Research prioritisation on prevention and management of preterm birth in low and middle-income countries (LMICs) with a special focus on Bangladesh using the Child Health and Nutrition Research Initiative (CHNRI) method

Background

Fifteen million babies are born preterm globally each year, with 81% occurring in low- and middle-income countries (LMICs). Preterm birth complications are the leading cause of newborn deaths and significantly impact health, quality of life, and costs of health services. Improving outcomes for newborns and their families requires prioritising research for developing practical, scalable solutions, especially in low-resource settings such as Bangladesh. We aimed to identify research priorities related to preventing and managing preterm birth in LMICs for 2021-2030, with a special focus on Bangladesh.

Methods

We adopted the Child Health and Nutrition Research Initiative (CHNRI) method to set research priorities for preventing and managing preterm birth. Seventy-six experts submitted 490 research questions online, which we collated into 95 unique questions and sent for scoring to all experts. A hundred and nine experts scored the questions using five pre-selected criteria: answerability, effectiveness, deliverability, maximum potential for burden reduction, and effect on equity. We calculated weighted and unweighted research priority scores and average expert agreement to generate a list of top-ranked research questions for LMICs and Bangladesh.

Results

Health systems and policy research dominated the top 20 identified priorities for LMICs, such as understanding and improving uptake of the facility and community-based Kangaroo Mother Care (KMC), promoting breastfeeding, improving referral and transport networks, evaluating the impact of the use of skilled attendants, quality improvement activities, and exploring barriers to antenatal steroid use. Several of the top 20 questions also focused on screening high-risk women or the general population of women, understanding the causes of preterm birth, or managing preterm babies with illnesses (jaundice, sepsis and retinopathy of prematurity). There was a high overlap between research priorities in LMICs and Bangladesh.

Conclusions

This exercise, aimed at identifying priorities for preterm birth prevention and management research in LMICs, especially in Bangladesh, found research on improving the care of preterm babies to be more important in reducing the burden of preterm birth and accelerating the attainment of Sustainable Development Goal 3 target of newborn deaths, by 2030.

Nitrous Oxide versus Medical Air Using in General Anaesthesia During Laparoscopic Cholecystectomy: A Comparative Study

This study was designed to observe the haemodynamic changes, recovery status and cost effectiveness during anaesthesia in laparoscopic cholecystectomy with medical air in comparison to anaesthesia with nitrous oxide associated with maintain of adequate analgesia and was conducted in the department of Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to June 2017. Nitrous oxide is popularly using as an analgesic in current balanced general anesthesia in addition carrier agent for anesthetic. Intraoperative pain intensity depends on many variables including, type of surgery, surgical stimulation and surgical incision. It is difficult to measure intraoperative pain properly under general anesthesia therefore anesthetist depends on the surrogate marker of inadequate analgesia like raised heart rate, blood pressure, sweating and lacrimation. However, unfortunately, these parameters may changes in same direction with light plane of anesthesia, hypercarbia and ongoing procedural status of the patient.

Electron microscopic studies of the corpuscles of Stannius of an airbreathing teleost (Heteropneustes fossilis)

The ultrastructure of the corpuscles of Stannius (CS) of Heteropneustes fossilis reveals a homogenous cellular composition characterized by only one cell type, with large secretory granules and abundant ribosomal endoplasmic reticulum. These cells are comparable to the type 1 cell described in the CS of other teleosts; type 2 cells, whose presence is ubiquitous in the CS of freshwater species are absent in H. fossilis. Our data on the CS of H. fossilis demonstrate that not all freshwater species possess type 2 cells in their CS and these are not essential for life in freshwater

Streptococcus sanguis bacteremia and colorectal cancer: a case report

Streptococcus sanguis, usually considered a nonpathogen of the oral cavity, was isolated from blood cultures from a patient who was subsequently found to have a cecal adenocarcinoma. Further studies are needed to determine if Streptococcus sanguis infections have diagnostic implications similar to those of Streptococcus bovis.

Chromosome analysis and sister chromatid exchange in encephalo-trigeminal angiodysplasia

A female, aged 32, with facial birthmarks and suffering migraine headaches and a slight hemiparesis was examined with isotope scanning, CT and angiography. She was found to have a massive, unilateral angiodysplasia, transforming the right cerebral hemisphere into an expanding vascular sponge-like structure. There was a family history of red facial birthmarks. The patient and her father were analysed cytogenetically by estimating the frequency of chromosome aberrations and sister chromatid exchanges (SCE). The frequency of gaps and breaks was normal compared to healthy controls, but the patient showed a significantly higher level of spontaneous SCE's. The patient and her father also had a higher than normal number of SCE's after addition of mitomycin C (MMC) to the blood culture. Numerical and structural chromosome deviations markedly exceeded normal in both, possibly representing a genetic imbalance in this syndrome.

Chromosome and DNA cytometric study of a papillary carcinoma of the bladder with a high stemline and numerous double minutes

A papillary cancer of the bladder [WHO grade 3] was studied with chromosome and DNA analysis. A high frequency of mitoses was noted, and analysis of 151 metaphases revealed a dominating stemline in the pentaploid region. More than 95% of the cells contained double minutes (dm). Flow cytometry showed the dominant stemline to be in the hexaploid region, that is, about 20% above the numerical chromosome value. This difference is generally obtained when these two methods are compared and is not influenced by the presence of dm. Both methods have been complementary in the evaluation of this tumor.

Weight of the Human Thyroid Gland – A Postmortem Study

Context: A cross-sectional study was designed to find out the difference in weight of the thyroid gland of Bangladeshi people in relation to age and sex and to compare with previous local and foreign studies. Materials & Methods: The present study was performed on 60 post mortem human thyroid gland (39 of male and 21 of female) collected from unclaimed dead bodies which were in the morgue under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into three age-groups including Group A (10-20 years), Group B (21-50 years) & Group C (>50 years) and the weight of the thyroid glands were measured and recorded. Results: The mean weight of the thyroid gland in male was 15.14 gm, 19.20 gm and 14.64 gm and in female was 16.02 gm, 19.03 gm and 14.67 gm in group A, B and C respectively. The mean weight of the thyroid gland was 15.48 gm in group A, 19.15 gm in group B and 14.65 gm in group C. There was no difference in mean weight of the thyroid gland between male and female. The difference in mean weight of the thyroid gland between group A & group B and group B & group C were found statistically significant. The weight of the gland was found to increase from early childhood and puberty up to 50 years of age and then decrease. Key words: Thyroid gland; Weight of thyroid gland. DOI: 10.3329/bjms.v9i1.5230 Bangladesh Journal of Medical Science Vol.09 No.1 Jan 2010 44-48