Health-care-seeking behaviour in patients with hypertension: experience from a dedicated hypertension centre in Bangladesh

Objective: The study aimed to assess health-seeking behaviour (HSB) and associated factors among hypertensive patients in Bangladesh.Methods: This cross-sectional study was conducted in the Hypertension & Research Centre, Rangpur, Bangladesh, between January 2022 and June 2022. A total of 497 hypertensive adults were recruited consecutively. A pre-tested structured questionnaire was deployed by the research team for data collection. Multivariable logistic regression analysis was used to explore the predictors of HSB.Results: The mean age of the hypertensive patients was 52 ± 11 (SD) years. Most of them were aged between 51 and 60 years (33%), female (55%), came from rural areas (57%), and belonged to middle socioeconomic class (68%). One-fourth of the patients (27%) had chosen informal healthcare providers for their first consultation. Fear of stroke (244, 45%), headache (170, 36%), and neck pain (81, 17%) were the three most common compelling causes of their visit to the hypertension centre. Age (aOR 0.78, 95% CI 0.68 - 0.89), male sex (aOR: 1.79, 95% CI 1.05 - 3.10), living in semi-urban (aOR 4.68, 95% CI 1.45 - 15.10) and rural area (aOR 1.68, 95% CI 1.01 - 2.80), farmers as occupation (aOR: 3.24, 95%CI: 1.31 - 8.06) and belonging to lower social economic class (aOR 4.24, 95% CI 1.68 - 10.69) were predictors of visiting informal providers of hypertensive patient. One-fourth of the hypertensive patients received consultation from informal healthcare providers.Conclusions: Raising awareness among patients and proper referral to specialised hypertension centres could promulgate the patients towards appropriate behaviour.

The impact of comorbidity on the quality of life of people who recovered from COVID-19 in Bangladesh

Objectives

COVID-19 affects the quality of life (QoL) in a reverse way after recovery, which might be multiplied by the comorbid non-communicable diseases. This study explored the relationship between comorbidities and the QoL of people who recovered from COVID-19 in Bangladesh.

Methods

The cross-sectional study was conducted among 3244 participants between June 2020 and November 2020 using a pre-tested questionnaire through over-the-phone interviews. The WHOQOL-BREF was used to explore the QoL among the study participants. A multivariable linear regression model was conducted to identify the effects of the number of comorbidities on QoL scores of all four domains.

Results

Of 3244 patients who recovered from COVID-19, over one-third (39.4%) had one or more chronic diseases, such as hypertension, diabetes mellitus, ischemic heart disease, bronchial asthma/chronic obstructive pulmonary disease, chronic kidney disease, and cancer. Around 46.85% of the participants aged above 40 years presented with one to two chronic diseases, and 16.33% had three or more chronic diseases. Among all comorbidities, the participants with cancer and chronic kidney disease were found to have relatively lower scores in all four domains than other comorbidities. The lowest QoL scores were observed in the psychological domain. Those with three or more simultaneous chronic comorbidities had the lowest QoL score in all four domains: physical, psychological, social relationship, and environmental.

Conclusions

Persons who recovered from COVID-19 with comorbidities undergo a lower QoL. Therefore, special attention is required to these vulnerable groups to ensure their smooth recuperation.

Real-life experience on the effectiveness of conjunctival flap and amniotic membrane graft in the treatment of refractory fungal corneal ulcer

PURPOSE

To evaluate and compare the results of the conjunctival flap (CF) and cryopreserved amniotic membrane graft (AMG) in the management of fungal corneal ulcers either with complications or non-responsive to medical treatment.

STUDY DESIGN

A retrospective observational study.

METHODS

Medical records of 30 patients with culture-positive fungal corneal ulcer treated with either CF or AMG (15 eyes in each group) in real world settings were retrieved for analysis. After the surgical procedure, patients were followed up on days 1, 7, 14, 21, 30, 60, 90, 120, and 180 to explore the outcomes of the operations along with complications.

RESULTS

Infecting fungi were of genus Fusarium (n = 11), Aspergillus (n = 10), Mucor (n = 4) and Penicillium (n = 10). The most common indication was resistant ulcer with perforation. After the procedure, epithelization was completed in 11(73.33%) patients in the CF, and 13 patients in the (86.67%) AMG group. Visual acuity improvement was significantly better in the latter group (CF: 1 [6.67%] vs. AMG: 7 [46.67%], p = 0.023). Flap failure occurred in 4 patients (26.67%) from the CF and 2 (13.33%) from the AMG group. No significant differences were found between the two groups regarding success rate (p = 0.651), epithelialization time (p = 0.691), healing of corneal ulcer (p = 0.651), and postoperative stability (p = 0.651) of the flaps.

CONCLUSIONS

CF and AMG are both effective for the management of refractory fungal corneal ulcers. However, AMG appears to improve visual acuity better than CF.

Marital status and suicidal behavior in South Asia: A systematic review and meta-analysis

Background and Aims

The connection between marital status and suicidal behavior has been poorly assessed in South Asia. We aimed to see the proportion of marital status in individuals with suicidal behavior in South Asian countries.

Methods

We followed PRISMA guidelines and registered the protocol in advance (PROSPERO 2023 CRD42023399906). A systematic search was conducted in Medline, Embase, and PsycINFO. Meta-analyses were performed to pool the proportion of married individuals with suicidal behavior (total [suicide + suicide attempts], suicide, and suicide attempt) in South Asian countries. We considered suicidal behavior consist of suicide and suicide attempts (nonfatal).

Results

Our search identified 47 studies for this review from 6 countries published from 1999 to 2022 with a sample size ranging from 27 to 89,178. The proportion of married individuals was 55.4% (95% CI: 50.1-60.5) for suicidal behavior, 52.7% (95% CI: 44.5-60.7) for suicides, and 43.1 (95% CI: 32.9-53.9) for suicide attempts. The proportion of married persons among suicide attempts varied significantly across countries (p = 0.016) which was highest (61.8%; 95% CI: 57.2-66.2) in India, followed by Bangladesh (52.5%; 95% CI: 41.8%-62.9%) and Pakistan (45.1%; 95% CI: 30.9-59.9). The pooled proportions did not differ significantly in relation to the quality of the studies (p = 0.633).

Conclusion

This review identified married persons died more than others by suicide in South Asian countries while single persons attempted suicide than married. As the current study did not assess any cause-and-effect association, a cautious interpretation is warranted while considering married marital status as a risk factor.

The road towards protection of all against tetanus

In low- and middle-income countries (LMICs), tetanus continues to be a major public health concern. Although vaccination campaigns have been effective in lowering the incidence of tetanus worldwide, some areas continue to experience a considerable number of cases and fatalities. Adult tetanus is frequently underreported because there is insufficient systematic surveillance and reporting. A high proportion of tetanus patients die because of a lack of adequate critical care services, particularly ventilator support, with limited access to existing facilities due to high costs. Hence, the case fatality rate of adult tetanus remains high. Women and children are protected because of regular and booster immunization strategies implemented around the world. However, men are disproportionately affected by tetanus. Booster dosage based on the World Health Organization (WHO)-recommended schedule should be given to eligible children and adolescent boys. In addition, tetanus vaccination needs to be promoted among adults in vulnerable jobs. Functional strategies could help pave the way toward the protection of all against tetanus.

Quality of life of COVID-19 recovered patients: a 1-year follow-up study from Bangladesh

BACKGROUND

The COVID-19 pandemic posed a danger to global public health because of the unprecedented physical, mental, social, and environmental impact affecting quality of life (QoL). The study aimed to find the changes in QoL among COVID-19 recovered individuals and explore the determinants of change more than 1 year after recovery in low-resource settings.

METHODS

COVID-19 patients from all eight divisions of Bangladesh who were confirmed positive by reverse transcription-polymerase chain reaction from June 2020 to November 2020 and who subsequently recovered were followed up twice, once immediately after recovery and again 1 year after the first follow-up. The follow-up study was conducted from November 2021 to January 2022 among 2438 individuals using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF). After excluding 48 deaths, 95 were rejected to participate, 618 were inaccessible, and there were 45 cases of incomplete data. Descriptive statistics, paired-sample analyses, generalized estimating equation (GEE) analysis, and multivariable logistic regression analyses were performed to test the mean difference in participants' QoL scores between the two interviews.

RESULTS

Most participants (n = 1710, 70.1%) were male, and one-fourth (24.4%) were older than 46. The average physical domain score decreased significantly from baseline to follow-up, and the average scores in psychological, social, and environmental domains increased significantly at follow-up (P < 0.05). By the GEE equation approach, after adjusting for other factors, we found that older age groups (P < 0.001), being female (P < 0.001), having hospital admission during COVID-19 illness (P < 0.001), and having three or more chronic diseases (P < 0.001), were significantly associated with lower physical and psychological QoL scores. Higher age and female sex [adjusted odd ratio (aOR) = 1.3, 95% confidence interval (CI) 1.0-1.6] were associated with reduced social domain scores on multivariable logistic regression analysis. Urban or semi-urban people were 49% less likely (aOR = 0.5, 95% CI 0.4-0.7) and 32% less likely (aOR = 0.7, 95% CI 0.5-0.9) to have a reduced QoL score in the psychological domain and the social domain respectively, than rural people. Higher-income people were more likely to experience a decrease in QoL scores in physical, psychological, social, and environmental domains. Married people were 1.8 times more likely (aOR = 1.8, 95% CI 1.3-2.4) to have a decreased social QoL score. In the second interview, people admitted to hospitals during their COVID-19 infection showed a 1.3 times higher chance (aOR = 1.3, 95% CI 1.1-1.6) of a decreased environmental QoL score. Almost 13% of participants developed one or more chronic diseases between the first and second interviews. Moreover, 7.9% suffered from reinfection by COVID-19 during this 1-year time.

CONCLUSIONS

The present study found that the QoL of COVID-19 recovered people improved 1 year after recovery, particularly in psychological, social, and environmental domains. However, age, sex, the severity of COVID-19, smoking habits, and comorbidities were significantly negatively associated with QoL. Events of reinfection and the emergence of chronic disease were independent determinants of the decline in QoL scores in psychological, social, and physical domains, respectively. Strong policies to prevent and minimize smoking must be implemented in Bangladesh, and we must monitor and manage chronic diseases in people who have recovered from COVID-19.

Cross-cultural adaptation and validation of the Bangla version of the Psoriasis Disability Index

Background

The Psoriasis Disability Index (PDI) is used for the quality-of-life assessment of psoriasis patients. However, a locally adapted Bangla version of the PDI (B-PDI) instrument is currently lacking in Bangladesh. To translate the instrument, adapt, and validate it among psoriatic patients of the country was the objective of the study.

Methods

Translation, adaptation, and back-to-back translation to Bangla were made from the original English PDI. The final Bangla instrument was applied among 83 psoriasis patients twice at 10 days intervals. The psychometric property of the instrument was evaluated. Item-level content-validity index (CVI) was used to check the content validity of the instrument. Convergent validity was tested by comparing the B-PDI with the validated Bangla version of Short Form 36(SF-36) and the Psoriasis Area Disability Index (PASI) score. Necessary testing was used to assess internal consistency and test-retest reliability.

Result

The B-PDI was well-accepted by the patients. It showed good internal consistency (Cronbach's alpha = 0.76) and very high test-retest reliability (Pearson r = 0.92, p < 0.001). The scale demonstrated excellent content validity (Content Valid Index [CVI] = 1). The instrument had satisfactory convergent validity with four components of SF-36. Pearson correlation coefficient for physical, emotional, social, and pain domains of SF-36 was 0.663, 0.644, 0.808, and 0.862, respectively, and for PASI score was 0.812. Factor exploration using Principal Component Analysis revealed four factors reflecting working disabilities, social, and hygienic disabilities, lifestyle difficulties, and leisure-associated disabilities.

Conclusion

This study supports the reliability and validity of the B-PDI instrument for measuring health-related quality-of-life for Bangla-speaking psoriasis patients.

Occupational Health Hazards Among Traffic Police in South Asian Countries: Protocol for a Scoping Review

BACKGROUND

Occupational health hazards and injuries are an alarming concern among traffic police. Occupational injuries affect the physical, social, and mental well-being of police personnel, which has various public health implications. The evaluation of occupational health and safety policies and regulations for the traffic police relies on their occupational exposure and health hazard statistics and assessments.

OBJECTIVE

The purpose of this scoping review is to systematically explore, analyze, and describe relevant findings from all studies conducted on occupational exposure and associated health hazards among traffic police in South Asia.

METHODS

The scoping review will include studies that assessed occupational exposure prevalence, types, knowledge, predisposing factors, and prevention strategies. Databases like PubMed, Springer Link, EBSCOhost, the Cochrane library, and Google Scholar will be used to obtain both published and unpublished works in the English language. Relevant gray literature, including governmental and international organization reports, will be examined. After removing duplicates and screening titles and abstracts, the full-text analysis will begin. Arksey and O'Malley's methodology framework for scoping reviews will be followed. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, the scoping review will be reported. Two qualified reviewers will independently conduct article screening and data extraction. The extracted data will then be tabulated and accompanied by an explanation to facilitate comprehension. We will extract relevant article results using NVivo (version 10; QSR International) and thematic content analysis. The included articles will be evaluated using the mixed methods appraisal tool (version 2018).

RESULTS

The scoping review will provide insight into how occupational health hazards affect traffic police physically and psychologically in South Asia. The theoretical conceptualization of different aspects of the occupational health of traffic police will emphasize future studies in this region, which will inform policy makers to revise their occupational health and safety policies and principles. It will have implications for taking necessary preventive measures in the future to reduce occupational injuries and fatalities resulting from different types of occupational hazards.

CONCLUSIONS

This scoping review will describe the overview of occupational hazards among South Asian traffic police and will provide insights for policy makers to implement changes and to adapt new strategies.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/42239.

Post-discharge quality of life of COVID-19 patients at 1-month follow-up: A cross-sectional study in the largest tertiary care hospital of Bangladesh

There is increasing evidence of the post-COVID-19 suffering and decreased quality of life in the COVID-19 patients. This study aimed to assess the quality of life and associated factors of COVID-19 patients at one month after discharge from the hospital. This was a cross-sectional study that was conducted at the post-covid clinic of Dhaka Medical College Hospital (DMCH) where RT-PCR-confirmed adult COVID-19 recovered patients were enrolled one month after discharge from the same hospital. They were consecutively selected from January 01 to May 30. A pretested semi-structured questionnaire was used for the data collection for clinical variables. The generic multi-attributable utility instrument EQ-5D-5L was used for assessing health-related quality of life (HRQoL). A total of 563 patients were enrolled in the study. The patients had a mean age with standard deviation (±SD) of 51.18 (±13.49) years and 55.95% were male. The mean (SD) EQ-5D-5L index score and EQ-VAS scores were 0.78 (±0.19) and 70.26 (±11.13), respectively. Overall, 45.77%, 50.99%, 52.79%, 55.14% and 62.16% had problems (slight to extreme) in the mobility, self-care, usual activities, pain/discomfort and anxiety/depression dimensions, respectively. Patients aged ≥60 years had significant problem in mobility (odds ratio [OR] 3.24, 95% confidence interval [CI]: 1.07-9.77). Female participants were 5.50 times (95% CI: 2.22-13.62) more likely to have problems in their usual activities. In comparison to urban area, living in a peri-urban setting was significantly associated with problems in mobility (OR 1.89, 95% CI: 1.13-3.20), pain/discomfort (OR 1.82, 95% CI: 1.04-3.12) and anxiety/depression (OR 2.16, 95% CI: 1.22-3.84). Comorbid patients were 1.75 times (95% CI: 1.07-2.85) more likely to report problems in the pain/discomfort dimension. Presence of symptom(s) was associated with problems in self-care (OR 3.27, 95%CI: 1.31-8.18), usual-activity (OR 3.08, 95%CI: 1.21-7.87), pain/discomfort dimensions (OR 2.75, 95%CI: 1.09-6.96) and anxiety/depression (OR 3.35, 95%CI: 1.35-8.30). Specific management strategies should be planned to address the factors associated with low health-related quality of life in post-acute care of COVID-19 patients.

Factors associated with low childhood immunization coverage among Rohingya refugee parents in Cox's Bazar, Bangladesh

INTRODUCTION

Immunization campaigns and Expanded Program on Immunization (EPI) were launched by Government of Bangladesh (GoB) in collaboration with WHO and other Non-governmental Organizations (NGOs) to tackle the increased risk of vaccine preventable disease outbreak in the Rohingya refugee camps. Immunization coverage was found to be lower than expected. However, a few studies explored the factors behind low vaccine uptake among Refugee children. Therefore, this study was aimed.

METHODS

A cross sectional study was carried out among Rohingya parents living in registered camps and makeshift settlements located in Teknaf and Ukhiya upazilla of Cox's Bazar, Bangladesh. A total of 224 Rohingya parents were conveniently selected (122 parents from each type of camps). Data was collected using a pretested interviewer-administered semi-structured questionnaire with the help of bilingual volunteers who understand Rohingya dialect. All statistical analyses were carried out in IBM SPSS Version 26 (New York, USA).

RESULTS

Total 63.1% of Rohingya parents had good practice regarding childhood immunization (completed EPI vaccination) as per schedule. Of all, 74.6% had good knowledge and 94.7% had positive attitude towards EPI vaccination. Good practice regarding vaccination was significantly more common among parents living in registered camps (77%) than those living in makeshift settlements (49.2%, p<0.001). Multivariable logistic regression analysis revealed that living in registered camps (Adjusted Odds Ratio [aOR]: 2.99; 95% Confidence Interval [CI]: 1.41-6.32) and good knowledge level (aOR: 2.88; 95%CI: 1.32-15.82) were independent determinants of good practice. A separate analysis in both type of camps revealed that in registered camps, good knowledge level (aOR: 3.62; 95%CI: 1.45-9.04) and having >2 children (aOR: 3.71; 95%CI: 1.34-10.27), and in makeshift settlements, father's employment (aOR: 2.33; 95%CI: 1.34-6.72), father's education (aOR: 3.00; 95%CI: 1.34-6.72) and presence of any electronic device (e.g., radio, television, mobile phone) (aOR: 4.01; 95%CI: 0.96-16.84) were significant determinants of good childhood immunization practice.

CONCLUSION

Health education and promotion strategies should be implemented to increase knowledge and awareness about EPI immunization benefits among Rohingya parents to ensure greater coverage.

Human monkeypox and preparedness of Bangladesh: A knowledge and attitude assessment study among medical doctors

OBJECTIVE

The recent increasing incidence of human monkeypox cases highlights the necessity of early detection, prompt response and preventive management to stop it in its tracks, and healthcare workers play the most crucial role here. This study aims at assessing the preparedness of Bangladeshi medical doctors by assessing their knowledge and attitude regarding monkeypox.

METHODOLOGY

This cross-sectional study was conducted among the practicing medical doctors all over Bangladesh. The data was collected from 26th May to 4th June of 2022 using a semi-structured and self-administered questionnaire which was distributed through the internet, and a total of 389 data was collected. The cut-off points for defining good knowledge and positive attitude towards human monkeypox were considered as 70% and 80% of total values, respectively. Multivariable logistic regression analyses were carried out to identify the factors associated with good knowledge and a positive attitude. Statistical software R version 4.2.0 was used for data analysis.

RESULT

Of all, 330 (84.83%) doctors displayed a positive attitude towards preventive practices, but only 119 (30.59%) participants had good knowledge regarding monkeypox. In multivariable logistic regression analysis, getting any information about monkeypox in the medical curriculum and learning about monkeypox within the last one month had a significant association with good knowledge. Apart from the participant's age, no other variables revealed any significant association with a positive attitude toward preventive practices. Good knowledge showed a significant association with positive attitude (p < 0.05).

CONCLUSION

Knowledge regarding human monkeypox among medical doctors in Bangladesh was comparatively lower than the attitude towards its preventive measures. Developing and implementing practical sessions regarding the virus to enhance the knowledge and capacity of the medical doctors could be an effective strategy to get prepared for the monkeypox outbreak in Bangladesh.

Spatial association of Aedes aegypti with dengue fever hotspots in an endemic region

Background and objective

Dengue is a vector-borne viral disease usually transmitted by Aedes mosquitoes. Around the world, the relationship between local vector density and frequency of dengue cases is being explored and needs further evidence. This study aimed to analyze the potential spatial relationships between the dengue vector (Aedes aegypti) and dengue cases in the megacity of Bangladesh during the 2019 dengue outbreak.

Methods

Vector density measures were used to estimate spatial associations with dengue case distribution. Location was determined for 364 dengue cases who were admitted to Dhaka Medical College Hospital over a period of 4 months. Data were collected using a semi-structured questionnaire, and prior consent was ensured before participation. The Moran global index, Getis-Ord Gi∗, ordinary least squares regression, geographically weighted regression and count data regression methods were used for spatial analysis.

Results

We found that dengue case distribution was not associated with immature Aedes aegypti mosquito (larvae) density across the city. The relationship between larval density measured by the Breteau Index (BI) and House Index (HI) with dengue cases was nonstationary and not statistically significant.

Conclusion

The location of dengue cases appears to be unrelated to vector distribution and vector density. These findings should prompt the search for other transmission risk factors.

Clinical and hematological profiles of children with dengue residing in a non-endemic zone of Bangladesh

BACKGROUND

The clinical and hematological parameters of children with dengue during an outbreak in a non-endemic region have not been well described. To delineate the clinical profile of pediatric cases from a tertiary care center located in a non-endemic zone (Tangail district) in Bangladesh was the objective of the study.

METHODS

A cross-sectional observational study was conducted in the Department of Pediatrics of a 250-bed general hospital in Tangail, Bangladesh, between June 2019 to September 2019. Data collection was done using a pre-structured case record form. All patients underwent detailed history taking, physical examination, and hematological profiling. A total of 123 confirmed dengue cases were analyzed.

RESULTS

The average age of patients was 7.3±4.1 (SD) years, with nearly two-thirds being male (61.8%) and the majority living in rural areas (76.4%). Fever (100%), body ache (57.7%), headache (56.9%), and rash (55.3%) were the four common clinical manifestations. NS1 antigen and anti-dengue IgM antibody tests were positive in 86% (102 out of 119) and 37.7% (20 out of 53) of cases, respectively. Thrombocytopenia was present in 42% of cases. The majority of the cases had dengue fever (73.2%), and the remaining cases were either dengue hemorrhagic fever or dengue shock syndrome (26.8%). Clinical and hematological parameters varied with the type of dengue. Particularly, rash (p = <0.001), bleeding manifestation (p = <0.001), vomiting (p = 0.012), hypotension (p = 0.018), pleural effusion (p = 0.018), ascites (p = 0.018), hepatomegaly (p = <0.001) and low platelet count (<150 x 103cells/μL) (p = 0.038) were significantly more common among dengue hemorrhagic fever or dengue shock syndrome cases.

CONCLUSIONS

The present study documented the clinical features of dengue in a pediatric group of patients from a non-endemic zone of Bangladesh. This vulnerable patient group requires earlier identification and keen attention during management.

Clinical profile and demographic characteristics of moderate and severe hemophilia patients in a tertiary care hospital of Bangladesh

BACKGROUND

Hemophilia is one of the commonest inherited bleeding disorders which may lead to chronic bleeding tendencies and life-long disabilities if not properly managed. Knowing the pattern of the disease aids in the prevention of disability and improvement of quality of life in hemophilia. However, there is a dearth of literature on the issue in Bangladesh. So, this study was designed to explore the frequency and site of spontaneous bleeding in moderate and severe hemophilia patients visiting in a tertiary level hospital.

METHODS

This descriptive cross-sectional study was conducted at the department of Hematology and Bone Marrow Transplantation (BMT) Center in Dhaka Medical College Hospital, Dhaka between February 2020 and August 2020. A total of 44 diagnosed cases of moderate to severe hemophilia were included in the study according to inclusion criteria. A detailed inquiry of history, thorough physical examination and relevant investigations were done and were recorded in case-record form. Informed written consent was taken from patients or their guardians where appropriate. All procedures were done according to Declaration of Helsinki. After entry and checking, data was analysed using SPSS version 26.

RESULTS

Out of 44 participants, 25 (56.8%) and 19 (43.2%) had moderate and severe hemophilia. Mean age of the study population was 21.31 (± 9.78) years with the majority aged between 11 and 20 years (45.5%). All sociodemographic features were similar across severity. Hemophilia A and B was found in 90.9% and 9.1%, respectively. However, all type B patients severe hemophilia making it statistically significantly different from type A (p = 0.029). The median age of first bleeding was 3.5 years and median age of first diagnosis was 5 years. Nevertheless, approximately 67.4% patients were diagnosed as a case of hemophilia at the time of their first diagnosis. The median spontaneous bleedings episodes among all patients was 32 (range: 0-97) which did not different significantly between severe and moderate patients. The most common affected (target) joint was knee joint (88.6%) followed by elbow joint (64%) among all patients. The knee joint was more commonly involved in severe than moderate disease.

CONCLUSION

This study observed the variations in pattern and frequency of spontaneous bleeding in patients with hemophilia. Severe disease was more frequent in hemophilia B than A and knee joint was the most frequent site of bleeding. However, further extensive studies are recommended.

Quality of life among health care workers with and without prior COVID-19 infection in Bangladesh

Background

Health care workers have been facing difficulties in coping with the COVID-19 infection from the beginning. The study aimed to compare Quality of Life (QOL) among health care workers (HCWs) with and without prior COVID-19 disease.

Methods

This study was conducted from July 2020 to January 2021 among 444 HCWs. We randomly interviewed 3244 participants for our earlier nationwide survey from a list of COVID-19 positive cases after their recovery, and we found 222 HCWs among the respondents. We randomly chose 222 HCWs unaffected by COVID as a comparison group from our selected hospitals. We measured QOL using World Health Organization’s WHOQOL-BREF tool. Physical, psychological, environmental, and social ties were the four areas assessed on a 5-point Likert scale where a higher score suggests better QOL. Due to pandemic restrictions, we used telephonic interviews for data collection.

Results

A higher QOL score was observed in HCWs with prior COVID-19 infection in all four domains than HCWs without previous COVID-19 conditions. Comorbidity was negatively associated with QOL scores of the physical (p = 0.001) and (p < 0.001) and psychological (p = 0.05, and (p < 0.05) domains for non-COVID and COVID-affected groups, respectively. Current smoking was significantly associated with lower psychological (p = 0.019) and environmental (p = 0.007) QOL scores among HCWs with prior COVID-19 infection. Hospitalization history due to COVID infection was a contributing factor for lower physical QOL scores (p = 0.048). Environmental (p = 0.016) QOL scores were significantly associated with the monthly income in the prior COVID-19 infection group, and physical scores were significantly associated (p = 0.05) with a monthly income in the non-COVID group.

Conclusion

Governmental and non-governmental stakeholders should focus on potentially modifiable factors to improve health care workers’ quality of life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08174-0.

Assessment of quality of life and its determinants in type-2 diabetes patients using the WHOQOL-BREF instrument in Bangladesh

BACKGROUND

Diabetes mellitus (DM) is rising at a rapid rate worldwide. As a chronic, incurable metabolic disease, diabetes affects a person's life in all ways. Studies thus far have focused on the impact of diabetes on the physical and mental health of persons affected by the quality of life (QoL). This study aimed to explore the whole range of QoL deficits using the World Health Organization Quality of Life brief version (WHOQOL-BREF) in type-2 diabetic patients.

METHODS

This cross-sectional study was carried out among individuals aged at or above 15 years with type 2 diabetes (T2DM). Patients with prior mental health illness and unwillingness to give consent were excluded. A pretested structured questionnaire including the 26-item WHOQOL-BREF questionnaire was used for face-to-face interviews. Appropriate ethical measures were ensured. All statistical analyses were carried out using the statistical software STATA (Version 16.1). Graphs were created using R (Version 4.0.0).

RESULTS

A total of 500 T2 DM patients with a mean age of 55.8 ± 13.2 years (± SD) and a female proportion of 50.8% were included. Overall, 22.2% of participants rated their QoL as poor, and 25% were dissatisfied with their health (as assessed by questions 1 and 2 of the WHOQOL-BREF questionnaire). More than half (54% and 51.2%, respectively) had an average evaluation of their QoL and health. The QoL scores were below average, with mean scores (± SD) for the physical health, psychological, social relationship, and environmental domains of 37.2 ± 20.5, 44.2 ± 21.0, 39.6 ± 23.2, and 41.6 ± 19.5, respectively. Multiple regression analysis revealed that the patient's level of education and monthly family income were significant positive modifiers and that complications (nephropathy, retinopathy, and peripheral artery disease) were significant negative determinants of the QoL score in different domains.

CONCLUSION

This study found the overall quality of life among T2DM patients below average. Health authorities and clinicians should take these findings into account and incorporate necessary measures to ameliorate negative modifiers of the quality of life of sufferers.

Quality of life (QoL) among COVID-19 recovered healthcare workers in Bangladesh

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has taken the lives of more than 100,000 healthcare workers (HCWs) so far. Those who survived continuously work under immense physical and psychological pressure, and their quality of life (QoL) is impacted. The study aimed to assess the QoL among HCWs in Bangladesh who recovered from COVID-19.

METHODS

This cross-sectional, telephonic interview-based study was conducted among 322 randomly selected HCWs from Bangladesh who were positive for COVID-19 and recovered from the infection before the interview. Data were collected from June to November 2020. We examined the impact of COVID on the QoL of the participants using the validated Bangladesh version of the World Health Organization (WHO) Quality of life questionnaire brief (WHOQOL-BREF). All analyses were done by STATA (Version 16.1).

RESULTS

More than half of the health care professionals were male (56.0%), aged between 26-35 years (51%), and completed graduation (49%). The majority of the study participants in the four domains were married (n = 263, 81%) and living in Dhaka. The average score of the participants was 70.91 ± 13.07, 62.68 ± 14.99, 66.93 ± 15.14, and 63.56 ± 12.11 in physical, psychological, social relationship and environmental domains, respectively. HCWs in urban areas enjoyed 2.4 times better socially stable lives (OR: 2.42, 95% CI: 1.18-4.96) but 72% less psychologically satisfactory lives.

CONCLUSION

HCWs' post-COVID quality of life depended on variable interaction of demographic socioeconomic, including old age, female sex, graduation, and higher monthly income. The findings indicate the issues which should be addressed to improve the quality of life of frontline workers who fight against the pandemic.

Virucidal Effect of Povidone Iodine on SARS-CoV-2 in Nasopharynx: An Open-label Randomized Clinical Trial

To assess the virucidal effect of povidone iodine (PVP-I) on severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) located in the nasopharynx and suitable dose-formulation for nasal application were the purpose of this clinical trial. This single-center, open-label randomized clinical trial with a 7-arm parallel-group design was conducted in Dhaka Medical College (DMC) Hospital. A total of 189 reverse transcription-polymerase chain reaction (RT-PCR)-confirmed SARS CoV-2 positive cases aged 12–90 years with symptoms was sequentially enrolled following randomization. Nasopharyngeal clearance of SARS-CoV-2 was tested against PVP-I nasal irrigation (NI) at diluted concentrations of 0.4%, 0.5% and 0.6%, and PVP-I nasal spray (NS) at diluted concentrations of 0.5% and 0.6%. All groups were compared to the corresponding controls (distilled water). Written informed consent was ensured before participation. All procedures were conducted in after ethical clearance from the Ethical Review Board and in accordance with the Declaration of Helsinki. Viral clearance in a repeat RT-PCR (qualitative) was the primary outcome, and occurrence of any adverse event following administration of testing drug was considered as the secondary outcome. Analysis was performed using SPSS (Version 26). All cases were randomized into seven groups and each group consists of 27-patient. Mean age of the cases 43.98 ± 12.67 years (SD). All strength of NI were effective in nasopharyngeal clearance compared to the control (0.4%, p = 0.006; 0.5%, p < 0.001; and 0.6%, p = 0.018). Similarly, all strength of the NS is also effective than control (0.5%, p =  < 0.001; and 0.6%, p ≤ 0.001). Highest nasopharyngeal clearance was observed in patients using 0.5% NI (n = 25, 92.6%, p = 0.018). Nasal irritation was the single most adverse event recorded in this trial and found in two patients using 0.4%, and 0.6% PVP-I NI, respectively. Both PVP-I NS and NI are effective for nasopharyngeal clearance in-vivo. However, further community trials are needed to repurpose these solutions as preventive agents against SARS-CoV2.

Ethical clearance memo no ERC-DMC/ECC/2020/93.

Trial registration NCT Identifier number NCT04549376.

The impact of the COVID-19 pandemic on the mental health of Rohingya refugees with pre-existing health problems in Bangladesh

BACKGROUND

Mental disorders among refugees have been well explored in several studies. However, longitudinal studies on the impact of the pandemic on refugee populations are widely lacking. This study was designed to examine the impact of the current pandemic on the mental health of Rohingya refugees living in Bangladesh.

METHOD

This longitudinal study involved a convenience sample of 732 Rohingya people with pre-existing health problems who lived in the Kutupalong refugee camp in Cox's Bazar, Bangladesh. The first recruitment was performed on 5 July 2019 (prepandemic visit) and assessed the health status of refugees using the Refugee Health Screener-15 (RHS-15). The follow-up survey was conducted on 10 November 2020, approximately 15 months later, during the pandemic. A total of 342 Rohingya refugees who completed the initial survey participated in the follow-up survey. A newly developed COVID-19 Impact on Quality of Life (COV19-QoL) scale was used alongside the RHS-15 scale during the second survey. Ethical measures were taken in compliance with the current Declaration of Helsinki. The analysis was performed using SPSS 26.

RESULT

A total of 342 Rohingya refugees completed this longitudinal survey. The average age of participants was 32.25 ± 14.01 years (SD), and the predominant age group was ≤ 30 years (n = 207, 60.5%). Most of the participants were female (n = 209, 61.1%). A significant increase in stress was noted from the prepandemic to pandemic periods, as determined by the RHS-15 scale (RHS-15 Part I: 22.96 ± 8.43 vs. 46.72 ± 1.87, p < 0.001; and RHS-15 Part II: 4.43 ± 1.59 vs. 6.91 ± 1.49, p < 0.001). The mean COV19-QoL score of the participants was 4.47 ± 0.15 (out of 5), indicating a perceived negative impact of the pandemic in their lives. In the multiple regression analysis, female sex (β = 0.604, p = 0.017) and COV19-QoL score (β = 2.537, p = 0.003) were significantly associated with higher perceived distress among participants.

CONCLUSION

Rohingya refugees experienced a significant deterioration of mental health during the COVID-19 pandemic. Alongside other socioeconomic, environmental, and political factors, the pandemic itself might have been a crucial contributor to this negative trend.

Factors associated with in-hospital mortality of adult tetanus patients–a multicenter study from Bangladesh

Background

Tetanus, a vaccine-preventable disease, is still occurring in the elderly population of low- and middle-income countries with a high case-fatality rate. The objective of the study was to elucidate the factors associated with in-hospital mortality of tetanus in Bangladesh.

Methods

This prospective observational study, conducted in two specialized infectious disease hospitals, conveniently selected adult tetanus patients (≥18 years) for inclusion. Data were collected through a preformed structured questionnaire. Kaplan Meier survival analysis and univariate and multivariable Cox regression analysis were carried out to assess factors associated with in-hospital mortality among patients. All analysis was done using Stata (version 16) and SPSS (version 26).

Results

A total of 61 tetanus cases were included, and the overall in-hospital mortality rate was 34.4% (n = 21). Patients had an average age of 46.49 ±15.65 years (SD), and the majority were male (96.7%), farmers (57.4%), and came from rural areas (93.4%). Survival analysis revealed that the probability of death was significantly higher among patients having an age of ≥ 40 years, incubation time of ≤12 days, onset time of ≤ 4 days, and having complication(s). However, on multivariable Cox regression analysis, age (adjusted hazard ratio [aHR] 4.03, 95% Confidence Interval [CI] 1.07–15.17, p = 0.039) and onset time (≤4 days) (aHR 3.33; 95% CI 1.05–10.57, p = 0.041) came as significant predictors of in-hospital mortality after adjusting for incubation period and complications.

Conclusion

Older age and short onset time are the two most important determinants of in-hospital mortality of tetanus patients. Hence, these patients require enhanced emphasis and care.

Factors affecting intention to take COVID-19 vaccine among Pakistani University Students

BACKGROUND

Widespread vaccination coverage is essential for reducing the COVID-19 havoc and regarded as a crucial tool in restoring normal life on university campuses. Therefore, our research aimed to understand the intention to be vaccinated for COVID-19 among Pakistani university students.

METHODS

This cross-sectional study was conducted in five administrative units of Pakistan, i.e., Punjab, Sindh, Balochistan, Azad Jammu and Kashmir, and Khyber Pakhtunkhwa. We obtained data from 2,865 university students between 17th January and 2nd February, 2021, using a semi-structured and self-administered questionnaire. We used Stata (version 16.1, StataCorp LLC) for data management and analysis.

RESULTS

The majority (72.5%) of our respondents were willing to take COVID-19 vaccine. The current level of education had a statistically significant relationship with the intention to be vaccinated (p < 0.05). Respondents answered 11 questions encompassing five different domains of the Health Belief Model (HBM). All the items of HBM were significantly associated with the positive intention towards receiving the vaccine (p < 0.05). We conducted a multivariable logistic regression analysis to assess the relative contribution of different factors towards the intention to receive COVID-19 vaccine. Multiple factors such as belief that vaccination should be mandatory for everyone (AOR: 3.99, 95% CI: 3.20-4.98) and willingness to take vaccine even if it is not free (AOR: 3.91, 95% CI: 3.18-4.81) were observed to be associated with high odds of showing willingness to be vaccinated against COVID-19.

CONCLUSION

Most of our study participants intended to take vaccines based on their belief regarding the high effectiveness of COVID-19 vaccine. But as rumor-mongers are generating and spreading conspiracy theories daily, the health department and policymakers need to undertake evidence-based campaigns through electronic and social media to ensure expected countrywide vaccination coverage. In this case, our study findings can serve as a foundation for them to ensure mass vaccination coverage among university students, which is crucial now to reopen the dormitories and restore everyday life on campuses.

Chikungunya outbreak in Bangladesh (2017): sociodemographic and clinical characteristics of patients from three hotspots

BACKGROUND

Chikungunya is a severely debilitating disease. Bangladesh witnessed one of the largest outbreaks in 2017. Here, we described the clinical profile of the chikungunya outbreak in Bangladesh and its heterogeneity across three hotspots.

METHODS

This was a descriptive cross-sectional study of 432 individuals interviewed from the outpatient department of three study sites (Dhaka, Chittagong, and Sitakundu Upazilla of Bangladesh) after confirmation by the study physicians. Both laboratory-confirmed cases and probable cases were recruited between July and October 2017.

RESULTS

Of all, 18% (79) were laboratory confirmed, and 353 82% (335) were probable cases. The male:female ratio was almost equal (1.09:1), and the predominant age group was 18-59 years. The mean age of the presentation was 36.07 ± 13.62 (SD) years. Fever and arthralgia were the most common presentations and were present in > 95% of cases. Other frequent symptoms were fatigue, myalgia, headache, nausea, and vomiting. Approximately half of the patients had arthritis and erythematous rash. Arthritis was predominant in Chittagong city, while maculopapular rash was not observed in Sitakunda city. However, fatigue, nausea, and vomiting are more common among patients in Dhaka city. Significant heterogeneity of clinical manifestations was present across the three hotspots (p < 0.05 for all). Both confirmed and probable cases shared similar characteristics except muscle ache (p = 0.22) and rash (p = 0.37).

CONCLUSION

The clinical profile of chikungunya virus-induced disease displays significant location-related heterogeneity in Bangladesh during a large outbreak. Although the causes of such differences are unclear, improved public and medical personnel education on this condition may lead to earlier diagnosis and treatment.

Antibody Response to ChAdOx1-nCoV-19 Vaccine Among Recipients in Bangladesh: A Prospective Observational Study

PURPOSE

The aim of the study was to assess the antibody response to the ChAdOx1-nCoV vaccine in individuals who were not previously infected by COVID-19.

PATIENTS AND METHODS

All people aged 18-65 years who received their first vaccination with ChAdOx1-nCoV from March to May 2021 were approached for inclusion. Individuals with sufficient antibody titers against SARS-CoV-2 infection before vaccination were considered previously infected and were excluded from the analysis. We observed viral spike protein RBD-S1-specific IgG antibody levels at day 28 of the first dose of vaccination and day 14 of the second dose of vaccination (74 days from index vaccination). An optical density ratio (ODR) of >1.1 was considered to have a positive antibody response, 0.8 to 1.1 borderline and <0.8 was denoted as negative. Informed consent was ensured before enrollment, and ethical principles conformed with the current Declaration of Helsinki.

RESULTS

This observational study comprised 769 infection-naïve individuals (mean age 40.5 years, 38.9% female). Spike-specific IgG antibody responses elicited after the first and second doses of vaccine were 99.9% and 100%, respectively. The median ODR was 5.43 (interquartile range [IQR]: 4.32-6.98) and 10.90 (IQR 9.02-11.90) after the first and second doses. Higher age was associated with lower antibody levels after both dosages. However, no sex-specific variation was seen. People with comorbidity had a lower antibody level after the second dose. Tenderness (51.46%) and fever (19.30%) were the most common local and systemic side effects after vaccination.

CONCLUSION

This study was one of the earlier attempts in the country to assess the antibody response to ChAdOx1-nCoV vaccine recipients. The results imply that general people should be encouraged to take the vaccine at their earliest.

Thwarted belongingness, perceived burdensomeness, and acquired capability for suicide among university students of Bangladesh: Scales validation and status assessment

BACKGROUND

Identification of prior mental events of suicide attempts has immense importance in suicide prevention. However, it has not been studied in Bangladesh as there was no available psychometrically valid instrument measuring it.

OBJECTIVES

We aimed to test the psychometric properties of the interpersonal needs questionnaire (INQ-15) and acquired capability for suicide scale-fearlessness about death (ACSS-FAD) in Bangla along with the determination of the level of thwarted belongingness, perceived burdensomeness, and acquired capability for suicide.

MATERIALS AND METHODS

We collected data between 29 March and 14 April 2022 from 1,207 students of medical colleges and universities in Bangladesh by Google form. We assessed the psychometric properties of Bangla INQ and ACSS-FAD scales and examined factors associated with thwarted belongingness, perceived burdensomeness, and acquired capability for suicide.

RESULTS

The mean age of the participants was 22.82 ± 1.68 (range 18-29) years, 51% were females, 84% were graduate students, and 92% were unmarried. Both of the scales revealed acceptable levels of reliability. Confirmatory factor analysis revealed a two-factor structure of Bangla INQ after dropping three items from thwarted belongingness domain (item 9, 11, and 12) and a single factor structure for Bangla ACSS-FAD after dropping three items (item 1, 4, and 6). Perceived burdensomeness was significantly higher in females, students with a history of mental illness, family history of suicide, and the history of suicidal attempts. Fearlessness about death was significantly higher among females, non-Muslim participants, and history of suicidal attempts.

CONCLUSION

The current study revealed psychometric properties of two suicide scales (INQ and ACSS-FAD) in Bangla that can be used in subsequent studies. Prevention strategies targeting to females, persons with psychiatric disorder, history of previous attempt(s) should be prioritized specially among the young age group.

Population attributable fractions of clinical and social risk factors for suicide in Bangladesh: Finding from a case-control psychological autopsy study

BACKGROUND

Our knowledge of suicide in low-income countries is limited. Understanding the importance of factors that contribute to suicide risk will allow for the appropriate allocation of limited resources. In order to prioritize suicide prevention activities in Bangladesh, we estimate the fractions of suicides attributable to key risk factors.

METHODS

Using data from matched cases (100) and controls (100) as part of a psychological autopsy study in Dhaka, we estimate the population attributable fraction for key clinical (psychiatric disorders and physical disability), and social (life events, psychical and/or sexual abuse, unemployment, and social isolation) risk factors for suicide in Bangladesh.

RESULTS

Assuming a causal relationship, life events were responsible for the largest proportion of suicide deaths (85.9%; confidence interval [CI], 79.6-90.2), followed by mental disorder (49.5%; CI, 45.3-53.4). The population attributable fraction for the risk factors was 42.9% (CI, 40.6-45) for depression, 11% (CI, 8.9-13) for sexual abuse, and 34.9% (CI, 10.1-52.9) for social isolation.

CONCLUSIONS

The study determined the population attributable fraction of risk factors for suicide in Bangladesh. Prevention strategies should be prioritized on the management of the aftermaths of adverse life events, treatment of psychiatric disorders, sexual abuse, and social isolation in the country.

Efficacy and safety of single-dose liposomal amphotericin B in patients with visceral leishmaniasis in Bangladesh: a real-life experience

Liposomal amphotericin B (LAmB) is the drug of choice in Bangladesh to eliminate the burden of visceral leishmaniasis, also known as kala-azar, a fatal protozoan parasitic disease if left untreated. We aimed to assess efficacy and safety of a single-dose (10 mg/kg) LAmB in visceral leishmaniasis (VL) treatment among the visiting children and adults in a tertiary care setting. This prospective study includes 11 children and 19 adults with a confirmed diagnosis of kala-azar (total 30 cases). Intravenous infusion of LAmB (10 mg/kg body weight) was given to all of the patients. Clinical assessments were conducted during treatment, before hospital discharge, and on days 30 and 180 after treatment. Efficacy was estimated in terms of initial cure (at day 30) and the final cure (at 180 days). All information was recorded in a preformed case record form and analysis was performed in SPSS 22. The mean age was 27.13 ± 18.04 years (3-65) with male predominance (60%). Significant regression of spleen size was found following treatment with LAmB at 30 days and 180 days follow up visit (p < 0.05 for all). Overall, rate of initial cure was 90% (n = 27) (child 90.9% vs 89.47% adult) and final cure was 96.66% (n = 29) (child 100% vs 94.73% adult). Fourteen adverse events were recorded mostly including fever and/or shivering (85.71%). No case relapsed or were referred either due to management or Severe Adverse Event (SAE). In real-life experience, the LAmB treatment for visceral leishmaniasis is as safe and effective for treatment of kala-azar patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12639-021-01379-w.

Risk factors of nonalcoholic fatty liver disease in lean body mass population: A systematic review and meta-analysis

The pathophysiology and risk factors of nonalcoholic fatty liver disease (NAFLD) among lean patients is poorly understood and therefore investigated. We performed a meta-analysis of observational studies. Of 1175 articles found through searching from Medline/PubMed, Banglajol, and Google Scholar by two independent investigators, 22 were selected. Data from lean (n = 6768) and obese (n = 9253) patients with NAFLD were analyzed; lean (n = 43 398) and obese (n = 9619) subjects without NAFLD served as controls. Age, body mass index, waist circumference, systolic blood pressure, and diastolic blood pressure (DBP) had significantly higher estimates in lean NAFLD patients than in lean non-NAFLD controls. Fasting blood sugar [MD(mean difference) 5.17 mg/dl, 95% CI(confidence interval) 4.14-6.16], HbA1c [MD 0.29%, 95% CI 0.11-0.48], and insulin resistance [HOMA-IR] [MD 0.49 U, 95% CI 0.29-0.68]) were higher in lean NAFLD patients than in lean non-NAFLD controls. All components of the lipid profile were raised significantly in the former group except high-density lipoprotein. An increased uric acid (UA) level was found to be associated with the presence of NAFLD among lean. Cardio-metabolic profiles of nonlean NAFLD patients significantly differs from the counter group. However, the magnitude of the difference of lipid and glycemic profile barely reached statistical significance when subjects were grouped according to lean and nonlean NAFLD. But DBP (slope: 0.19, P < 0.037), HOMA-IR (slope: 0.58, P < 0.001), and UA (slope: 0.36, P = 0.022) were significantly higher if NAFLD was present compared to that of non-NAFLD group. Lean and nonlean NAFLD patients are metabolically similar and share common risk factors.

Comparison of clinical manifestation of dengue fever in Bangladesh: an observation over a decade

BACKGROUND

The clinical presentation of dengue fever had been observed to change with time since its first outbreak in 2000 in Bangladesh. This report showed the clinical presentation of the 2019 outbreak in Bangladesh along with its comparison to previous outbreaks witnessed in this region.

METHODS

This hospital-based cross-sectional study was conducted in one of the largest tertiary care hospitals in Dhaka city. A total of 553 laboratory-confirmed and 194 probable dengue cases were interviewed. The clinical manifestation of the confirmed cases of the current outbreak was compared with three of the outbreak reports retrieved from the databases. R version 3.6.3 was used for data analysis.

RESULTS

Among the confirmed cases, two-thirds were male (63.2%) and the average age was 27(± 11) years. Positive tests for NS1 and IgM were present in 99.6% (n = 525/527) and 82.6% (n = 38/46) of the cases, respectively. Thrombocytopenia was present in 66.1% of cases. Fever (100%) was common for all. Gastrointestinal (GIT) features, including abdominal pain (86.5%), anorexia and/or vomiting (69.6%), and Diarrhea (> 3 motions/day) (26.2%) were more frequent than typical rash and other pain symptoms. Hypotension was present in approximately a quarter of patients (25%). GIT features (anorexia, nausea, and/or vomiting) and hypotension were more common among adult participants while bleeding manifestation (melena and vaginal bleeding, p = 0.009 & 0.032) was more frequent in pediatric patients. Compared to outbreaks of 2008, 2016, and 2018, increasing trends in GIT symptoms e.g. anorexia, abdominal pain, and diarrhea were observed. While a negative trend in hemorrhagic manifestations (skin rash, melena, and conjunctival hemorrhage/hemorrhagic sclera) and arthralgia/joint pain were found.

CONCLUSION

The present outbreak was noticeably characterized by GIT symptoms and hypotension in addition to the typical clinical features like rash and pain symptoms. An increasing trend in GIT features and decreasing trend in hemorrhagic manifestations was noted over the last decade of dengue outbreaks.

Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh

BACKGROUND

The mosquito-borne arboviral disease dengue has become a global public health concern. However, very few studies have reported atypical clinical features of dengue among children. Because an understanding of various spectrums of presentation of dengue is necessary for timely diagnosis and management, we aimed to document the typical and atypical clinical features along with predictors of severity among children with dengue during the largest outbreak in Bangladesh in 2019.

METHODS

We conducted a cross-sectional study between August 15 and September 30, 2019. in eight tertiary level hospitals in Dhaka city. Children (aged < 15 years) with serologically confirmed dengue were conveniently selected for data collection through a structured questionnaire. Descriptive, inferential statistics, and multivariable logistic regression were used to analyze data.

RESULTS

Among the 190 children (mean age 8.8 years, and male-female ratio 1.22:1) included in the analysis, respectively 71.1 and 28.9% children had non-severe and severe dengue. All children had fever with an average temperature of 103.3 ± 1.2 F (SD). Gastrointestinal symptoms were the most common associated feature, including mostly vomiting (80.4%), decreased appetite (79.5%), constipation (72.7%), and abdominal pain (64.9%). Mouth sore, a less reported feature besides constipation, was present in 28.3% of children. Atypical clinical features were mostly neurological, with confusion (21.3%) being the predominant symptom. Frequent laboratory abnormalities were thrombocytopenia (87.2%), leucopenia (40.4%), and increased hematocrit (13.4%). Age (AOR 0.86, 95%CI 0.75-0.98, p = 0.023), mouth sore (AOR 2.69, 95%CI 1.06-6.96, p = 0.038) and a decreased platelet count (< 50,000/mm3) with increased hematocrit (> 20%) (AOR 4.94, 95%CI 1.48-17.31, p = 0.01) were significant predictors of severity.

CONCLUSIONS

Dengue in children was characterized by a high severity, predominance of gastrointestinal symptoms, and atypical neurological presentations. Younger age, mouth sores, and a decreased platelet with increased hematocrit were significant predictors of severity. Our findings would contribute to the clinical management of dengue in children.

Quality of life of COVID-19 recovered patients in Bangladesh

Coronavirus Disease-2019 (COVID-19) quickly surged the whole world and affected people's physical, mental, and social health thereby upsetting their quality of life. Therefore, we aimed to investigate the quality of life (QoL) of COVID-19 positive patients after recovery in Bangladesh. This was a study of adult (aged ≥18 years) COVID-19 individuals from eight divisions of Bangladesh diagnosed and confirmed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) from June 2020 to November 2020. Given a response rate of 60% in a pilot study, a random list of 6400 COVID-19 patients was generated to recruit approximately 3200 patients from eight divisions of Bangladesh and finally a total of 3244 participants could be recruited for the current study. The validated Bangla version of the World Health Organization Quality of Life Brief (WHOQOL-BREF) questionnaire was used to assess the QoL. Data were analyzed by STATA (Version 16.1) and R (Version 4.0.0). All the procedures were conducted following ethical approval and in accordance with the Declaration of Helsinki. The mean scores of QoL were highest for the physical domain (68.25±14.45) followed by social (65.10±15.78), psychological (63.28±15.48), and environmental domain (62.77±13.07). Psychological and physical domain scores among females were significantly lower than the males (p<0.001). The overall quality of life was lower in persons having a chronic disease. Participants over 45 years of age were 52% less likely to enjoy good physical health than the participants aged below 26 years (AOR: 0.48, CI: 0.28-0.82). The quality of life of employed participants was found 1.8 times higher than the unemployed (AOR: 1.80, CI: 1.11-2.91). Those who were admitted to hospitals during infection had a low QoL score in physical, psychological, and socials domains. However, QoL improved in all aspect except the psychological domain for each day passed after the diagnosis. These findings call for a focus on the quality of life of the COVID-19 affected population, with special emphasis given to females, older adults, unemployed, and people with comorbidities.

Acceptance of COVID-19 vaccine and its determinants: evidence from a large sample study in Bangladesh

AIM

Our study aimed to understand the acceptance level of the COVID-19 vaccine and its determinants among the adult Bangladeshi population.

METHODOLOGY

This cross-sectional study was conducted in all eight divisions of Bangladesh. Data from 7,357 adult respondents were collected between January 17 and February 2, 2021, using a self-administered semi-structured questionnaire. Statistical software STATA (Version 16.1) was used for all analyses.

RESULTS

The majority of study participants were from the Dhaka division (34.24%). The most common age group was ≤30 years (46.18%). Almost two-thirds of respondents were male (65.50%) and married (67.76%). A large portion (79.85%) of people who had positive vaccine intentions believed that vaccination should be made mandatory for everyone. The majority of the respondents thought that the vaccine would work against COVID-19 infection (67%). In the binary logistic regression analysis, participants who had the education level of graduation or above (AOR = 1.80), age ≥50 years (AOR = 1.97), students (AOR = 2.98), monthly income ≥41,000 BDT (AOR = 2.22), being resident of rural area (AOR = 2.24), respondents from Khulna division (AOR = 6.43) were more likely to receive a COVID-19 vaccine. Those who had family members diagnosed with COVID-19 (AOR = 1.24), presence of chronic disease (AOR = 0.72), and those who were vaccinated in the last few years (AOR = 1.32) were also more likely to accept the COVID-19 vaccine.

CONCLUSION

Most of the respondents were willing to be vaccinated based on the belief that the vaccine will work against COVID-19. As rumors are generating daily, there is a need for policy-level initiative and evidence-based mass media promotion to keep inspired the general Bangladeshi people to accept the COVID-19 vaccine whenever it will be available at the individual level.

Mental health of young people amidst COVID-19 pandemic in Bangladesh

BACKGROUND

The psychological burden of the coronavirus disease 2019 (COVID-19) outbreak and lockdown strategy among young people not diagnosed with COVID-19 in the general population remains unknown and often have been overlooked. The objective of the study was to assess the prevalence and predictors of anxiety, depression and stress among young people diagnosed with COVID-19 of Bangladesh amidst the pandemic.

METHODS

A cross-sectional online survey was conducted from 1 May to 30 May 2020 using an online Google form-based questionnaire posted on Facebook. A snowball sampling approach was used for data collection. A total of 974 self-declared healthy individuals not diagnosed with COVID-19 participated here. Anxiety, depression and stress were measured using Bangla validated Generalized Anxiety Disorder Scale-7 (GAD-7), Patient Health Questionnaire (PHQ-9) scale, and Perceived Stress Scale (PSS), respectively. Statistical software SPSS 20 was used for analysis.

RESULT

Average age of the population was 25.86 ± 6.26 (SD) years with nearly half (48.6%) of them being young people (15 to ≤24 years). Most of the participants were male (76.3%). The overall prevalence of anxiety, depression and stress was found to be 64.1%, 73.3% and 69.4%, respectively. Young people had significantly higher proportion of anxiety (67.2% vs 61.1%), and depression (78.2% vs 68.7%) compared to adults (p = 0.045 and p < 0.001, respectively). However, most of the participants had mild depression (30.3%), minimal anxiety (31.4%), and moderate stress (67.5%), and severity of depression and anxiety was higher in the young participants. The mean GAD-7, PHQ-9 and PSS scores were 7.57 ± 5.61, 9.19 ± 6.15 and 16.02 ± 5.55 (SD), respectively. On multivariable logistic analysis, unemployment (Adjusted Odds Ratio [AOR] 3.642; Confidence Interval [CI]: 1.005-13.200; p < 0.05) was the single most important predictor of depression. For stress, unemployment (AOR 1.399; CI: 1.055-1.855), and female sex (AOR 1.638; CI: 1.158-2.317) were significant predictors.

CONCLUSION

Anxiety, depression and stress were highly prevalent among young people (≤24 years) not diagnosed with COVID-19 in Bangladesh amidst the pandemic. Unemployment is the most common underlying determinant. Authorities should address the issue on a priority basis.

Association of hyperlipidemia with breast cancer in Bangladeshi women

Background

The association of circulating lipids with breast cancer is being debated. The objective of this study was to examine the relationship between abnormal plasma lipids and breast cancer risk in Bangladeshi women.

Methods

This was a case-control study designed using a population of 150 women (50 women in each group). The lipid levels of women with breast cancer were compared to the lipid levels of women with benign breast disease (control group 1) and healthy women (control group 2). Study samples were collected from the Department of Surgery, Bangabandhu Sheikh Mujib Medical University, for a period of 1 year. Ethical measures were in compliance with the current Declaration of Helsinki. Statistical analysis was performed with SPSS version 26.

Results

All of the comparison groups shared similar sociodemographic, anthropometric and obstetric characteristics. The incidence of dyslipidemia was significantly higher in breast cancer patients (96%) than in healthy women (84%) and patients with benign breast disease (82%) (P < 0.05 for both). The levels of total cholesterol, triglycerides, and low-density lipoprotein (LDL) cholesterol among the breast cancer patient group were significantly higher than those among both benign breast disease patients and healthy women (P < 0.05), except for high-density lipoprotein (HDL) cholesterol. Adjusting for other factors, body mass index (BMI) (kg/m²) (> 23) [OR 53.65; 95% CI: 5.70–504.73; P < 0.001] and total cholesterol (mg/dl) (≥ 200) [OR 16.05; 95% CI: 3.13–82.29; P < 0.001] were independently associated with breast cancer.

Conclusions

Total cholesterol and BMI are independent predictors of breast cancer risk among Bangladeshi women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12944-021-01480-2.

Virucidal effect of povidone iodine on COVID-19 in the nasopharynx: an open-label randomized clinical trial

Povidone-iodine (PVP-I) is a time-tested antiseptic agent with excellent virucidal (99.99%) properties. Repurposing it against coronavirus disease-19 (COVID-19) is a relatively newer concept and has been sparsely tested in vivo. The most common route of entry of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is the nasopharynx. Averting colonization of the virus could be one of the best options to reduce the incidence of infection. PVP-I gargle and mouthwash were found to be effective in vitro rapid inactivation against SARS-CoV-2 on a smaller scale (Hassandarvish et al. in BDJ 1–4, 2020, Pelletier et al. in ENTJ 1–5, 2020). However, efficacy in humans is lacking. To assess the virucidal effect of PVP-I against SARS-CoV-2 located in the nasopharynx was the objective of this parallel armed randomized clinical trial. We screened all RT-PCR-confirmed COVID-19 cases aged 18 years and above with symptoms. Written informed consent was obtained before randomization. Nasopharyngeal clearance of SARS-CoV-2 was tested after single time application of PVP-I nasal irrigation (NI) at diluted concentrations of .4%, .5% and .6% and PVP-I nasal spray (NS) at diluted concentrations of .5% and .6%. All groups were compared to the corresponding controls (distilled water). The primary outcome was viral clearance in a repeat RT-PCR (qualitative), and the secondary outcome was the number of adverse events. Final data analysis was performed using the statistical software SPSS (Version 20). A total of 189 confirmed COVID-19 cases were randomized into seven groups: 27 patients in each group. Of all, 159 (84.1%) were male, and 30 (15.9%) were female. We observed a statistically significant proportion of nasopharyngeal clearance with all strengths of PVP-I NI and PVP-I NS compared to the corresponding controls. Additionally, 0.5% NI was significantly better than 0.5% NS for viral clearance (p = 0.018) and had the highest nasopharyngeal clearance among all strengths (n = 25, 92.6%). 0.6% NS is better than CNS and 0.5%NS in viral clearance. The only adverse event was nasal irritation recorded in two patients each in the 0.4% and 0.6% PVP-I NI groups (Tables 1 and 2). PVP-I NI and NS are proved as effective virucidal agent against SARS-CoV-2 in human body. Our recommendation is to use PVP-I in naopharynx (as well as oropharynx) to prevent COVID-19.

Healthcare Workers' Knowledge, Attitude, and Practice Regarding Personal Protective Equipment for the Prevention of COVID-19

PURPOSE

Adequate knowledge, positive attitude, and proper practice of personal protective equipment by healthcare workers are necessary to get protection from COVID-19 infection. But this area is yet to be explored. Hence, we aimed to assess the knowledge, attitude, and practice (KAP) regarding personal protective equipment (PPE) among healthcare workers, along with a survey of the possible determinants.

SUBJECTS AND METHODS

For this cross-sectional study, online and offline surveys were conducted among a sample of 393 healthcare workers from five different districts of Bangladesh. A validated self-administered questionnaire comprising five sections (socio-demography, work-related information, knowledge, attitude, and practice) was used for data collection. Multivariate stepwise forward logistic regression was applied to find significant factors associated with good attitude, and practice using SPSS version 25.

RESULTS

The average age of the 393 participants was 28.9±5.2 years with a male-female ratio of one. Of them, 99.5% (n=391) had good knowledge, 88.8% (n=349) had positive attitude and 51.7% (n=203) had good practice regarding PPE. Results revealed that being a physician and living at home were significantly associated with a positive attitude. While being a non-physician, having lower education, working in private hospitals, and using office transport were associated with good practice regarding PPE.

CONCLUSION

The findings demonstrated that the healthcare workers had an overall good knowledge and a positive attitude but a poor practice regarding PPE. This study also highlighted the factors influencing KAP towards PPE that must be addressed in future education, awareness, and counseling programs.

Synthesis and characterization of nanozeolite based composite fertilizer for sustainable release and use efficiency of nutrients

In this research work, we propose macronutrients incorporated slow-release based nano-fertilizer using nanozeolite as a carrier. A simple chemical approach was used to synthesis the proposed nanozeolite composite fertilizer (NZCF). To gain an insight into the properties, morphology and structure of the synthesized NZCF, it was further characterized by different techniques such as powder XRD, FT-IR, SEM, and TG/DTA. A considerable enhancement of the quality and the water retention capacity of the soil was observed as a result of applying the proposed NZCF when compared with a commercial fertilizer. Furthermore, the swelling ratio and the equilibrium water content of NZCF were compared to the commercial fertilizer and their effect on plant growth was observed. Slow-release studies were carried out for both NZCF and the commercial fertilizer. The results of these studies reveled that NZCF possessed a long-term release pattern of the macronutrients and that showed a great potential for promoting plant growth. Hence, the prepared nanocomposite fertilizer can be safely used as an environment-friendly source of nutrients to enhance plant growth.

Leishmaniasis in Dhaka Medical College-experience of three years

The People's Republic of Bangladesh has been working to eliminate visceral leishmaniasis or Kala-azar cases since there was a memorandum of understanding signed between neighboring countries in 2005. As a part of the elimination activity, 44 cases of Kala-azar were diagnosed and treated in the regional referral center Dhaka Medical College Hospital (DMCH) during the last three years, which is reported here. Confirmed leishmaniasis cases were included. Patients attending this specialized center with different demographic characteristics and varied presentations with laboratory findings were reviewed and recorded in a structured case record form. Ethical clearance was obtained prior to starting the study. A total of 44 patients with leishmaniasis were reviewed. Approximately 89% (n = 39) were New Kala-azar (NKA), 7% (n = 3) were Relapse Kala-azar (Relapse KA), only one case (2%) was Kala-azar Treatment Failure (KATF) and Post Kala-azar Dermal Leishmaniasis (PKDL) for both. The mean age of presentation was 32 years. Forty percent of patients had houses made by mud, 26% by tin shed, and the rest lived in buildings and semi-buildings. The predominant clinical features were fever (90.9%), pallor (88.6%), splenomegaly (81.8%) and hepatomegaly (68.2%). rK39 was positive in 90.7% of cases, and 94.4% of cases were positive for LD bodies on splenic aspirate. Of all, 90.90% were treated with Inj. Liposomal amphotericin B and 9.10% with the combination of Inj. Liposomal Amphotericin B and Inj. Miltefosine. Moving forward to the elimination of leishmaniasis from Bangladesh, the study highlights the status, characteristics and treatment of the disease in the country.

Effect of Weight Reduction on Histological Activity and Fibrosis of Lean Nonalcoholic Steatohepatitis Patient

BACKGROUND AND OBJECTIVES

Weight reduction has evidenced benefit on attenuation of histological activity and fibrosis of nonalcoholic steatohepatitis (NASH), but there is scarcity of data for lean NASH subgroup. We have designed this study to compare the effects of weight reduction on histological activity and fibrosis of lean and non-lean NASH.

METHODS

We have included 20 lean and 20 non-lean histologically proven NASH patients. BMI < 25 kg/m2 was defined as non-lean. Informed consent was taken from each subject. All methods were carried out in accordance with the Declaration of Helsinki. Moderate exercise along with dietary restriction was advised for both groups for weight reduction. After 1 year, 16 non-lean and 15 lean had completed second liver biopsy.

RESULTS

Age, sex, alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltrasferase (GGT), Homeostasis model assessment insulin resistance (HOMA-IR), triglyceride and high density lipoprotein (HDL) was similar in both groups. Steatosis, ballooning, lobular inflammation, nonalcoholic fatty liver disease activity score (NAS) and fibrosis was similar in the two groups. In lean/non-lean group, any amount of weight reduction, ≥ 5% weight reduction and ≥ 7% weight reduction was found in respectively 8/11, 5/6 and 2/6 patients. In both lean and non-lean groups, weight reduction of any amount was associated with significant reduction of steatosis, ballooning and NAS, except lobular inflammation and fibrosis. In both groups, weight reduction of ≥ 5% was associated with significant reduction in NAS only. However, significant improvement in NAS was noted with ≥ 7% weight reduction in non-lean group only.

CONCLUSION

Smaller amount of weight reduction had the good benefit of improvement in all the segments of histological activity in both lean and non-lean NASH.

Chikungunya outbreak (2017) in Bangladesh: Clinical profile, economic impact and quality of life during the acute phase of the disease

Background

Chikungunya virus causes mosquito-transmitted infection that leads to extensive morbidity affecting substantial quality of life. Disease associated morbidity, quality of life, and financial loss are seldom reported in resources limited countries, such as Bangladesh. We reported the acute clinical profile, quality of life and consequent economic burden of the affected individuals in the recent chikungunya outbreak (May to September 2017) in Dhaka city, Bangladesh.

Methods

We conducted a cross-sectional study during the peak of chikungunya outbreak (July 24 to August 5, 2017) to document the clinical profiles of confirmed cases (laboratory test positive) and probable cases diagnosed by medical practitioners. Data related to clinical symptoms, treatment cost, loss of productivity due to missing work days, and quality of life during their first two-weeks of symptom onset were collected via face to face interview using a structured questionnaire. World Health Organization endorsed questionnaire was used to assess the quality of life.

Results

A total of 1,326 chikungunya cases were investigated. Multivariate analysis of major clinical variables showed no statistically significant differences between confirmed and probable cases. All the patients reported joint pain and fever. Other more frequently reported symptoms include headache, loss of appetite, rash, myalgia, and itching. Arthralgia was polyarticular in 56.3% of the patients. Notably, more than 70% patients reported joint pain as the first presenting symptom. About 83% of the patients reported low to very low overall quality of life. Nearly 30% of the patients lost more than 10 days of productivity due to severe arthropathy.

Conclusions

This study represents one of the largest samples studied so far around the world describing the clinical profile of chikungunya infection. Our findings would contribute to establish an effective syndromic surveillance system for early detection and timely public health intervention of future chikungunya outbreaks in resource-limited settings like Bangladesh.

A major outbreak of chikungunya virus occurred for the first time in Dhaka, Bangladesh between May and September 2017. In this study, a face-to-face interview with a structured questionnaire was conducted to collect data to investigate the clinical symptoms, quality of life, and economic aspects of 1,326 chikungunya patients during the first two weeks of infection. The severity of the disease was similar to previously reported severe outbreaks elsewhere but joint pain prior to fever emerged as a unique symptom in the Dhaka outbreak. This unique clinical feature was consistent across age and sex of the patients. Some clinical symptoms varied with age. For instance, a higher proportion of skin rash were found among children (under 15) while morning stiffness, severity, and duration of pain were proportionally higher among other age groups. Joint swelling was most commonly noted in elderly patients (60+ years). About 83% of the patients reported low to very low overall quality of life (QoL) during first two weeks of chikungunya infection. Elderly patients reported lower average QoL scores compared to <60 years. Interestingly, housewives reported higher QoL score compared to those of businessmen and service holders. In particular, patients in the highest monthly income category bracket (BDT 50,000 per month; >$606 per month) reported the lowest average overall score. Nearly 95% of the patients have mostly confined to sickbed and approximately 30% of them lost more than 10 days of productivity due to severe arthropathy. Our study would contribute to establishing an effective syndromic surveillance system for early detection and timely public health intervention of future chikungunya outbreaks in resource-limited countries like Bangladesh.

Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

Background

The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.

Methods

Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).

Results

Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.

Conclusion

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

Significance of R1 resection margin in colon cancer resections in the modern era

AIM

Circumferential resection margin involvement (R1) in rectal cancer is a predictive factor for poor prognosis. The aim of this study was to confirm the prognostic significance of R1 in colon cancer resection and to establish whether the introduction of laparoscopic colorectal surgery influenced this.

METHOD

Prospectively collected data on a patient pathway data manager for sequential patients with colon cancer treated at our specialist unit from January 2005 to December 2010 were analysed. There were 1110 colonic resections (elective 865; emergency 245). A circumferential resection margin involvement of < 1 mm was considered positive.

RESULTS

The total R1 rate was 13.3% (elective 10.4%; emergency 23.6%; P < 0.001). Other statistically significant risk factors for an R1 resection included tumour perforation (P < 0.001), poorly differentiated carcinoma (P < 0.001), T4 tumour (P < 0.001), vascular invasion (P < 0.001), lymph node metastasis (P < 0.001), distant metastasis (P < 0.001) and palliative resection (P < 0.001). Over half of the elective resections were undertaken laparoscopically (486/865; 56.2%). When compared with elective open resection (379/865; 43.8%), the R1 rate was similar (P = 0.491) with similar disease-free survival (DFS) and overall survival (OS). The overall relapse rate was 18.9% in R0 and 55.5% in R1 resections (P < 0.001). Kaplan-Meier survival analysis showed significant improvements in DFS and OS in R0 over R1 patients.

CONCLUSION

The R1 margin in colon cancer resection is an important marker for advanced disease and a prognostic factor for DFS and OS. The introduction of laparoscopic surgery has not influenced the outcome in our unit despite a complex case mix.

Retrograde intussusception through a loop ileostomy: a case report and review of the literature

Intussusception through loop ileostomy is rare and must be treated without delay to avoid further complications. Retrograde intussusception is even rarer. We report a case of small bowel obstruction caused by retrograde intussusception through the distal limb of loop ileostomy in a male patient. A literature search is also carried out regarding this entity and published reports are discussed.