Pregnancy is a natural physiological state with hormonal and metabolic changes that helps the growth and survival of the fetus. Adequate body mass index (BMI) in pregnancy is important for securing, protecting and promoting the health of women and newborns. High or low maternal body mass index is associated with adverse outcome. Thyroid physiology plays a major role in pregnancy and thyroid disorders constitute one of the most common endocrine disorders in pregnancy. To assess the levels of body mass index and serum thyroid stimulating hormone (TSH) in third trimester of pregnancy in order to compare these parameters with non-pregnant women of same age range. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh from January 2019 to December 2019. A total number of 140 subjects, age range between 20-35 years were included in this study. Among them, 70 healthy subjects were taken as control group (Group I) and 70 pregnant women of third trimester were taken as study group (Group II). The results were calculated and analyzed by using SPSS. Quantitative data were expressed as mean (±SE) and statistical significance of difference among the group was calculated by unpaired student's 't' test. In this study we found that BMI was 27.87±1.9kg/m² and serum TSH level was 2.27±1.18μIU/ml in study group. Both (BMI & TSH) are significantly increased in study groups in comparison with control group. Therefore, by this study we recommended that routine estimation of these parameters is important for prevention of complication related to pregnancy.

Diabetes Mellitus and COVID-19: Unholy Association of Two Pandemics

Not Available.

Molecular Detection of Human Coronavirus from North Central Part of Bangladesh Depending on ORF1ab and N Gene

The Coronavirus disease 2019 (COVID-19) resulted severe respiratory illness such as pneumonia and lung dysfunctions that was first identified at Wuhan, the capital of Hubeiin China during the end of December 2019. The etiological cause of COVID-19 has been confirmed as a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which was similar with the zoonotic virus SARS-CoV (2002). Now a days for early diagnosis of COVID-19 the nucleic acid based test like RT PCR (real time reverse transcription polymerase chain reaction) is most consistent and used all over the world. In this study among 11,280 cases 825(7.31%) were positive by molecular RT PCR method on June 2020 at Microbiology department of Mymensingh Medical College and the samples are collected from different areas of Northern part of Bangladesh. Among this positive cases 588(71%) N gene, 10 ORF1ab (2%) and 227(27%) both N and ORF gene showed significant curve which is specific for COVID-19 positive patients. Because N and ORF gene of this virus inhibit immune system of human body especially interferon. Out of SARS-CoV-2 positive cases maximum number of N gene were found in male patients and above 40 years old aged group. So, Molecular diagnosis of this pandemic virus especially by N and ORF gene might be helpful to reduce the spread of SARS-CoV-2 as well as early treatment for saving many lives.

Thyroid Function Status in Elderly Male

With the advancement of age, the production, metabolism and action of thyroid hormone are also changed. The incidence of thyroid dysfunction is increased greatly with age. Aim of the study was to assess the age-related change in thyroid function status in elderly male in order to compare it with younger male. This analytical type of cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2019 to December 2019. A total number of 140 male subjects were included in this study. Among them seventy (70) younger male were taken as control group (Group I) and seventy (70) elderly male were taken as study group (Group II). For assessment of thyroid function, serum free tri-iodothyronine (FT₃), free thyroxine (FT₄) and thyroid stimulating hormone (TSH) levels were estimated by RIA method. Data were expressed as mean (±SD) and statistical significance of difference among the group was calculated by unpaired student's t-test. Pearson's correlation coefficient test was done to find the correlation of serum FT₃, FT₄ & TSH with age. In this study we found that mean serum free tri-iodothyronine (FT₃) & free thyroxine (FT₄) levels were significantly lower and serum thyroid stimulating hormone (TSH) level was significantly higher in elderly male persons in comparison to younger male. Again, serum FT₃, FT₄ was negatively correlated with age of the subjects whereas serum TSH level was positively correlated with age of the subjects. Based on the study carried out it is concluded that there is a progressive decrease in thyroid function with advancement of age.

Relationship of Serum Creatinine and Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease

Chronic kidney disease (CKD) is a common condition in which there is a loss of kidney function over time. CKD is associated with increased risks of several co morbidities, not limited to but including cardiovascular disease and chronic renal failure. Hypercreatininemia is associated with low level of estimated glomerular filtration rate (eGFR) in chronic kidney diseased patients. Objective of the study was to assess the relationship of eGFR and serum creatinine in chronic kidney diseased patients in order to compare this parameter with healthy subjects. This analytical type of cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 200 subjects, age range (30-70 year) were included in this study. Among them, 100 healthy subjects were taken as control group (Group I) and 100 chronic kidney diseased patients were taken as study group (Group II). Control group (Group I) again subdivided into male healthy subject (Group IA) and female healthy subject (Group IB). Study group (Group II) also subdivided into male chronic kidney diseased patient (Group IIA) and female chronic kidney diseased patient (Group IIB). The results were calculated and analyzed by using SPSS. Data were expressed as mean(±SE) and statistical significance of difference among the group was calculated by unpaired Student's t-test. In this study we found that eGFR was significantly decreased and serum creatinine was significantly increased in study groups in comparison with control groups. Therefore, by this study we recommended that routine estimation of these parameters is important for prevention of complications related to chronic kidney disease.

Response to First-Line Antiretroviral Therapy Among PLHIV from a High-Risk, Low-Prevalence Setting

The study reports the response of first-line antiretroviral therapy (ART) by assessing CD4 and CD8 T-lymphocyte and viral load (VL) among Bangladeshi people living with HIV (PLHIV). This observational approach was conducted on 100 PLHIVs, grouped into therapy naive (n = 33), therapy initiators with CD4 T-cell count of <350 cells/µL (n = 33), and therapy receivers for >1 year prior to the study period (n = 34). Therapy initiators who continued the study (n = 20) were followed up after 12 and 24 weeks of therapy initiation. The CD4 and CD8 T-lymphocyte count estimation and (VL) were quantified. The mean CD4 T-lymphocyte count was significantly reduced among the therapy initiators in comparison to therapy naive and therapy receivers. Similar findings were observed for CD8 T-lymphocyte count among the study groups. The mean HIV-1 RNA VL among therapy initiators showed a significant decrease after 12 and 24 weeks, and 85% patients in this group obtained undetectable VL status indicating the good therapeutic outcome.

Evaluation of the Changes of Blood Pressure and Serum Calcium Level In Postmenopausal Women

Menopause is the permanent cessation of menstruation at the end of the reproductive life due to loss of ovarian follicular activity. The prevalence of hypertension in women increases after menopause, suggesting that an absence of female gonadal steroids may represent a major risk factor for postmenopausal hypertension. Menopause is the phase from where bone mineralization becomes critics because of various physiological and hormonal changes. Estrogen deficiency and age related processes alter the rate of calcium turnover in bone that the ageing women face. Both systolic and diastolic blood pressure is significantly higher and serum calcium level is significantly lower among post menopausal women as compared with reproductive aged women. The objective of the study was to assess the blood pressure and serum calcium level changes in healthy postmenopausal women in order to compare this parameter with healthy reproductive aged women. This comparative study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. Two hundred healthy women (100 female were postmenopausal as study group and 100 female were reproductive aged women as control group) aged between 25 to 65 years were enrolled in this study. Blood pressure was measured by indirect auscultatory method with an aneroid sphygmomanometer and serum calcium level of the individual was measured by enzymatic colorimetric method with o-cresoftaline-complexon. Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean value ±SD of blood pressure was higher and serum calcium level was lower in postmenopausal group in comparison to the reproductive women group. This study concludes, blood pressure increases and serum calcium level decreases in postmenopausal women.