The Prevalence and Associated Factors of Depressive Symptoms Among Medical Students in Bangladesh During the COVID-19 Pandemic: A Cross-Sectional Pilot Study

Background

Whilst very limited studies have demonstrated a correlation between the COVID-19 pandemic and depressive symptoms amongst Bangladeshi medical students, the prevalence and associated factors of depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9) remains widely unknown.

Objective

The study aimed to investigate the prevalence and factors associated with depression symptoms among Bangladeshi medical students during the COVID-19 pandemic lockdown period.

Method

In this web-based cross-sectional pilot study, medical students' data was collected using the Google Forms web survey platform after obtaining electronic informed consent. A total of 425 medical students were selected using a systematic sampling technique to accumulate depression symptoms and demographic and pandemic-related information. Depression was measured by a self-administered, validated English version of the Patient Health Questionnaire (PHQ-9) tool. The descriptive analysis utilized frequency and percentages, while the stepwise binary logistic regression analysis was performed to investigate the factors associated with depressive symptoms.

Result

Among 425 medical students, 62.3% were female, 97.4% unmarried. Almost 80.2% of medical students had mild to severe levels of depressive symptoms as characterized by PHQ-9. A significantly higher probability of depression was found amongst female students (adjusted OR = 1.8), those who struggled to stay away from social media (adjusted OR = 1.8), those who tried to be optimistic for maintaining better psychology (adjusted OR = 11.1), and those who always had a sleeping difficulty in the last 4 weeks (adjusted OR = 8.9).

Conclusion

A very high prevalence of depression symptoms among Bangladeshi medical students was found across the majority of socio-demographic variables. The alarming prevalence and associated factors of depression suggests the need for follow-intensity psychosocial interventions designed for medical students during the COVID-19 pandemic.

From Fighting Critters to Saving Lives: Polyphenols in Plant Defense and Human Health

Polyphenols, such as flavonoids and phenolic acids, are a group of specialized metabolites in plants that largely aid in plant defense by deterring biotic stressors and alleviating abiotic stress. Polyphenols offer a wide range of medical applications, acting as preventative and active treatments for diseases such as cancers and diabetes. Recently, researchers have proposed that polyphenols may contribute to certain applications aimed at tackling challenges related to the COVID-19 pandemic. Understanding the beneficial impacts of phytochemicals, such as polyphenols, could potentially help prepare society for future pandemics. Thus far, most reviews have focused on polyphenols in cancer prevention and treatment. This review aims to provide a comprehensive discussion on the critical roles that polyphenols play in both plant chemical defense and human health based on the most recent studies while highlighting prospective avenues for future research, as well as the implications for phytochemical-based applications in both agricultural and medical fields.

Comparison of α-amylase, α-glucosidase and lipase inhibitory activity of different types of vinegar

Vinegar is regarded as a fine example of a traditional food that has several medicinal values. It is used as a home-remedy for the management of diabetes and obesity. We investigated how selected vinegar inhibit the digestive enzymes involved in carbohydrate and lipid metabolism. A total of seven types of vinegar were examined as follows: apple cider (ACV), balsamic (BV), brown rice (BRV), distilled white (DWV), malt (MV), nipah palm (NPV), and red wine (RWV) vinegar. In vitro enzyme inhibition tests were performed using α-amylase and lipase from porcine pancreas, and α-glucosidase from Saccharomyces cerevisiae. In the α-amylase assay, NPV (IC50 = 60.97±1.71 mg/mL) exhibited the strongest inhibitory effect, while RWV (IC50 =786.7±0.96 mg/mL) showed the lowest inhibitory effect. RWV (IC50 =92.49±1.51 mg/mL), by contrast, had the highest inhibitory effect against α-glucosidase and was followed by NPV (IC50 = 227.5±1.06 mg/ mL) and BRV (IC50 = 565.1±2.65 mg/mL). All of the samples showed potent inhibitory effects against pancreatic lipase, with MV having the strongest and ACV the lowest effects, respectively. IC50 values ranged from 48.45 mg/mL to 399.8 mg/mL. A concentration-dependent inhibitory effect was recorded for each of the vinegar against all three tested enzymes. None of the vinegar, however, exceeded the effects recorded for the standard drugs. Interestingly, a weak correlation was found between total acidity and enzyme inhibition, which asserted the presence of bioactive compounds in the vinegar. As a conclusion, vinegar can be incorporated into the diet to lower the meal’s glycaemic index and benefit those at risk of diabetes as well as diabetics.

Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

BACKGROUND

The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain.

METHODS

We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale.

RESULTS

A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P = 0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P = 0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events.

CONCLUSIONS

Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000476336; Clinical Trials Registry-India number, CTRI/2017/04/008326.).

Understanding patients' experience living with diabetes type 2 and effective disease management: a qualitative study following a mobile health intervention in Bangladesh

BACKGROUND

In 2017, 425 million adults worldwide had diabetes; 80% were living in low and middle-income countries. Bangladesh had 6.9 million adults with diabetes; death from diabetes comprised 3% of the country's total mortality. This study looked at different factors (personal, familial, social, and financial) affecting both the life of patients with diabetes type 2 and the management of the disease. It also explored patient's perception of the mobile health intervention in the context of disease management and helped to explain the findings obtained from the quantitative part of this study.

METHOD

The study was a mixed-method, sequential explanatory design. A mobile health project (interactive voice call and call center) was implemented in Dhaka district, Bangladesh from January to December, 2014. Patients received treatment at the outpatient department of Bangladesh Institute of Health Science Hospital, Dhaka, Bangladesh, were included in intervention and control groups of the main study following a Randomized Control Trial. Among them, a total of 18 patients (9 + 9) were selected purposefully for the qualitative study, which was conducted in July, 2015. The sample was selected purposefully considering the age, sex, socio-economic status and proximity of living due to the political instability of the country during the data collection period. The interviews were transcribed and analyzed applying investigator triangulation.

RESULTS

Most patients stated that diabetes has affected their lives. In general, both groups´ evaluation of mobile health services were good and both regarded the recommendations for medication, diet, physical exercise, and other lifestyle behaviors (use of tobacco and betel nuts) as helpful. The cost of overall treatment (medications, physician consultations, laboratory investigations), the lack of availability of safe public places for physical exercise and unfavorable weather conditions (heat, rainfall) were mentioned as barriers to the overall management of the disease.

CONCLUSION

A patient-centered mobile health intervention supported by a collaborative patient-provider relationship, a strong family support system, available public spaces for exercise and the introduction of a functional public health insurance system could be beneficial for the better management of diabetes.

Neglected treasures in the wild - legume wild relatives in food security and human health

The legume family (Fabaceae) is the third-largest flowering family with over 18 000 species worldwide that are rich in proteins, oils, and nutrients. However, the production potential of legume-derived food cannot meet increasing global demand. Wild legumes represent a large group of wild species adaptive to diverse habitats and harbor rich genetic diversity for the improvement of the agronomic, nutritional, and medicinal values of the domesticated legumes. Accumulating evidence suggests that the genetic variation retained in these under-exploited leguminous wild relatives can be used to improve crop yield, nutrient contents, and resistance/tolerance to environmental stresses via the integration of omics, genetics, and genome-editing technologies.

Role of Liver Biopsy in the Diagnosis of Neonatal Cholestasis due to Biliary Atresia

Biliary atresia is the commonest cause of cholestatic jaundice. Early diagnosis & surgical correction helps long time survival & prevent development of cirrhosis. This study was conducted to find out the role of liver biopsy in the diagnosis of biliary atresia having positive hepatobiliary scintigraphy as there is chance of false positivity. This cross sectional study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh at Paediatric Gastroenterology & Nutrition Department from January 2014 to June 2015. All admitted patients with the diagnosis of neonatal cholestasis were evaluated clinically and by scintigraphy for biliary atresia. Having positive hepatobiliary scintigraphy but highly suggestive of biliary atresia were enrolled for this study. A total of 108 cases were initially selected. Among them 33 patients showed no excretion of tracer during hepatobiliary scintigraphy. Liver biopsy was done in these 33 cases. All cases (100%) had history of passage of pale or acholic stool. Fractionated serum bilirubin of >2mg/dl was found all of the cases. Histological scoring system reveals typical features of biliary atresia in 27(81.8%). Two had no conclusive histology of biliary atresia, four had features of neonatal hepatitis (12.1%). In this study, percutaneous liver biopsy with histological analysis by scoring system was found useful for the correct diagnosis of biliary atresia.

Quercetin protects against stress-induced anxiety- and depression-like behavior and improves memory in male mice

The present study evaluates the protective role of Quercetin (Quer), against immobilization stress- induced anxiety, depression and cognition alteration in mice using behavioral and biochemical parameters. 24 adult Albino mice were distributed into 2 groups vehicle (n=12; 1 ml/kg) and Quer injected (n=12; 20 mg/kg/ml). The animals received their respective treatment for 14 days. On day 15, after the drug administration, animals were sub-divided into 4 groups (n=6); (i) unstressed + vehicle; (ii) stressed + vehicle; (iii) unstressed + Quer; (iv) stressed + Quer. On day 16, 24 h after the immobilization stress behavioral activities (light-dark activity, elevated plus maze, Morris water maze, and forced swim test) monitored and then animals were decapitated 1 h after the drug administration. Brain samples were collected for biochemical (antioxidant enzymes, AChE, ACh, 5-HT and its metabolite) analysis. The present study indicates the Quer reversed the stress-induced anxiety and depression, in addition, memory performance was more enhanced in stressed group. Following the treatment of Quer, stress-induced elevation of lipid peroxidation and suppression of antioxidant enzymes were also reversed. Administration of Quer decreased AChE in unstressed, while levels of acetylcholine were increased in vehicle and Quer treated stressed animals. The metabolism of 5-HT was increased in Quer treated stressed than unstressed animals. In conclusion, the present finding showed that Quer could prevent the impairment of antioxidant enzymes and also regulate the serotonergic and cholinergic neurotransmission and produce antianxiety, antidepressant effect and enhance memory following 2 h immobilization stress in mice.

Positive influence of short message service and voice call interventions on adherence and health outcomes in case of chronic disease care: a systematic review

BACKGROUND

Chronic diseases have emerged as a serious threat for health, as well as for global development. They endenger considerably increased health care costs and diminish the productivity of the adult population group and, therefore, create a burden on health, as well as on the global economy. As the management of chronic diseases involves long-term care, often lifelong patient adherence is the key for better health outcomes. We carried out a systematic literature review on the impact of mobile health interventions -mobile phone texts and/or voice messages- in high, middle and low income countries to ascertain the impact on patients' adherence to medical advice, as well as the impact on health outcomes in cases of chronic diseases.

METHODS

The review identified fourteen related studies following the defined inclusion and exclusion criteria, in PubMed, Cochrane Library, the Library of Congress, and Web Sciences. All the interventions were critically analysed according to the study design, sample size, duration, tools used, and the statistical methods used for analysing the primary data. Impacts of the different interventions on outcomes of interest were also analysed.

RESULTS

The findings showed evidence of improved adherence, as well as health outcomes in disease management, using mobile Short Message Systems and/or Voice Calls. Significant improvement has been found on adherence with taking medicine, following diet and physical activity advice, as well as improvement in clinical parameters like HbA1c, blood glucose, blood cholesterol and control of blood pressure and asthma.

CONCLUSIONS

Though studies showed positive impacts on adherence and health outcomes, three caveats should be considered, (i) there was no clear understanding of the processes through which interventions worked; (ii) none of the studies showed cost data for the m-health interventions and (iii) only short term impacts were captured, it remains unclear whether the effects are sustained. More research is needed in these three areas before drawing concrete conclusions and making suggestions to policy makers for further decision and implementation.

Constitutive Overexpression of the Plasma Membrane Na+/H+ Antiporter for Conferring Salinity Tolerance in Rice

At the cellular level, the Salt Overly Sensitive (SOS) signaling pathway comprising SOS3, SOS2, and SOS1 has been proposed to mediate cellular signaling under salt stress to maintain ion (Na+) homeostasis. In this regulatory pathway, both OsSOS1 encoding plasma membrane and OsNHX1 encoding vacuolar Na+/H+ antiporters are regulated by SOS3?SOS2 protein kinase complex. In the present study, the rice variety BRRI dhan28 - which is popular with farmers and high yielding, but salt sensitive, was transformed with the OsSOS1 gene isolated from salt tolerant Pokkali rice and driven by the constitutive promoter, CaMV35S. The construct was transformed through a tissue culture-independent Agrobacteriummediated in planta transformation method that circumvents the problems associated with tissue culture-based indica rice transformation methods. Integration of the foreign genes (OsSOS1) into the genome of transgenic plants was confirmed by gene-specific PCR and Southern blot analysis. The level of transgene expression (SOS1) was also quantified by semi-quantitative RT PCR and real time PCR. Genetic segregation ratio for T1 progenies was calculated and found to follow the Mendelian law of inheritance in case of positive transformants. The transformants were shown to be salt tolerant compared to wild type in molecular analysis as well as physiological screening. Future work will involve transformation of both the OsSOS1 and OsNHX1 genes together; with the expectation for enhancing the tolerance level compared to currently available transgenic rice.Plant Tissue Cult. & Biotech. 25(2): 257-272, 2015 (December)

Markers of Hepatitis Viruses by ELISA among Healthy Blood Donors

This cross sectional study was done to have a comprehensive idea about prevalence and distribution of HBsAg and anti-HCV. The present serosurveilance study was done on healthy selected blood donors and conducted in the Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh for their relatives and friends and also voluntarily from January 2001 to July 2003. Samples were collected from blood donors (Voluntary and Party) who came for donation of blood. Blood samples taken from 10,200 apparently healthy blood donors with or without the previous history of jaundice in the Transfusion Medicine department of BSMMU was tested for HBsAg and Anti-HCV by standard commercial ELISA method during the period from 1st January 2001 to 30th June 2003. Reactive samples were retested. Samples positive in duplicate tests were taken as positive. Within 10,200 samples 550(5.39%) were found positive for HBsAg and 84(0.823%) positive for anti-HCV. Among 8670(8%) male donors 470(5.42%) was positive for HBaAg and 70(0.91%) positive for anti-HCV. Among 1530(15%) female donors 80(5.29%) found positive for HBsAg and 14(0.807%) positive for anti-HCV. Prevalence of both is more in male than female, young donors below 30 years (80%) are of least prevalence 4.43% for HBsAg and 0.73% for anti-HCV. Markers are raised in prevalence with age, highest among aged donors above 40 years 14.5% and 2.62 respectively. Markers are of least prevalence among students (4.47% and 0.47%), highest among working people (7.90 and 0.91%). Within 10,200 donors no one was found concomitantly positive for HBsAg and anti-HCV, study may help to have a comprehensive idea about prevalence and distribution of HBV and HCV among healthy blood donors/party donors 9,996(98%) and voluntary donors 204(2%).

Aerosol-Assisted Chemical Vapour Deposition for Iron Selenide Thin Films from Single Source Ferrocene-Incorporated Selenourea Precursor in the Presence of Surfactants

This article presents the synthesis and characterisation (Fourier transform infrared spectroscopy, 1H NMR and 13C NMR spectroscopy, CHNS (carbon, hydrogen, nitrogen, sulfur) analysis, atomic absorption spectrometry, and single-crystal X-ray diffraction) of a single source molecular precursor 1-(2-fluorolbenzoyl)-3-(3-ferrocenylphenyl)selenourea (M2F). This precursor has been used for the fabrication of FeSe thin films by aerosol-assisted chemical vapour deposition (AACVD) in the presence of different concentrations of two different surfactants (triton and span) keeping all other conditions the same. Fabricated thin films have been characterised with powder X-ray diffraction, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. The interaction of the surfactants with the precursor (M2F) has been evaluated with cyclic voltammetry and UV–vis spectroscopy.

Preparation, characterization and antibacterial activity of ZnO nanoparticles on broad spectrum of microorganisms

Nano particles have received increased attention regarding their potential utility in biomedicine. In this study, we have investigated the antibacterial activity of ZnO nano particles with various particle sizes. ZnO nano particles were synthesized by conventional precipitation method using zinc sulphate and sodium hydroxide as precursors followed by the calcinations of precipitates at 350 °C for 6 h (sample A) and 550 °C for 2 h (sample B). The products were characterized by X-ray diffraction (XRD) analysis and morphology of the particles was evaluated by Scanning Electron Microscopy (SEM). Antibacterial activities against four different microorganisms were evaluated by determining the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and zones of inhibitions using different concentrations of ZnO nanoparticles. The antibacterial activity was directly proportional to the concentration and inversely proportional to the particle size in all the microorganisms; moreover Gram positive bacteria were generally more affected than Gram negative bacteria. The stability of ZnO nanoparticles combined with potent antibacterial properties favours their application as antibacterials against broad spectrum of microorganisms.

Particle size distribution of ambient aerosols in an industrial area

Aerosol samples of PM(10) and PM(2.5) were collected from 38 sampling locations in and around the industrial area. The 24 h average mass concentration of PM(10) and PM(2.5) was 137.5 and 61.5 μg/m(3) respectively during summer, 122 and 97.5 μg/m(3) respectively in winter and 70 and 54 μg/m(3) respectively during post monsoon season. The relative contribution of coarse, fine and ultrafine particle to ambient air was analyzed for its temporal and seasonal variability in an industrialized area. This paper aims to establish baseline between PM(10) and PM(2.5) mass concentration levels.