Study of Serum Electrolytes (Sodium and Potassium) Abnormalities in Acute Stroke

Stroke is the common cause of death and disability worldwide, as well as in Bangladesh. Serum electrolytes abnormalities or dyselectrolytaemia is one of the major acute complications of stroke. Dyselectrolytaemia or serum electrolytes (sodium and potassium) abnormalities are more common in patients with acute stroke that can be easily measured. The study was planned to find out the serum electrolytes (sodium and potassium) abnormalities in acute stroke patients. This cross-sectional study was conducted in the Department of Neurology and Medicine, Mymensingh Medical College and Hospital from January 2019 to June 2020. Total 84 purposively selected patients with acute strokes were evaluated following informed written consent. Diagnosis was confirmed by neuroimaging of brain. Moreover, serum electrolytes level was measured for each patient. Data were collected by interviews, clinical examinations & laboratory investigations of the patients using a case record form and analysis was carried out by the help of SPSS 25.0. Mean age of the patients with acute strokes were 57.65±15.79 years. About two thirds (60.7%) of the patients were male and the remaining (39.3%) were female. Sodium imbalances were observed in 32.2% and potassium imbalances in 25.0% cases. About 66.7% haemorrhagic strokes patients and 42.2% ischaemic strokes patients had dyselectrolytaemia (p<0.05). More than twenty eight percent (28.6%) of all stroke patients had hyponatraemia, which was more common (35.9%) among haemorrhagic strokes patients (p<0.05). Of all stroke patients 21.4% had hypokalaemia, which was more common (28.2%) in haemorrhagic strokes patients (p<0.05). This study reveals that, serum electrolytes (sodium and potassium) abnormalities are more common in haemorrhagic than ischaemic strokes, which is mainly hyponatraemia and hypokalaemia.

The role of diffusion-weighted MRI in the accurate diagnosis of vertebral compression fractures: A comparative study

INTRODUCTION

Accurately distinguishing between benign and malignant vertebral compression fractures is crucial for clinical management. This study evaluated the predictive accuracy of diffusion-weighted imaging (DWI) in differentiating the cause of vertebral fractures using MRI.

METHODS

A longitudinal cross-over study was conducted at Jinnah Postgraduate Medical Centre (JPMC) Karachi from July 2018 to January 2021. Patients with vertebral compression fractures underwent T1-weighted, T2-weighted, and DWI imaging with ADC mapping on a 1.5 T MRI scanner. Imaging findings were compared with histopathologic results and clinical follow-up. Sensitivity, specificity, and ROC curve analyses were performed.

RESULTS

The study enrolled 303 patients with a mean age of 43.6 ± 10.9 years, of whom 118 were male. DWI demonstrated high accuracy in predicting the cause of vertebral compression fractures, with a sensitivity of 96.2 %, a specificity of 76.2 %, and an area under the ROC curve of 0.857. The optimal ADC cut-off value was 0.82 × 10˄-3 mm˄2/s, which yielded a positive predictive value of 79.7 % and a negative predictive value of 95.4 %.

CONCLUSIONS

DWI is a safe and non-invasive imaging modality with excellent predictive accuracy in differentiating between benign and malignant vertebral compression fractures. Iso- or hypointensity of collapsed vertebral bodies on DWI suggests a benign lesion, while T2-weighted hyperintensity is highly indicative of malignancy. Low signal on ADC is also highly indicative of malignant vertebral fractures. Incorporating DWI improves accuracy in assessing vertebral lesions, especially when standard sequences are inconclusive.

IMPLICATIONS FOR PRACTICE

DWI revolutionizes vertebral compression fracture diagnosis, distinguishing between benign and malignant cases. This precision guides treatment decisions, minimizing the necessity for invasive procedures like biopsy. As a safe and reliable imaging method, DWI elevates patient care, ensuring accurate diagnostics and improved outcomes.

Women's Overall Satisfaction with Childbirth Experience in a Tertiary Level Hospital of Bangladesh

Women's satisfaction with care in labour is a positive indicator for the woman herself, as well as healthcare organization as a whole. This study was aimed to find out the women's satisfaction with their childbirth. It also tried to identify significant differences across various mode of delivery and satisfaction related to women's childbirth experience. It was a descriptive type of cross-sectional study conducted among 278 post-natal mother who give live birth at government tertiary hospital namely Mymensingh Medical College Hospital, Bangladesh. The study was conducted in the department of Obstetrics and Gynaecology during the period of January 2020 to December 2020. Data were collected from the respondents by face to face interview using a self-administered semi-structured questionnaire including Salmon's Item List. Level of overall satisfaction with childbirth was assessed by Salomon's Item List. Data analysis was carried out by SPSS version 25.0. The dimension of physical discomfort, emotional distress and fulfilment had a Cronbach's alpha of 0.746, 0.966 and 0.982 respectively. The internal consistency of each dimension was found to be acceptable and reliable. The mean scores of the dimensions in Salmon's Item List for Fulfilment, Emotional distress and Physical discomfort was found to be 69.20, 50.85 and 50.40 respectively. Higher total scores indicate a more positive evaluation of the childbirth experience and lower scores indicate a more negative evaluation. In this study the Overall mean scores of the three dimensions was 50.75. The mean scores of 'fulfillment' was higher in normal vaginal delivery (NVD) and scores of both "emotional distress" and "physical discomfort" were higher in lower uterine cesarean section (LUCS). Among all the three dimensions, mean scores of 'fulfillment' was higher in NVD indicating more satisfaction with NVD than LUCS and instrumental delivery. On the other hand, scores of "physical discomfort" and "emotional distress" were lower in NVD indicating less satisfaction with NVD than LUCS.

Burnout Rates in Clinical Radiation Oncology and Variations across Professional Subgroups

PURPOSE/OBJECTIVE(S)

Physician and medical professional burnout has emerged as an important issue in clinical medicine and has been shown to negatively affect patient outcomes. The aim of this study is to determine how rates of burnout vary between different radiation oncology professional subgroups.

MATERIALS/METHODS

Participants were selected from those employed in one of the professional subgroups (radiation therapists, nurses, physicists, dosimetrists, and physicians) at two institutions that cover a total of seven sites. 126 individuals were recruited to participate. In addition to demographics, participants were asked to respond to questions regarding professional burnout utilizing the Maslach Burnout Inventory (MBI). Responses were on a seven-point Likert scale with subcategories of Exhaustion, Depersonalization, and Personal Achievement. Each participant's score per subcategory was categorized as either low, moderate, or high. For our primary outcome, frequencies and proportions were reported and Fisher's Exact Test was used to evaluate whether there was a statistically significant difference in proportions in categorized burnout scores across professional subgroups. Secondary analyses were performed comparing burnout across sex, age, and categorized years in position. An alpha level of 0.05 was used for all analyses.

RESULTS

In total, 55 participants responded to the survey: 12 nurses, 8 dosimetrists, 12 physicians, 5 physicists, and 18 radiation therapists for a response rate of 43.6%. Demographics were consistent across professional subgroups with the exception of participant sex (p = .0397), which had a greater proportion of females (72.22%) in the Radiation Therapist subgroup. Among the three subcategories, only Exhaustion had a significant difference between groups (p = .0494) with Dosimetrists (62.50%) and Physicists (40.00%) experiencing the highest level of burnout. For Depersonalization, at least one individual in each subgroup identified high burnout with higher rates among the Dosimetrists (25.00%) and Physicists (40.00%). Similarly, at least one person in each subgroup reported high burnout in Personal Achievement, but the highest response was among Dosimetrists (37.50%). In total, at least 12.75% of participants reported high burnout in at least one subcategory. No statistically significant differences in burnout were detected in our secondary analyses across sex, age, and years in position.

CONCLUSION

Our study showed that burnout rates are moderate in members of the radiation oncology team, with dosimetrists and physicists displaying the highest levels of burnout. In order to better estimate professional burnout, larger studies should be conducted to determine causes of burnout. Furthermore, wellness programs should be encouraged and incentivized to help reduce burnout and improve workplace morale, occupational fulfillment, and effective patient care.

Phase 2 Trial of Anti-PD1 and 8 Gy in 1 Fraction for Relapse/Refractory Myeloma

PURPOSE/OBJECTIVE(S)

Relapsed, refractory multiple myeloma is associated with poor outcome. Role of radiotherapy is mainly for palliation. Anti-PD1 inhibitors have failed to show efficacy in relapsed refractory myeloma patients. A phase 2 trial (NCT03267888) was conducted to see if radiotherapy (8 Gy in 1 fraction) and anti-PD1 (Pembrolizumab) could provide early signals of safety and response.

MATERIALS/METHODS

A prospective single-center phase 2 trial involving patients >18 years of age with ECOG 0-1 was conducted after obtaining IRB approval. Patients had to have ISS stage I-III multiple myeloma that was either relapsed or refractory, an osseous and/or extraosseous lesion that could be radiated, and who were candidates for pembrolizumab. Patients had to have either measurable disease per the International Myeloma Working Group Criteria (IMWG) and/or had to have progressive disease on imaging. Radiotherapy was given on day 0, cycle 1 followed by pembrolizumab (200 mg/kg iv on day 2 or 3, then every 3 weeks +/- 7 days) on day 2-3 for at least 2 years or until progression. Primary endpoint was toxicity. Secondary endpoints were IMWG response, abscopal response, overall survival, and immunological changes in patient's blood. Patients were assessed at 3 months, 6 months, and 12 months IMWG criteria as well as serial PET/CT based imaging. Patients with stable disease or better were continued on the trial. Patients that progressive were removed. Standard statistical analysis was performed, and included Kaplan-Meier to estimate OS and PFS.

RESULTS

From June, 2018 until October, 2021, 32 patients were screened and 25 were enrolled. Of the enrolled patients, 76% were Caucasian, 64% had ECOG 1, and the mean age was 60 years. Prior to enrollment, the mean number of prior lines of therapy that the patients had failed was 5.20 (range: 2 - 11), suggesting a cohort with poor expected outcome. These cohort also had limited alternative options. Toxicity, as its primary endpoint, was acceptable. There were no grade 2 or higher radiation related toxicity within the irradiated volume. Only one case of grade 3 or higher pembrolizumab-related toxicity was noted amongst the 25 patients. Abscopal response was noted in 5 of 25 patients (20% patients). Several patients showed robust reductions in the paraproteins and other myeloma labs, suggesting response to radiotherapy and anti-PD1 combination. These patients were also associated to have a robust CD 8 T cell activation and an abscopal response. The secondary outcomes were better than expected for this cohort.

CONCLUSION

Combination therapy of single-fraction, low-dose radiation therapy with pembrolizumab in patients with relapsed or refractory multiple myeloma is worth assessing in future trials.

Phase wise evaluation of teachers by the students in Mymensingh Medical College, Bangladesh

Students' evaluations of teachers are used to ensure quality in medical education and as a tool for faculty development. Teacher evaluation is also one of the performance measurements of the Annual Performance Agreement (APA). The objective of this research was to evaluate teachers of four phases of MBBS program by the students of corresponding phase. This cross sectional descriptive type of observational study was conducted in Mymensingh Medical College (MMC), Bangladesh during the period of January 2023 to March 2023. A total of 40 purposively selected teachers engaged in either lecture, tutorial or clinical bedside classes were evaluated by 469 randomly selected students using a self-response evaluation form provided by Centre for Medical Education (CME) which contains 16 statements of 5 points: 1=Never, 2=Once in a while, 3=Sometimes, 4=Most of the time and 5=Almost always. Data were analyzed in SPSS, version 22.0. Ten (10) teachers from each phase were included in the study. Among the students 169(36.0%) were from phase I followed by each 100(21.3%) from phase II, III and IV. Out of 80, total mean score of phase I was 64.11±9.187. Total mean score of phase II was 72.08±7.520 and that of phase III was 72.19±6.510. Highest total mean score (76.95±5.032) was found in phase IV. Overall mean score of teachers of MMC irrespective of phase was 70.27±9.017. Mean scores of teachers in individual statement of phase I, II, III and IV were 4.02±0.847, 4.49±0.706, 4.51±0.614 and 4.81±0.482 respectively. Mean scores in individual statement of every phase were between "Most of the time (4)" and "Almost always (5)" indicating positive performance of evaluated teachers. All of the 40 teachers had a median score of more than 4 in the explicit issues indicating that most of the students agreed that the teachers taught their core subjects well. They had a median score of more than 4 in the implicit issues too which indicated that the students felt that all of the teachers gave importance to the core values. Moreover, 21(52.5%) teachers had a median score of 5 in both explicit and implicit issues indicating highly positive performance of those evaluated teachers. Teachers of Mymensingh Medical College performed admirably across all phases. This type of feedback evaluation should be applied throughout every institute as it will help faculty members enhance their abilities and academic performance, leading to overall faculty development. As a result, quality of medical education will be ensured.

Mental Health among the Infertile Women Attending Tertiary Level Hospital in Bangladesh

Infertility is a global public health issue and is a low control stressor often leading to increased level of depression, anxiety and stress. It is a severely distressing experience for many couples and it may significantly affect the physical and mental life of infertile individuals. The study was to assess the level of mental health state (depression, anxiety and stress) among the infertile women in tertiary level hospital in Bangladesh. This cross sectional descriptive study was conducted at two tertiary level hospitals in Bangladesh named BSMMU and CARe Medical College. Three hundred and fifty-two (352) infertile women were taken as a sample and a semi-structured questionnaire which contains question with related variables and DASS 21 was used. The study results revealed that, the mean age of the respondents was 29.32 years. Almost three-fourth 260(73.86%) of the respondents were Muslim and 349(99.14%) respondents were educated. Two-third 223(63.35%) of the respondents were from rural area and 177(50%) were housewife. About 229(65.05%) were live in a joint family and 205(58.23%) had an abortion history. Majority 312(88.63%) of the respondents had monthly income BDT <30000 Taka. According to DASS 21, 175(49.71%) had depression, 212(60.22%) had anxiety and 157(44.60%) suffered from stress. There was a significant association (p<0.05) found between mental health state with age, religion, residence and occupation. This finding reinforces the need of attention counseling and others advance psychological interventions for positive impact on outcome during treatment of this group of women.

Combined Analysis of a Phase III Randomized Trial and Phase II Prospective Trial with Blind Control Matching of Patients Receiving Whole-Lung, Low-Dose Radiation for COVID-19: Full Results and Immunologic Correlates of the RESCUE 1-19 Trial

PURPOSE/OBJECTIVE(S)

Whole-lung, low-dose radiation (LD-RT) for COVID-19 requires randomization and biologic correlates to determine causality and mechanism.

MATERIALS/METHODS

A phase III trial randomized COVID-19 patients to physician's choice of drug therapy with or without LD-RT. Primary endpoint was intubation-free survival (IFS). The trial was designed with 80% power (two-sided log rank, alpha 0.05) to detect a hazard ratio of 0.3 after 12 intubation events. Estimating a 25% event rate, the planned sample size was 84 patients plus 25 to account for declining intubation rates and screen failures. Due to hospitalization declines and other barriers, the trial closed prematurely. Available randomized data were analyzed by intention-to-treat and combined with phase II results and immunologic correlates, using one-sided significance and an alpha of 0.1 to inform future trial design.

RESULTS

From Jun 2020-Jun 2022, 14 patients were randomized on a phase III trial. From Apr 2020-Dec 2020, 42 patients were enrolled on a phase II trial and blindly matched to 40 controls from contemporaneous trials. 96 total patients and 193 blood samples were available for analysis. Mean hospital duration with LD-RT was 12.9 vs 15.4 days in controls (p = 0.12). Oxygen flow rate >15 L/min (26% vs 38%, p = .27), high-flow oxygen >30 L/min (24% vs 38%, p = 0.18), non-invasive positive-pressure >60 L/min (9% vs 27%, p = 0.03), and mechanical ventilation (9% vs 24%, p = 0.05) reduced with LD-RT. Mean supplemented oxygen volume was 171,759 vs 547,626 liters in controls, with daily means of 10 vs 23 L/min (p = 0.03). Radiographs worsened in 43% vs 71% of controls (p = 0.03). Arterial blood gas mean P/F ratios improved 22% after LD-RT vs declined 8% in controls (p = 0.12). Mean days febrile were 1.8 vs 2.9 in controls (p = 0.10). Rate of myocardial injury was 47% vs 40% in controls (p = 0.77). Flow cytometry revealed 4-fold and 30-fold larger expansions, respectively, in CD8- and CD4-positive CD3+PD1+Ki67-high proliferating cytotoxic T-cells (300% vs 75% expansion, p = 0.07) and helper T-cells (200% expansion vs 6% contraction, p = 0.03) at day 7. In the randomized cohort, mean oxygen volume fell 75% with LD-RT to 78,336 vs 316,786 liters in controls (p = 0.13), mean flow rates were 5.1 vs 18.4 L/min (p = 0.13), radiographs worsened in 50% vs 100% (p = .17), P/F ratios improved 31% vs declined 68% in controls (p = 0.03), hospital duration was 8.9 vs 11.5 days (p = 0.22), and zero LD-RT patients vs one control intubated.

CONCLUSION

Combined analysis of a phase II/III randomized trial suggests that LD-RT prevents ventilation, reduces supplemental oxygen need, improves clinical course, and enhances immune response. LD-RT may have both immediate direct effects and delayed enhanced immunity in COVID-19. Larger multi-institutional trials are justified.

Phase II Multi-Institutional Study of a Low-Dose (4 Gy) Palliative Response-Adapted Radiotherapy Regimen for Symptomatic Bone Metastases from Multiple Myeloma: Planned Interim Analysis of First 40 Patients

PURPOSE/OBJECTIVE(S)

Painful bone lesions are common in patients with multiple myeloma (MM). Radiotherapy (RT) is effective in providing pain relief from MM bone lesions in over 80% of patients. There is no consensus as to the most effective dose or fractionation for palliation. Shorter courses of therapy are not only more convenient for patients, but they also have less impact on timing of systemic therapies. There is precedent for using 4 Gy in the palliation of lymphomas, which have similar radiosensitivity to myeloma. The primary objective of this trial is to determine whether treatment with a total dose of 4 Gy to a painful myeloma bone lesion achieves patient-reported pain reduction comparable to historical controls at 4 weeks.

MATERIALS/METHODS

Patients with a known diagnosis of MM and a painful bone lesion that was not at the base of skull, in need of stabilization, or causing cord compression were treated with 4 Gy (2 Gy x 2 or 4 Gy x 1). Patients' pain was measured using the brief pain index (BPI) prior to treatment and at 2, 4, 8 weeks and 6 months following treatment. Pain response was determined by the international consensus on palliative radiotherapy and considered change in BPI and oral morphine equivalent dose (OMED). A planned interim analysis for futility was completed after 40 patients. Reirradiation with clinician choice regimens could be considered at ≥4 weeks following initial treatment for indeterminate pain response or pain progression.

RESULTS

Forty patients were treated at 6 institutions between 2019 and 2022. Median age was 65 years with 40% women and 88% with an ECOG of 0-1. A complete response (CR) was defined as a BPI score of 0 with no concomitant increase in OMED. A partial response (PR) was defined as BPI reduction in 2 or more without analgesic increase, or an OMED reduction of 25% or more without an increase in pain. An indeterminate response (IR) was any response that is not captured by a CR, PR or pain progression. A CR was achieved in 48%, a PR in 38% of patients, an IR in 13% with 1 patient who refused participation. Pain response was achieved in 86% of patients. Seven patients (18%) requested reirradiation at ≥4 weeks. Median BPI at baseline and 4 weeks after RT for patients with CR, PR, and IR were 3.75 and 0, 4.00 and 1, and 5.25 and 4.75, respectively. Median change of BPI between baseline and 4 weeks after RT for all responders (CR and PR) was -3.25. The median PTV volume (cc) for patients with CR, PR and IR were 81, 140 and 226, respectively. Based on these results, the futility threshold was not met, and the recommendation by the DSMC is to continue the trial.

CONCLUSION

In the first 40 patients who received 4 Gy palliation for painful bone lesions from multiple myeloma, there were 86% that had a pain response (48% CR, 38% PR). This low dose, response-adapted treatment, led to reirradiation in less than 20% of patients.

The Impact of Hypertension, Coronary Heart Diseases and Diabetes on COVID-19 Illness

This study tried to understand the impact that hypertension, coronary heart diseases and diabetes can have on the intensity of coronavirus within the human body. This study was conducted using a systematic review process where secondary data have been collected from 10 previously published research papers. Most of the individuals contracting COVID-19 are also suffering from diabetes, cardiovascular diseases and hypertension. The studies used to carry out this systematic review have exhibited a pattern that indicates a strong correlation. That being said, because of the possibility of extraneous variables, most of the studies at this point have significant drawbacks. Many of such variables for example, smoking behavior or level of fitness have not been considered while selecting sample for most of the studies. Therefore, more highly targeted studies need to be carried out for understanding this disease and the long- and short-term impact it can have.

Comparison of Wet Mount Microscopy and Giemsa Staining to PCR in the Diagnosis of Vaginal Trichomoniasis in a Tertiary Level Hospital of Bangladesh

Trichomonas vaginalis (T vaginalis) is the most prevalent non-viral sexually transmitted infection of the reproductive age group, which may lead to various complications, if left untreated. This study aimed to diagnose Trichomonas vaginalis infection by different diagnostic procedures and to evaluate the efficacy of different diagnostic procedures. This cross-sectional descriptive study was conducted among 102 women with vaginal discharge at the Department of Obstetrics & Gynecology at Mymensingh Medical College Hospital (MMCH) from July 2019 to December 2020. Three ectocervical swabs were collected from each patient. Saline wet mount microscopy, giemsa staining and PCR were performed for each patient. Data were collected using a structured questionnaire and analyzed using Excel 2007, statistical package for social sciences (SPSS) version 26.0. The PCR assay detected Trichomonas vaginalis positivity in 6(5.9%) of 102 patients, followed by Giemsa staining 4.9% and Wet mount examination 2.9%. Wet mount microscopy showed less sensitivity 33.33%, but high specificity 98.95%, 66.67% positive predictive value, 95.96% negative predictive value and accuracy 95.09%. The sensitivity, specificity, PPV, NPV and accuracy of Giemsa staining were 66.67%, 98.96%, 80.0%, 97.94% and 97.06% respectively. Statistical significance was observed when both WMM and Giemsa staining were compared to gold standard test PCR. In resource limited settings, a wet mount is a good option for diagnosis of T vaginalis infection as giemsa staining requires heavy T vaginalis infection to be positive. But wherever facilities are available, PCR should be performed.

Impact of COVID-19 Pandemic on Family Life of Undergraduate and Postgraduate Medical Students

The COVID-19 pandemic has taken a heavy toll in people's life all over the world. Not only it effected the physical aspect of normal life, it also affected the day to day life in every country. The objective of this study was to assess the impact of COVID-19 pandemic in family life of undergraduate and postgraduate medical students. This observational research was carried out on undergraduate and postgraduate students at Mymensingh Medical College in Bangladesh, and it is of a cross-sectional descriptive research design. This study enrolled 218 undergraduate and 94 postgraduate students of Mymensingh Medical College. A self-administered semi-structured questionnaire survey was conducted to gather the views of participants on the impacts of COVID-19 pandemic. The pandemic had negatively impacted student's family life. The study found that a total of 173(79.3%) undergraduate and 73(77.7%) postgraduate students reported that bondage among family member was strengthened; 101(46.3%) undergraduate and 42(44.7%) postgraduate students reported their monthly family income had decreased remarkably; 156(71.6%) undergraduate and 55(58.5%) postgraduate students reported their household expenditure had increased; 145(66.5%) undergraduate and 55(58.5%) postgraduate students believed that the overall emotional wellbeing of their families had deteriorated during the pandemic; 166(76.2%) undergraduate and 73(77.6%) postgraduate students reported that stress among their family members had increased; 174(79.8%) undergraduates and 75(79.8%) postgraduates reported that uncertainties resulting from the COVID-19 pandemic developed a sense of anxiety among their family members.This study found that conflict among family members had increased during COVID-19 pandemic. Among undergraduate students 131(60.1%) agreed and among postgraduate students 44(46.8%) agreed to this; 127(58.2%) undergraduate and 54(57.4%) postgraduate students responded the same that they became more concerned about the health of their family members.

Domestic Violence against the Female Garment Workers in Selected Area of Bangladesh

Domestic violence is a global problem and it affects millions of people and often results in physical, sexual and emotional injuries and even deaths. The study was to assess the prevalence, form and reasons of domestic violence among the female garment workers in Dhaka, Gazipur and Narayanganj of Bangladesh. This Cross sectional descriptive study was conducted at four Garments in Bangladesh named Tusuka Fashions Limited Dhaka, Ananta Casual Wear Limited, Gazipur, Spectra Sweaters Limited, Dhaka and Modele de capital Limited Narayanganj from January 2019 to December 2019. Three hundred and six (306) female garment workers were taken as sample. A semi-structured questionnaire and Abuse Assessment Screen was used. Then in-depth interviews were conducted. The study results revealed that the mean age of the respondents was 29.85 years and almost two-third (69.0%) of the respondents was Muslim. About 246(81.0%) were married and 164 (64.06%) had 1-2 children. Two third respondents (63.0%) were married for 5-15 years and 72.0% lived in nuclear families and the majority (39.5%) of the respondents had monthly income of BDT 15000-30000 where mean monthly income was BDT ±23,529. Proportion of Domestic Violence was 15.4% and all of them (100.0%) were the victim of both physical and mental violence. Husband was the perpetrators in 98.0% cases and most of the cases (43.0%) reason of domestic violence was relationship doubt with another person. Significant difference (p<0.05) found between domestic violence with religion and marital status, duration of marriage, number of children and family monthly income. The study findings demand an intensified effort should be made towards creating awareness about the domestic violence and solved this to improve their quality of life.

Hormonal Parameters in Diverse Phenotypes of Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is a polygenic and multifactorial condition, regarded as the most common endocrine abnormality of women in reproductive period. It is commonly assumed that insulin resistance, hyperandrogenism and obesity significantly influence the pathophysiological process of PCOS. This study was designed to estimate hormonal parameters in different phenotypes of PCOS. The cross sectional descriptive type of observational study was carried out at Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to June 2019. Data were collected from purposively selected 107 patients with PCOS by interview, clinical examination and laboratory investigations using a pretested case record form. Data were analyzed by computer software, SPSS-version 22.0. Hormonal parameters in different phenotypes of PCOS were compared with ANOVA test. Phenotype A was found in highest number (59.8%) followed by phenotype B (14.9%), phenotype D (14.0%) and phenotype C (11.2%). Biochemical hyperandrogenism was observed highest in phenotype A (57.8%) followed by phenotype B (36.4%) and phenotype C (6.1%). Biochemical or clinical hyperandrogenism was not observed among patients of phenotype D. Altered LH:FSH ratio was high in phenotype A (14.1%) and Phenotype B (2.8%). Increased serum prolactin level was found highest in phenotype A (10.3%) and increased serum TSH was found highest in phenotype D (4.7%). Statistically significant difference was observed among levels of serum testosterone of different phenotypes (p<0.001). Hormonal derangements among different phenotypes reflect the severity of reproductive dysfunction and metabolic aberrations. Screening for metabolic risks of diverse phenotypes is important to detect and prevent long term health consequences of PCOS.

Butin Mitigates Memory Impairment in Streptozotocin-Induced Diabetic Rats by Inhibiting Oxidative Stress and Inflammatory Responses

It has been reported from the previous literature that butin restores mitochondrial dysfunction by modulation of oxidative stress and glutamate-induced neurotoxicity in mouse hippocampus HT22 cells. Butin also possesses an anti-Huntington's effect in rats. Considering the current background, this study was designed to evaluate the neuroprotective effect of butin against memory loss caused by streptozotocin (STZ). STZ (40 mg/kg) was intraperitoneally injected into rats. Three days later, diabetic rats were identified and included in the study. A total of 30 rats (12 nondiabetic and 18 diabetics) were grouped as Group A (control-non-diabetic rats) and Group B (STZ diabetic control) were treated with 1 mL of sodium CMC (0.5% w/v). Group C (STZ+ butin 25) were treated with butin 25 mg/kg. Group D (STZ+ butin 50) and Group E (butin per se) were administered with butin 50 mg/kg. Each therapy was administered orally once each day for 15-day. The Morris water maze and the Y-maze behavioural tests were run throughout the experimental programme. Animals were put to death on day 15 and their brains were removed for biochemical assays (CAT, SOD, GSH, MDA, nitrite, acetylcholinesterase (AchE), IL-1, and mitochondrial enzyme complexes). Rats with neurobehavioral impairments brought on by STZ have less spontaneous movement, learning capacity, and memory. Additionally, STZ decreased endogenous antioxidants and increased pro-inflammatory cytokines, nitrite, MDA, and AchE. Neurobehavioral deficits and metabolic markers were dramatically improved by butin.

Proportion of Risk Factors among Women Attending Antenatal Checkup Unit of A Tertiary Level Hospital of Bangladesh

Women constitute a large population group in any country and they are the vulnerable or special risk group. The risk is associated with child-bearing. The purpose of antenatal care is to detect early the high risk cases from a large group of antenatal women and to arrange special skilled care for them. Aim of this cross sectional descriptive type of observational study was to find out the proportion of risk factors among women attending antenatal checkup unit of a tertiary level hospital and carried out in the antenatal checkup unit of Model Family Planning Clinic of Mymensingh Medical College Hospital, Bangladesh from January 2022 to June 2022. Data were collected from purposively selected 403 women seeking antenatal care by face to face interview, clinical examination and necessary laboratory investigations. Data were analyzed by using SPSS version 26.0. More than three forth (320, 79.4%) of the respondents were in the age group of less than 30 years and the remaining (83, 20.6%) were in the age group of 30 years and over. Mean age of the pregnant women was 24.7 years with a standard deviation of 4.7 years. Most of the pregnant women were housewives (350, 86.8%); 41(10.2%) were students and 12(3.0%) were service holders. Among the respondents rural women (254, 63.0%) were more than urban women (149, 37.0%). Seventy seven (19.1%) respondents were interviewed during 1st trimester; 140(34.7%) during 2nd semester and 186(46.2%) during 3rd semester. It was found that 12 (3.0%) women were elderly primi and 6(1.5%) were short statured primi. Eighteen (4.5%) pregnant women had malpresentations- 17(94.4%) had breech presentation and 1(5.6%) had transverse lie. Each 18(4.5%) had threatened abortion and antepartum haemorrhage. Pre-eclampsia was found in 4(1.0%) and anaemia in 14 (3.5%); twin pregnancy was found in 4 (1.0%) and hydramnios in 9(2.2%) pregnant women. Thirty one (7.7%) women had previous history of either still birth or intrauterine death or manual removal of placenta. One (0.2%) pregnant women was categorized as elderly grand multiparas. Prolonged pregnancy was found in 4(1.0%) women and 76(18.9%) women had the history of previous caesarean or instrumental delivery. Nine (2.2%) pregnant women had general diseases along with pregnancy- 5(55.6%) had asthma, 3(33.3%) had diabetes mellitus and 1(11.1%) had cardiovascular disease. Four (1.0%) women got pregnant after treatment for infertility and 2 (0.5%) women had history of three or more spontaneous consecutive abortions. Finally all the pregnant women under study were categorized on the basis of criteria of "high risk cases" and 97(24.1%) women had high risk pregnancy and the remaining 306 (75.9%) had normal pregnancy. Proportion of women with high risk pregnancy in this study is 24.1% who needs special attention and skilled care in addition to continuing better Maternal and Child Health (MCH) services for all pregnant women.

Relationship of Conduction Defects and In-Hospital Outcome after Acute ST Segment Elevation Myocardial Infarction

The presence of conduction defects complicating acute myocardial infarction (MI) is relatively frequent and is associated with increased short and long term mortality. Thrombolytic therapy has been established to reduce the mortality in acute MI, however its role in reducing the incidence of conduction defects is less clearly defined. Morbidity and mortality associated with conduction defects also remain unchanged. This study was aimed to assess the correlation between conduction defects and adverse in-hospital outcome of patients with acute ST segment elevation MI. This cross sectional descriptive type of observational study was conducted among 100 purposively selected patients with acute ST segment elevation MI in the coronary care unit (CCU) of Mymensingh Medical College Hospital, Bangladesh from June 2012 to March 2013. The patients were divided into two groups depending on the presence or absence of conduction defects namely Group A- 40 patients with conduction defects and Group B- 60 patients without conduction defects. Highest number of the patients (36.0%) was in the age group of 45-55 years. In case of inferior MI, age groups 45-55 years and 55-65 years had equal number of patients (30.4%). Only 2.0% patients were in age group of 75-85 years and this group had only inferior MI. Total number of female patients were 16(16.0%). Female patients had more inferior MI (17.4%) than anterior MI (15.9%). Number of MI patients was slightly more in inferior MI (46.0%) than anterior MI (44.0%). Group B had equal number of patients in both anterior and inferior MI. Conduction defects were more common in inferior MI (43.5%) than anterior MI (40.9%). Atrio-ventricular conduction defects were more common in inferior MI whereas intra-ventricular conduction defects were more common in anterior MI. Complete heart block (CHB) was more prevalent in inferior MI. Complications were more common in Group A (65.0%) than Group B (18.3%). In terms of complications the difference between two groups were significant (p<0.001). Group A showed higher rate of mortality (20.0%) than Group B (3.3%). In cases of anterior MI difference in mortality between Group A and Group B was highly significant (p<0.001). Conduction defects in the setting of acute MI are a common finding. Atrio-ventricular conduction defects occur more frequently in inferior MI whereas intra-ventricular conduction defects were more frequently encountered in anterior MI. Patients with conduction defects had more complications than those without conduction defects. Presence of conduction defects significantly increases the mortality of patients with anterior MI.

Distribution and Pattern of Anti-Tubercular Drug Resistance in Patients with Pulmonary Tuberculosis in Mymensingh Region of Bangladesh

Globally, the emergence of multidrug-resistant strains of Mycobacterium tuberculosis is an increasing problem that adversely affects patient care and public health. This cross sectional descriptive study was carried out in the Department of Microbiology, Mymensingh Medical College from January 2010 to December 2010 to isolate M. tuberculosis from smear-positive sputum samples by Lowenstein-Jensen (L-J) media and investigate the drug resistance pattern. Among 101 smear-positive cases 80(79.20%) yielded growth of Mycobacteria, 5(4.95%) were contaminated and 16(15.84%) showed no growth. Among 80 isolates 76(95.0%) were M. tuberculosis and the remaining 4(5.0%) were Non-tuberculous Mycobacteria (NTM). Out of 76 M. tuberculosis 27(35.52%) were resistant to at least one drug, 4(5.26%) to Isoniazid (INH), 1(1.32%) to Rifampicin (RMP), 8(10.53%) to Streptomycin (SM) and 0(0.0%) to Ethambutol (EMB) and multi-drug resistant tuberculosis (MDR-TB) was 9(11.84%). The present study creates the impression that fairly high rate of anti-tuberculosis drug resistance among the tuberculosis cases and also high MDR-TB (Resistant to both Rifampicin and Isoniazide). The emergence of MDR-TB poses significant trouble to TB control activities throughout the world. The complexity of MDR-TB operation makes it essential to produce new skills to design, plan, application and monitor interventions for the management of MDR-TB. More surveillance and immediate remedial interventions should be performed to combat the trouble of MDR-TB to the general population.

Platelet Count as a Prognostic Factor in Stage IV Non-Small Cell Lung Cancer

Increase platelet count can accompany various cancers including lung cancer. This finding has recently been suggested to indicate poor prognosis. In patients with malignancies, thrombocytosis has previously been related disease stage, histological type and survival. In this study, the prevalence of thrombocytosis and the prognostic information provided by platelet count were analyzed in patients with stage IV Non-Small Cell Lung Cancer (NSCLC) with an aim to assess elevated platelet count as a prognostic factor in patients with stage IV NSCLC and to investigate whether there is relationship between thrombocytosis, other clinico-pathologic factors and median survival. This prospective observational study was conducted in National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh from September 2019 to August 2020. A total of 108 patients were enrolled purposively. Detail history taking, thorough physical examination was done along with relevant investigations. Data were collected by semi structured questionnaire and analysis was done with the help of Statistical Package for Social Science (SPSS), version 21.0. The mean age of the patients was found 56.4±12.2 years with range from 35 to 75 years. Majority (79.6%) patients were male, 52.8% patients came from low income and 36.1% were farmer. Majority (40.7%) were symptomatic; in bed >50.0% of day. Almost two third (59.3%) had <5.0% weight loss. Almost three fourth (69.4%) had squamous cell carcinoma. At the time of first assessment 75(69.4%) patients had normal and 33(30.6%) had elevated platelet count level. Age, sex and histological type were statistically not significant between normal and elevated platelet count level groups. But performance status, weight loss were statistically significant (p<0.05) between two groups. According to univariate analysis, age, performance status at presentation, weight loss more than 10.0% for 3 months and platelet count prior the start of treatment were all significant predictors for the overall survival. In multivariate analysis age, performance status at presentation and initial thrombocytosis were independent prognostic determinants for overall survival. Median survival time was significantly higher for the normal platelet count group and elevated platelet count group (7.5 months versus 5.5 months) respectively (95% CI, 5.5-7.5), p<0.001. The frequency of thrombocytosis in patients with stage-IV NSCLC at first presentation was 30.6% and median survival time in these patients was significantly shorter compared in patients without thrombocytosis. These results concluded that an elevated platelet count could be a useful prognostic factor for survival in patients with stage-IV NSCLC.

Pattern of Fetal Congenital Anomalies and Its Relation with Maternal Factors

Congenital anomalies are one of the four leading causes of neonatal mortality in Bangladesh. The risk factors which are predictive of congenital anomaly in babies vary from country to country. In a developing country like Bangladesh many possible factors are present which should be identified & frequency needs to be assessed to understand the burden. The aim of this study was to determine the patterns and related maternal factors of fetal congenital anomaly. This cross-sectional type of comparative study was conducted at Department of Obstetrics & Gynecology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2019 to August 2020. All the births occurring in the labor room were recorded. All newborn babies born with congenital anomalies were identified & included in this study. The rate of congenital anomalies was estimated and common types of congenital anomalies were noted. This study was conducted involving all women who had babies with congenital anomalies and the same number whose babies had no congenital anomalies. A structured questionnaire was used during data collection. Data was analyzed by Chi square test, bivariate analysis & multivariate logistic regression using statistical package for social sciences (SPSS) version 26.0. During the study period, 11479 deliveries were conducted. Among them 87 cases with congenital anomalies were identified. Frequency of congenital anomaly was 0.8%. Central nervous system was the predominant system involved (49.4%). Regarding risk assessment, Maternal age >30 years (OR 2.96, 95% CI 1.10-7.93, p value 0.032), consanguinity (OR 7.73, 95% CI 1.79-33.39, p value 0.006), first degree relative with history of congenital anomaly (OR 35.52, 95% CI 4.31-292.86, p value 0.001) and no intake of folic acid (OR 15.99, 95% CI 5.28-48.52, p value <0.001), passive smoking (OR 6.45, 95% CI 1.66-25.09, p value 0.007) were independent risk factors for congenital anomalies.

Estimation of Serum Lipid Profile among Patients Admitted with Myocardial Infarction in a Tertiary Level Hospital of Bangladesh

Different studies worldwide showed that dyslipidaemia is involved in the pathogenesis of ischemic heart diseases (IHD). This cross sectional descriptive type of observational study was carried out at Mymensingh Medical College Hospital during the period of six months from January 2021 to September 2021 to estimate the lipid profile among patients admitted in the coronary care unit (CCU) with myocardial infarction (MI). Data were collected from purposively selected 343 patients with MI by face to face interview and laboratory investigations using a case record form. Informed written consent of participants was taken prior to interview. Data were analyzed by using SPSS version 21.0. The study results revealed that mean age of the patients with myocardial infarction was 53.16 years with a standard deviation of 11.68 years. Majority of them (284, 82.8%) were male and the remaining (59, 17.2%) were female. Proportion of risk factors for ischaemic heart disease (IHD) were estimated and found that 244(71.1%) patients were smoker; 150(43.7%) had hypertension and 110(32.2%) had family history of IHD. Ninety nine (28.9%) patents were obese with BMI ≥25kg/m². Eighty three (24.2%) patients had diabetes mellitus; 66(19.2%) lead sedentary life and 61(17.8%) patients with myocardial infarction had dyslipidaemia. Mean LDL of patients with myocardial infarction was 103.65±39.73mg/dl; mean total cholesterol (TC) was 189.44±45.41mg/dl; mean TG was 243.11±205.19mg/dl and mean HDL was 39.29±8.98mg/dl. LDL was increased in 10(2.9%) patients; total cholesterol was raised in 121 (35.3%) patients and TG was raised in 195(56.9%) patients. HDL was raised in 26(7.6%) patients and it was lowered in 57(16.6%) patients. Mean LDL, TC, TG and HDL of younger (≤45 years) and older (>45 years) patients were compared and t-test showed no significant difference (p>0.05). Similarly mean LDL, TC, TG and HDL of male and female were compared and again t-test showed no significant difference (p>0.05). Though the pattern of lipid profile was found similar in younger and older patients and in males and females, a significant number of patients (61, 17.8%) with MI had dyslipidaemia which should be address by dietary and lifestyle modification.

Chest HRCT Severity Scores among Hospitalized Patients with COVID-19

Corona Virus Disease 2019 (COVID-19) was declared a pandemic in March 2020. This global health crisis caused thousands of pneumonia related death all over the world since December 2019. RT-PCR is the primary test for diagnosis of COVID-19, though its sensitivity and specificity is variable. Several studies revealed that chest HRCT complements RT-PCR in highly suspected cases or in false negative RT-PCR and helps to gauge disease severity. This study was carried out with an aim to find out the severity scores of chest HRCT in hospitalized patients with COVID-19. This cross sectional descriptive type of observational study was carried out at COVID-19 unit of Sylhet Women's Medical College Hospital, Bangladesh from April 2021 to September 2021. Data were collected from purposively selected 204 patients with COVID-19 by face to face interview, chest HRCT and necessary laboratory investigations. Informed written consent was taken from the participants of the study at the beginning of the interview. Data were analyzed by using SPSS version 21.0. The results of the study showed that mean age of the patients with COVID-19 was 57.9 years with a standard deviation of ±15.8 years. Majority of them (121, 59.3%) were female and the remaining (83, 40.7%) were male. Regarding co-morbidities it was found that each 115 (56.4%) patients were hypertensive and diabetic. Thirty five (16.2%) had ischemic heart disease; 3(1.5%) had congestive cardiac failure and 2(1.0%) had asthma. One (0.5%) patient has atrial fibrillation. In case of 160(78.4%) RT-PCR confirmed patients with COVID-19, chest HRCT was found positive and in 44(21.6%) it was found negative. Among the positive cases mild (7 or less) chest HRCT score was found in 26(12.7%) patients; moderate (8-17) score was found in highest number of patients (128, 62.7%) and severe (18 or more) chest HRCT score was found in 6(2.9%) patients with COVID-19. Chi-square test was carried out to assess the relation of chest HRCT scores with age group, sex, troponin-I, D-Dimer and clinical outcomes within CCU but statistically significant relation was not found (p>0.05). The negative scans were highest (20, 9.8%) in the age group of 41-60 years. Mild, moderate and severe chest HRCT scores was found highest in the age group of 61-80 years (13, 6.4%; 51, 25.0% and 5, 2.5% respectively) (p=0.508). Chest HRCT scans were negative in 18(8.8%) male and 26(12.7%) female. Mild scores were equally distributed between each sex i.e. male 13(6.4%) and female 13(6.4%). Both moderate and severe scores were found more in female (77, 37.7% and 5, 2.5% respectively) than male (51, 25.0% and 1, 0.5% respectively) (p=0.492). Negative chest HRCT scans, mild, moderate and severe scores-all were found more in patients with elevated D-Dimer (p=0.194). Among 204 patients one (0.5%) died in the CCU who had mild score of chest HRCT (p=0.076) but highly elevated Troponin-I (21.70ng/mL). Chest HRCT was found positive among 78.4% of patients with COVID-19 confirmed by RT-PCR. Chest HRCT can help physicians to detect suspected cases and to assess the severity and outcome of the disease. However, further research is recommended to clarify the role of chest HRCT in assessing severity of COVID-19 and prediction of prognosis.

Tracking Side Effects of the COVID-19 Vaccine in Mymensingh District of Bangladesh

The Coronavirus disease 2019 (COVID-19) has turned into a worldwide human tragedy and economic devastation. There had an intensive search for an effective drug against the coronavirus but not led to any breakthrough agents. Only one choice was left namely an effective and safe vaccine. Many people are ambivalent regarding corona vaccines because they also fear possible side effects from vaccination. This study was designed to track the side effects after first and second dose of the Oxford-AstraZeneca vaccines used in Mymensingh district of Bangladesh. This cross-sectional descriptive type of observational study was conducted in Mymensingh Medical College, Mymensingh, Bangladesh during the period of five months from 1 February, 2021 to 30 June, 2021 among 293 purposively selected vaccine recipients who received two doses of the Oxford-AstraZeneca vaccines. Data were collected by face to face interview of the selected vaccine recipients using a semi-structured questionnaire. Data were inputted into SPSS version 26.0. Qualitative data were summarized by percentage and quantitative data were summarized by mean and standard deviation. Necessary bivariate and multivariate analysis was done. Mean age of the respondents was 40.3 years with a standard deviation of ±8.7 years. Among the vaccine recipients female were 159(54.3%) and male were 134(45.7%). The most of the vaccine recipients were graduate and master 256(87.3%) and more than half of the vaccine recipients (156, 53.2%) were government service holder. The most of the vaccine recipients (242, 86.0%) were from urban area and 263(89.8%) vaccine recipients were non-smoker. Sixty eight (23.2%) of the vaccine recipients had different types of co-morbidities. It was found that 217(74.1%) vaccine recipients had side effects after first dose while 162(55.3%) had side effects after second dose. The difference in occurrence of side effects of first and second dose was statistically highly significant (p<0.001). Pain on the injection site was present in 172(58.7%) vaccine recipients after first dose and in 142 (48.5%) after second dose. Fever was prevalent in 98 (33.4%) after first dose and in 61 (20.8) after second dose. Headache was in 61(20.8%) and in 22(7.5%) after first and second dose respectively. Thirty one (10.6%) vaccine recipients had loose motion after first dose and 26(8.9%) had this after second dose. First dose of vaccination caused nausea in 28(9.6%) and second dose caused it in 16(5.5%) vaccine recipients. Joint pain was prevalent in 24(8.2%) after first dose and in 15(5.1%) after second dose. Rash was present in 9(3.1%) and in 3(1.0%) after first and second dose respectively. Cough was present in 5(1.7%) after first dose and in 2(0.7%) after second dose. Each 2(0.7%) had history of fainting and bodyache and 1(0.3%) reported intense weakness after first dose only. Side effects of first dose of AstraZeneca vaccine were more prevalent in female (124, 78.0%) than male (93, 69.4%). The side effects of second dose of AstraZeneca vaccine were also more prevalent in female (103, 64.8%) than male (59, 44.0%). The study results revealed that 217(74.1%) vaccine recipients had side effects after first dose while 162(55.3%) had side effects on second dose of the Oxford-AstraZeneca vaccine. Commonly experienced side effects were pain in the injection site, fever, headache, diarrhoea and joint pain. Most of the people tolerated these side effects and did not use any medicine.

Measurement of brain simulant strains in head surrogate under impact loading

Impact-induced traumatic brain injury (TBI) is a major source of disability and mortality. Knowledge of brain strains during impact (accelerative) loading is critical for the overall management of TBI, including the development of injury thresholds, personal protective equipment, and validation of computational models. Despite these needs, the current understanding of brain strains in humans or humanlike surrogates is limited, especially for injury causing loading magnitudes. Toward this end, we measured full-field, in-plane (2D) strains in a brain simulant using the hemispherical head surrogate. The hemispherical head was mounted on the Hybrid-III neck and subjected to impact loading using a linear impactor system. The resulting head kinematics was measured using a triaxial accelerometer and angular rate sensors. Dynamic, 2D strains in a brain simulant were obtained using high-speed imaging and digital image correlation. Concurrent finite element (FE) simulations of the experiment were also performed to gain additional insights. The role of stiff membranes of the head was also studied using experiments. Our results suggest that rotational modes dominate the response of the brain simulant. The wave propagation in the brain simulant as a result of impact has a timescale of ~100 ms. We obtain peak strains of ~20%, ~40%, ~60% for peak rotational accelerations of ~838, ~5170, ~11,860 rad/s², respectively. Further, peak strains in cortical regions are higher than subcortical regions by up to ~70%. The agreement between the experiments and FE simulations is reasonable in terms of spatiotemporal evolution of strain pattern and peak strain magnitudes. Experiments with the addition of falx and tentorium indicate significant strain concentration (up to 115%) in the brain simulant near the interface of falx or tentorium and brain simulant. Overall, this work provides important insights into the biomechanics of strain in the brain simulant during impact loading.

Norovirus Gastroenteritis Outbreaks, Genomic Diversity and Evolution: An Overview

Norovirus, often called winter vomiting bug, is the most common cause of outbreaks of acute gastroenteritis in all age groups all over the world. It was discovered in 1972; belong to the genus Norovirus in the family Caliciviridae. Based on genomic organization and phylogenetic analysis, the family Caliciviridae is divided into four genera- Norovirus, Sapovirus, Vesivirus and Lagovirus. The aim of this review article was to find out the present status of prevalence and evolution of norovirus strains in developed and developing countries. In this article various literature on norovirus from different countries was reviewed. The detection of norovirus in the lower middle income countries (LMIC) was reported 15% in cases and 8% in controls during 1997 to 2018. On the other hand, detection rate of norovirus in low income countries (LIC) was 11% in cases and 9% in controls during the same period. Overall detection rate of norovirus was 14% in LIMC and 8% in LIC during 1997 to 2018. Noroviruses are divided genetically into seven different type of Geno groups namely GI, GII, GIII, GIV, GV, GVI and GVII which are further classified into different genetic clusters or genotypes. For example, Geno group II, the most prevalent human Geno group, presently contains 19 genotypes. Among the genogroups I, II and IV infect humans, on the other hand genogroup III infects bovine species and genogroup V was isolated from mice. Several new noroviruses were reported and the number of genogroups increased to 10 (GI-GX) and the number of genotypes expanded to 49: 9 GI, 27 GII, 3 GIII, 2 GIV, 2 GV, 2GVI, 1 GVII, 1 GVIII, 1 GIX, 1 GX. Noroviruses are spread directly from individual to individual as well as indirectly via contaminated food and water. They are highly contagious, and around twenty virus particles can cause an infection. This virus usually exhibits winter seasonality. The global norovirus prevalence in under-5 years, ≥5 years and mixed age was similar (16% - 19%). Norovirus infection is characterized by diarrhea, vomiting, fever, headache and stomach pain. It may be complicated with dehydration and electrolyte imbalance. Gastroenteritis develops 12 to 48 hours after exposure and recovery typically occurs within 1 to 3 days. There is no specific treatment of norovirus gastroenteritis. Prevention includes proper hand washing and cleaning or disinfection of contaminated surfaces. Various genotypes of norovirus may be circulating around the world and can emerge either nationally or globally. In this overview, general characteristics of norovirus, current status of genomic diversity and classification, recent status of norovirus gastroenteritis outbreaks in the developed and developing countries is outlined for comprehensive understanding of the present status of prevalence and evolution of norovirus strains to develop strategies for prevention and control of norovirus infection in human.

Proportion of Low Back Pain among Physicians Working in a Tertiary Level Hospital of Bangladesh

Low back pain (LBP) is a common problem and is an important public health issue. A major proportion of LBP is concomitant with prolong and repetitive awkward postures, related with occupation like miners, health workers and professional drivers. Physicians are exposed to a wide range of occupational risk factors which results in LBP. A variety of occupational and personal factors are responsible for increased risk of low back pain among physicians. This cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to June 2018, to estimate the proportion of LBP among physicians. Data were collected from purposively selected 102 physicians of different levels by face to face interview using a case record form. Informed written consent of participants was taken prior to interview. Data were analyzed by using SPSS version 20.0. The study results revealed that majority (60.8%) of the physicians were in the age group of 31-50 years. Mean age of the physicians was 49.9 years with a standard deviation (SD) of 3.61 years. More than three fourth (79, 77.5%) of the physicians were male and 23(22.5%) were female. Out of 102 physicians more than two third (70, 68.6%) had LBP while 32(31.4%) did not have any LBP. Proportion of low back pain among physician was 68.6%. Low back pain was found in all age group. Among the physicians having low back pain, 55(78.6%) were male and 15(21.4%) were female. Among 102 physicians, 45(44.1%) had different types of comorbidities while 57(55.9%) did not have any comorbidities. Among the co-morbidities HTN, DM, Dyslipidemia, CHD and asthma were common. Results of the study concluded that 68.6% physicians had low back pain. Physicians of age group 31-60 years (88.5%) and male (78.6%) experienced LBP more. Further multi-centric large scale case control study is recommended to determine the risk factors of LBP among physicians of Bangladesh.

Hyponatraemia in Adult Patients with Pneumonia in a Medical College Hospital of Bangladesh

Pneumonia is an acute on chronic infection involving the pulmonary parenchyma. Most cases are caused by microbial pathogens usually bacteria or viruses and less often fungi or parasites. Hyponatraemia on admission is associated with greater risk of death and increased length of hospital stays. Hyponatraemia is usually related to severe disease and specially occur in old aged people. This study is designed to identify proportion of hyponatraemia in patients with pneumonia and to determine the association of hyponatraemia with the severity of pneumonia. The cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to December 2018. Data were collected from purposively selected 73 admitted patients with pneumonia by interview, clinical examination and laboratory investigations using a pre-tested case record form. Data were analyzed by using SPSS version 20.0. Quantitative variables were summarized by mean and standard deviation. On the other hand qualitative variables were summarized by percentage. Necessary bivariate analysis was done. Majority (68.5%) of the patients were in the age group of 21 years to 50 years. Mean age of the patients was 41.9 years with a SD of 17.4 years. More than three fourth (57, 78.1%) were male and 16(21.9%) were female. More than two third (51, 69.9%) of the patients were smoker and 45(61.6%) was abuse of chewable tobacco or ghul. All the patients had fever (73, 100.0%); 70(95.9%) had cough, 50(68.5%) had chest pain, 10(13.5%) had respiratory distress and 8(11.0%) had haemoptysis. Vomiting was present in 9(12.3%) patients and 3(4.1%) had impaired level of consciousness. About one third of patients (32, 43.8%) had comorbidities. On chest X-ray consolidation was found in 59(80.8%) of patients with pneumonia. In 35(47.9%) patients serum Na⁺ level was normal and 38(52.1%) had different level of hyponatraemia; 26(35.6%) patients had mild hyponatraemia, 7(9.6%) had moderate hyponatraemia and 5(6.8%) had severe hyponatraemia. Majority (58, 79.5%) had lobar pneumonia and 71(97.3%) had community acquired pneumonia. Severity of pneumonia was assessed according to CURB 65. Less than half (35, 47.9%) of the patients had mild (score 0-1) pneumonia; 33(45.2%) had moderate (score 2) pneumonia and 5(6.8%) patients had severe (score ≥3) pneumonia. Average duration of hospital stay was 6.5±3.2 days. Maximum (69, 94.5%) patients were cured after treatment. In case of 3(4.1%) patients pneumonia was unresolved. One (1.4%) patients died due to pneumonia. In this study hyponatraemia was not associated with the severity of pneumonia (p>0.05) and outcome on discharge from the hospital (p>0.05). Difference in mean duration of hospital stay between patients of pneumonia with or without hyponatraemia was not significant (>0.05). The study results revealed that 52.1% patients with pneumonia developed different level of hyponatraemia. Hyponatraemia was not associated with the severity of pneumonia, duration of hospital stay and outcome of pneumonia.

Association of Low Thyroid Hormone with Migraine Headache

This cross sectional comparative study was done to investigate the association between low thyroid hormone level and migraine headache in adults patients. The study was conducted in Mymensingh Medical College Hospital, a tertiary level hospital of Bangladesh. Study period was from November 2017 to April 2018. The study subjects consisted of 50 patients with migraine headache as case, compared with 50 patients of headache other than migraine as control, seen in Neurology out patient department (OPD). Thyroid function test was performed by new automated immuno-chemiluminometric assay. Mean age was 29.80±9.87 years in migraine group and 34.18±11.82 years in non migraine group. Male female ratio was 1:2.3 and 1:1.7 in two groups. Level of TSH was significantly higher in migraine patients (3.52±2.53 vs. 2.25±2.13) than other headache patients (p=0.008). Thyroid disorder especially subclinical hypothyroidism was significantly higher (28% vs. 08%) in migraineurs than non migraineurs (p=0.032). No significant relationship was found between thyroid hormone level and headache characteristics of migraine patients (p>0.05). Migraine headache is associated with low thyroid hormone and thyroid disorder can be considered as comorbidity of migraine headache.

Checklist of the dragonflies and damselflies (Insecta: Odonata) of Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka

A checklist of the dragonflies and damselflies occurring in Bangladesh, Bhutan, India (including Andaman and Nicobar Islands), Nepal, Pakistan and Sri Lanka is presented. In total 588 (including 559 full species) taxa are known to occur in the region of which 251 taxa (species subspecies) are single country endemics. Recent taxonomic changes relevant to the area are summarized. Sixteen taxa are synonymized and a checklist of all synonyms established since 1950 is provided. Information is given on available larval descriptions including a list of genera present in the region for which no larvae have yet been described. Numerous species occurring in the area are still poorly known and a list of genera for which a revision is urgently needed is provided.                The following new synonyms are established: Calicnemia sudhaae Mitra, 1994 = Calicnemia imitans Lieftinck, 1948 syn. nov.; Ceriagrion fallax cerinomelas Lieftinck, 1927 = Ceriagrion fallax Ris, 1914 syn. nov.; Ceriagrion fallax pendleburyi Laidlaw, 1931 = Ceriagrion fallax Ris, 1914 syn. nov.; Coenagrion kashmirus Chowdhary Das, 1975 = Ischnura forcipata Morton, 1907 syn. nov.; Enallagma insula Fraser, 1920 = Aciagrion occidentale Laidlaw, 1919 syn. nov.; Himalagrion pithoragarhicum Sahni, 1964 = Ceriagrion fallax Ris, 1914 syn. nov.; Ischnura bhimtalensis Sahni, 1965 = Ischnura rubilio Selys, 1876 syn. nov.; Onychargia indica Sahni, 1964 = Paracercion calamorum (Ris, 1916) syn. nov.; Anaciaeschna kashmirense Singh Baijal, 1954 = Anaciaeschna martini (Selys, 1897) syn. nov.; Cyclogomphus vesiculosus Selys, 1854 = Cyclogomphus ypsilon Selys, 1954 syn. nov.; Chlorogomphus brittoi Navás, 1934 = Chlorogomphus xanthoptera (Fraser, 1919) syn. nov.; Hylaeothemis indica Fraser, 1946 = Hylaeothemis apicalis Fraser, 1924 syn. nov.; Sympetrum durum Bartenef, 1916 = Sympetrum striolatum commixtum Selys, 1884 syn. nov.; Sympetrum himalayanum Navás, 1934 = Sympetrum hypomelas (Selys, 1884) syn. nov.; Sympetrum haematoneura Fraser, 1924 = Sympetrum speciosum Oguma, 1915 syn. nov.; Sympetrum speciosum taiwanum Asahina, 1951 = Sympetrum speciosum Oguma, 1915 syn. nov.                In addition, Periaeschna lebasi Navás, 1930 is regarded a nomen nudum. The following new combinations are proposed: Onychogomphus acinaces Laidlaw, 1922 is transferred to the genus Melligomphus Chao, 1990 resulting in Melligomphus acinaces (Laidlaw, 1922) comb. nov. Onychogomphus saundersii Selys, 1854 is transferred to the genus Nychogomphus Carle, 1986 resulting in Nychogomphus saundersii (Selys, 1854) comb. nov..

Detection of 2019-Novel Coronavirus (2019-nCoV) by rRT-PCR at Mymensingh Medical College, Mymensingh, Bangladesh

The coronavirus disease (COVID-19) is highly pathogenic viral infection caused by SARS-CoV-2. Currently, COVID-19 has caused global health concern. WHO has declared COVID-19 as a pandemic disease on March 11, 2020 and characterized by fever, dry cough, fatigue, myalgia and chest pain with pneumonia in severe cases. The virus has spread to at least 213 countries and more than 9093827 confirmed cases and 471490 deaths have been recorded. In the beginning, the world public health authorities tried to eradicate the disease in China through quarantine but are now transitioning to prevention strategies worldwide to delay its spread. There are some newly developed and promising methods for detection of SARS-CoV-2, in order to facilitate the development of novel approaches for early diagnosis. Nucleic acid based tests currently offer the most sensitive and early detection and confirmation for SARS-CoV-2 infection. Among them Real-time reverse transcription polymerase chain reaction (rRT-PCR) is the most popular and the "gold standard" testing method for the detection of SARS-CoV-2. The present study was carried out to detect 2019-Novel Coronavirus (2019-nCoV) by rRT-PCR method at Mymensingh Medical College, Mymensingh, Bangladesh from 1st April, 2020 to 31st May, 2020. A total of 14356 samples were tested from four districts of Mymensingh division namely, Mymensingh, Jamalpur, Sherpur, Netrokona and some parts of Sunamganj for rRT-PCR. Among them 1086 (7.5%) patients were positive for SARS-CoV-2. Out of 1086 positive cases 716(65.9%) were male and 370(34.1%) were female with a Mean±SD age 34.1±12 years. Maximum positivity was found in Mymensingh district followed by Netrokona, Jamalpur, Sherpur and Sunamganj respectively. This is the first base line study for genetic detection of 2019-nCoV in Mymensingh division which may reflect the total scenario of Bangladesh situation. We hope this paper will help the researcher to increase the availability, accuracy, and speed of widespread COVID-19 testing throughout the world in this crisis moment.

Depression among Medical Students of Bangladesh

Now a days depression is one of the leading cause of disabilities all over the world. Depression leads to a wide range of disorders and affects people of all communities. Medical students pass through a relatively high level of stress. Several studies revealed that anxiety and depression is significantly prevalent among medical students and often it persists even when they become physicians. The study was designed with an aim to estimate the prevalence of depression among the medical students of Bangladesh. The cross sectional descriptive type of observational study was conducted among randomly selected 399 Bangladeshi students of third year MBBS from six (6) randomly selected public medical colleges of Bangladesh from February 2017 to July 2017. Data were collected by a semi-structured self-administered questionnaire containing Beck's Depression Inventory. Data were entered and analyzed by SPSS version 20.0. Among 399 medical students, 45.6% were male and 54.4% were female. Regarding presence of depression among the medical students, 35.8% students had normal score. More than one fourth of the students (25.1%) had mild mood disturbance. Borderline clinical depression was found in 15.5% and moderate depression was found in 18.0% of the students. Severe depression was found in 5.3% students and one (0.3%) student was suffering from extreme depression. Overall 39.1% students were suffering from different levels of depression. Depression was prevalent more in female students (45.6%) than male students (31.3%). Suicidal tendency was present in 18.8% students. Among them 14.3% had thoughts of killing themselves but they would not carry them out; 3% would like to kill themselves and 1.5% would kill themselves if they had the chance. Suicidal tendency was also a bit higher in female students (19.3%) than male students (18.1%). A significant number (39.1%) of medical students of Bangladesh are suffering from depression and many of them (18.8%) have suicidal tendency which demands immediate attention of the authority. The findings of the study warrant a need for psychiatric counseling and support services for vulnerable students.

Risk Factors for Hypertension in Young Adults of Bangladesh

Hypertension is a major public health challenge to population in socio-economic and epidemiological transition. It is a risk factor for cardiovascular mortality which accounts for 20-50 per cent of all deaths. Hypertension has been recognized among young adults more frequently in recent years. Data regarding hypertension in Bangladesh is often insufficient. The purpose of the study was to find out the risk factors of hypertension in young adults of Bangladesh. The study was conducted among 322 purposively selected young adults aged 20 to 49 years attending in the outpatient department of one public and five private hospitals of Mymensingh and Dhaka division of Bangladesh during the period of January 2018 to December 2018. More than half (54.4%) of the patients were at or below the age of 40 years. Mean age of the patients was 38.7±7.8 years and 58.7% were male. Maximum patients (87.6%) were married and with variable educational and occupational status. More than three fourth of the patients (76.7%) were from urban area whereas 14.3% from rural and 9.0% were from sub-urban area. Family history of hypertension was positive in 86.6% of patients. Blood pressure was categorized according to JNC 7. About half (49.4%) of the patients were stage I hypertensive; 22.4% were stage II hypertensive and 28.3% were pre-hypertensive. The major risk factor was tobacco smoking (46.0%), obesity (29.2%), dyslipidaemia (25.2%), high salt intake 21.8% and use of chewable tobacco (13.7%). Serum creatinine was found raised in 11.5%, cardiomegaly in 2.2% and concentric left ventricular hypertrophy in 18.6% of patients. In 38.5% patients hypertension was complicated affecting heart (27.0%) and kidney (11.5%). Common comorbidities were ischaemic heart diseases (20.5%) and diabetes mellitus (13.4%). Tobacco use, obesity, dyslipidaemia and high salt intake are the major modifiable risk factors found in hypertensive young adults. In addition to medication these factors should be addressed for prevention and effective control of hypertension.

Knowledge and Attitude Regarding National Tobacco Control Law and Practice of Tobacco Smoking among Bangladesh Police

Tobacco is an important public health problem of Bangladesh having both high production and consumption. Police are engaged in enforcement of the tobacco control law. For effective enforcement of national tobacco control law (NTCL), they should have sound knowledge of tobacco control law and their attitude to the tobacco control law must be a positive one. The objective of the study was to explore the status of knowledge and attitude regarding national tobacco control law and practice of tobacco smoking among Bangladesh Police. The descriptive cross sectional study was conducted among 440 members of Bangladesh Police during the period of March 2015 to November 2015. Police personnel of different ranks were interviewed randomly using a semi-structured questionnaire from the selected SP offices, police lines, police stations and police camps. Among the respondents 414(94.1%) were male and 26(5.9%) were female. About half (214, 48.6%) of the respondents never smoked in life, while 226(51.4%) smoked in life even one or two puffs. There was no female among the ever smokers. One quarter (114, 25.9%) of the respondents ever smoked but quitted and 112(25.4%) respondents were currently smoker. Among the current smokers 31(7.0%) were occasional, while 81 (18.4%) were daily smoker. It was observed that there was lack of knowledge among police personnel regarding various rules and clauses of national tobacco control law. Most of the respondents (434, 98.6%) showed positive attitude regarding rationality of prohibition of smoking in public places and public transports. The most of the respondents (418, 95.0%) agreed that there should not be any advertisement of tobacco products in cinema hall, radio and television channel. A highest majority (377, 85.7%) of the respondents gave their opinion that Government should increase taxes on tobacco products. Most of the respondents (433, 94.4%) opined against the selling of tobacco products to the minor. Almost every respondent (436, 99.1%) wanted proper implementation of tobacco control law. Nearly half of the respondents (213, 48.4%) thought that smoking among police was one of the obstacles in effective implementation of tobacco control law. An overwhelming majority of the respondents (435, 98.9%) agreed that police personnel should not smoke tobacco for keeping their health and fitness and thereby for better performance. Almost all respondents (436, 99.1%) gave a positive opinion that police personnel may be a role model for the public by not smoking tobacco. Most of the respondents (427, 97.1%) think that orientation or training program on tobacco control law should be arranged for police personnel. More than one fourth (25.5%) of the police personnel in Bangladesh are currently smokers and this should be intervened. Smoke-free police station initiative is started but not being 100% implemented. Lack of knowledge regarding various rules and clauses of NTCL was sufficient enough to draw intervention in this regard. Positive attitude of police personnel towards NTCL and smoke free police station initiative will help to implement tobacco control law properly.

Environmental Situation in Some Selected Villages of Bangladesh

Health is multifactorial and influenced by nutritional, biological, chemical and psychological factors. It is quite true that environment has direct impact on those diseases that are the outcome of man's maladjustments to his environment. Often man is responsible for pollution of environment through urbanization, industrialization and other human activities. Improvement of environmental condition is one of the best ways to prevent some of the diseases prevailing in our country. The study was designed to explore the environmental situation of rural area of Bangladesh. The descriptive cross sectional study was conducted in purposively selected six villages of Dewanganj Upazila of Jamalpur district, Bangladesh during the period of January 2018 to February 2018. A total of 227 purposively selected women having at least one under five children were interviewed face to face using a semi-structured questionnaire. Mean±SD age of the respondents was 27.31±6.4 years. About three fourth (167, 73.57%) of the respondents were literate while one fourth (60, 26.43%) of them were illiterate. On the other hand about two third (149, 65.64%) of husbands were literate and remaining (78, 34.36%) were illiterate. The most (215, 94.71%) of the respondents were housewives. Majority (143, 62.99%) of them had children of less than 3 and mean±SD age of children was 2.85±1.17 years. Majority (140, 61.67%) of the respondents belonged to nuclear family while 86 (37.89%) belonged to joint family. Mean±SD family member was 6.42±8.12 persons. The mean monthly family income was BDT 8066.52 with a standard deviation of BDT. 6767.12. Out of 277 respondents, almost half 110(48.46%) of them lived in mixed houses followed by 92(40.53%) and 25(11.01%) lived in Kantcha & Pucca houses respectively. The most (180, 79.30%) of the respondents were used separate kitchen in their houses. About two forth (171, 75.33%) of the respondents did not have any kitchen garden. All 227(100.0%) of the respondents were used tube well as source of drinking water. The most (211, 92.95%) of the respondents got supply water within their compounds. All of the respondents got water supply within 15 minute walking distance. Majority 149(65.64%) of the respondents used sanitary toilets & 40(17.62%) used pit latrines and rest 30(13.22%) of them practiced open air disposal. More than half (118, 51.99%) of the respondents' children were not using toilets for excreta disposal. Efforts are needed to increase environmental health related knowledge and awareness to maintain environment sanitation. People should use sanitary latrines and avoid practice of open air disposal of children's feces to prevent excreta borne diseases. Further wider scale details study is needed to formulate policy in regards to improve the environmental sanitation of Bangladesh.

Estimation of Vitamin D levels among Physicians Working in a Tertiary Level Hospital of Bangladesh

Vitamin D is essential for the body to regulate calcium and phosphate levels and mineralization of bone. It is synthesized in the skin after ultraviolet radiation exposure or obtained in the diet to a less extent. Vitamin D deficiency is attracting attention due to higher prevalence in different populations. Physicians of Bangladesh are supposed to be vulnerable to low Vitamin D levels owing to long indoor work hours in both government and private settings. The study was conducted to evaluate Vitamin D status among physicians working in a tertiary level public hospital of Bangladesh. The cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to June 2018. Data were collected from purposively selected 102 doctors of different levels using a case record form. Interview, measurements and laboratory investigations were done accordingly. Vitamin D levels were categorized as deficient (<20.00ng/L), Insufficient (20.00-29.00ng/L), Sufficient (30.00-100.00ng/L) and Potential Toxicity (>100.00ng/L). Among 102 doctors 79(77.5%) were male and 23(22.5%) were female. Maximum (60.8%) were in the age group of 31 years to 50 years. Mean±SD age of the subjects was 49.9±3.61years. Vitamin D deficiency was found in 19(18.6%) subjects and insufficiency was in 49(48.0%) of the subjects. On the other hand 34(33.3%) subjects had sufficient Vitamin D levels. Potential Vitamin D toxicity was not found in any of the subjects. Vitamin D deficiency was found more in female (30.4%) than male (15.2%) but insufficiency was found more in male (50.6%) than female (39.1%). The study revealed that 66.6% physicians had either deficiency or insufficiency of Vitamin D. Exposure to sunlight, dietary intake and Vitamin D supplementation should be considered to increase the status of Vitamin D levels in Physicians of Bangladesh.

An Overview on Epidemiology of Tuberculosis

Tuberculosis (TB) is a progressive granulomatous infectious disease caused by the gram positive, acid fast bacilli classified under the genus Mycobacterium. Tuberculosis in human is mostly by Mycobacterium tuberculosis and primarily affects lungs causing pulmonary tuberculosis. It can also affect intestine, meninges, bones, joints, lymph nodes, skin and other tissues of the body causing extra-pulmonary tuberculosis. Human TB is transmitted mainly through droplet infection and droplet nuclei. Infection of human with M. avium and M. africanum is very rare. M. microti is not known to cause TB in human, while M. bovis has a wider host range. Human may be infected by M. bovis through milk and milk products or meat of an infected animal. It is estimated that in some developing countries up to 10% of human tuberculosis is due to bovine TB. Tuberculosis causes more than 2 million deaths annually and the death toll is worsened by the emergence of drug resistant Mycobacterium tuberculosis. The South East Asia Region accounts for 39% of global burden of TB in terms of incidence. It is estimated that about 3.4 million new cases of TB continue to occur each year in this region, most of them in India, Bangladesh, Indonesia, Myanmar and Thailand. Tuberculosis is a social disease with medical aspects. It has also been described as a barometer of social welfare. The social factors include poor quality of life, poor housing, overcrowding, population explosion, under-nutrition, smoking, alcohol abuse, lack of education, large families, early marriages, lack of awareness regarding cause and transmission of TB. These factors are interrelated and contribute to the occurrence and transmission of tuberculosis. It is estimated that approximately 10% of total TB is occurred in children. Childhood deaths from TB are usually caused by tuberculous meningitis or disseminated disease. The number of individuals infected with both HIV and TB is increasing worldwide. The HIV affects the body's immune system and enhances the speed at which TB progresses from a innocuous infection to life threatening condition. TB is a major cause of death of HIV positive individuals. Diabetes has been shown to be an independent risk factor for tuberculosis in community based studies from south India and multiple studies globally. It is suggested that diabetes accounts for 14.8% of all tuberculosis and 20.8% of smear positive TB. Understanding of epidemiology of tuberculosis is essential for its effective control. This review tried to summarize the epidemiological aspects of tuberculosis in global, regional and Bangladesh perspectives. For this review article, data available in books and at the official websites of WHO, MBDC, NTP, DGHS, The Ministry of Health and Family Welfare, Government of Bangladesh were consulted through PubMed central and Google scholar search engines. This paper has been written with an aim to offer general education to health professionals, policy makers, patients and the public.

Situs Inversus Totalis: Laparoscopic Cholecystectomy and Some Modifications

Laparoscopic cholecystectomy has become the standard approach since its introduction in 1987 by Mouret. Situs inversus totalis is a rare anomaly in which transposition of the organ to the opposite site of the body occurs. Laparoscopic cholecystectomy due to gall stone disease in such few cases has been reported in the literature. The presentation of the cholecystitis, its diagnosis and the operative procedure can pose problems. Laparoscopic cholecystectomy in those patients is technically more demanding and needs reorientation of visual motor skill to left upper quadrant. We present here two such cases and difficulties encountered during surgery with some modification of the procedure to cope with the situation. The case study was done in April, 2014 and May, 2014 respectively in Islamic Bank Central Hospital Kakrail, Dhaka.

Outcome of Surgery in Chronic Inactive Mucosal Otitis Media

Chronic otitis media is a common condition seen in patients attending the otorhinolaryngology Department. The discharging ear presents the otologists with the dilemma of operating on it or not. The aim of the this cross-sectional observational study was to find out the outcome of surgery in chronic inactive mucosal otitis media and was conducted on 62 patients of either sex in the age group of 15-60 years in the Department of ENT and Head Neck surgery, Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka, Bangladesh From July 2015 to January 2016. Pre and post operative hearing assessment was done with pure tone audiometry (PTA). Post operative graft status also noted. All the information's were recorded in the fixed protocol. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using updated computerized program SPSS-19. Among 62 cases the mean age were 36.79±10.33 in chronic inactive mucosal otitis media. Majority of the study population were in age group of between 15-25 in this group of which was 16(51.6%). Male were 36(58.06) and 26(41.94) were female. All patients presented with history of otorrhoea in this group, 52(83.87%) had hearing impairment in chronic inactive mucosal otitis media, 30(48.39%) involved in right ear and 26(41.94%) involved in left ear and 06(9.68%) in both ear in chronic inactive mucosal otitis media. Majority of perforation were medium in size in this group of which was 30(48.39%). anterior perforation was 24(38.71%), posterior perforation 28(45.16%) and subtotal 10(16.13%) in chronic inactive mucosal otitis media. Sixty two (100%) cases underwent myringoplasty. Post-auricular approach used in most of operation in this group of which was 60(96.77%). Preoperative air conduction threshold 32(51.61%) were in between 31-45 dB in myringoplasty group (p<0.05) that was statistically significant. Postoperative air conduction threshold 30(48.39%) were between 16-30 dB in myringoplasty group (p<0.05) that was statistically significant. Difference between preoperative and postoperative air conduction threshold mean difference was 11.38 dB and 36.75±5.84 and 25.37±7.46 respectively (p<0.001) in myringoplasty group. Hearing gain was 42(67.74%) in myringoplasty (p>0.05) that was not statistically significant. Graft uptake in myringoplasty was 52(83.9%). Graft failure in myringoplasty was 10(16.1%). post operative complication was tinnitus in 12(19.35%) cases in myringoplasty. Success rate was more in case of posterior perforation than anterior and subtotal perforation in both chronic inactive mucosal otitis media which was 92.86%. Success rate was more in case of medium size perforation than subtotal perforation in chronic inactive mucosal otitis media which was 86.67%. Success rate was (100%) in small perforation in this group. From this study it can be concluded that myringoplasty is a valid treatment modality for chronic inactive mucosal otitis media to achieve an intact tympanic membrane and to gain hearing.

Variation in the Position and Diameter of Basilar Artery in Different Ages of Bangladeshi People

Basilar artery is formed by the fusion of right and left vertebral artery and terminates as right and left posterior cerebral arteries. The aim of the study is to observe the diameter of basilar artery at three different levels (at its formation, at its midlevel and at its termination). This cross sectional descriptive study was performed on total 60 postmortem human hindbrain to find out the variation of position and diameter of the basilar artery of Bangladeshi people in relation to age. The specimens were collected from morgue in the department of Forensic Medicine, Mymensingh medical College, Mymensingh, Bangladesh by purposive sampling technique. All the specimens were grouped into four categories: Group A (20 to 29 years), Group B (30 to 39 years), Group C (40 to 49 years) and Group D (50 to 59 years). Diameter of basilar artery was measured with the help of digital slide calipers at three different levels. At the level of its formation, mean±SD diameter was 3.76±0.37 mm, 3.75±0.32 mm, 3.68±0.24 mm & 3.54±0.46 mm in Group A, B, C & D respectively. At mid-level, it was 3.49±0.36 mm, 3.48±0.30 mm, 3.45±0.21 mm & 3.36±0.44 mm in Group A, B, C & D respectively. At the termination, it was 3.55±0.35 mm, 3.51±0.30 mm, 3.48±0.22 mm & 3.38±0.38 mm in Group A, B, C & D respectively. This knowledge of variations of the diameter of basilar artery is of diagnostic importance for the neurosurgeons and radiologists for clinical investigation and surgery.

Level of Serum C-reactive Protein among Patients with Stroke

Stroke is defined by abrupt onset of neurologic deficit that is attributable to a focal vascular cause. The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain and its vasculature. Ischaemic cerebrovascular disease accounts for a substantial proportion of all stroke although the proximate cause of most brain infarcts is thrombus formation, atherosclerosis is the chief underlying cause. Elevated blood level of C-reactive protein (CRP) is associated with an increased risk of atherosclerotic vascular disease including stroke. This descriptive, cross sectional study was carried out in the Department of Medicine, Mymensingh Medical College Hospital, Bangladesh from January 2016 to June 2017 among purposively selected sixty one patients following inclusion and exclusion criteria with a view to estimate the C-reactive protein level among stroke patients. Data were collected through interview, physical examinations and laboratory investigations. Collected data were checked for consistency and completeness. Statistical analysis was performed using SPSS version 17.00 for windows. Most (27.87%) of the patients were in age group 69-79 years. Majority (80.33%) were male. A good number (63.90%) of patients were illiterate. An overwhelming number (90.16%) of patients came from rural area and most (54.10%) were farmers. Significant number (68.86%) of patients came within 10 hours of attack. Majority of the patients (68.85%) had C-reactive protein level raised from base line and had statistical association with acute ischemic stroke. Most (80.95%) of patients with ischaemic stroke had raised level of CRP which was statistically significant. Elevation of CRP in more common in ischaemic stroke than haemorrhagic stroke.

Length of Vermiform Appendix in Bangladeshi People of Different Age and Sex

A cross sectional descriptive study was performed on 70 postmortem vermiform appendix (male 34 and female 36) to find out the length of vermiform appendix of Bangladeshi people in different age and sex. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh from October 2016 to March 2017 by purposive sampling technique. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy techniques. The vermiform appendix was collected and preserved in 10% formol-saline solution. The length of the vermiform appendix was determined by measuring the distance from its base to tip with the help of a flexible thread. Then the thread was placed on measuring scale graduated in centimeter which represents the length of vermiform appendix. The data were analyzed by using student unpaired 't' test and compared with the findings of other national and international studies and standard text books. It was observed that length of vermiform appendix gradually decreased as age advanced. The mean±SD length of vermiform appendix was 9.41±1.26cm, 8.63±1.32cm, 7.96±1.20cm and 6.81±0.75cm in Group A, B, C and D respectively. Mean length of vermiform appendix in male was 9.92±1.55cm in Group A, 9.09±1.19cm in Group B, 8.04±1.10cm in Group C, 6.88±0.86cm in Group D and in female mean length of vermiform appendix was 9.12±1.06cm in Group A, 8.31±1.34cm in Group B, 7.79±1.60cm in Group C, 6.69±0.63cm in Group D. Statistical analysis shows that the mean differences of the length of vermiform appendix between A & D, B & D were statistically highly significant. The mean difference between Group A & C was moderately significant. Between Group C & D the difference was statistically significant and between Group A & B, B & C were statistically non significant. No significance difference of length of vermiform appendix between male and female was observed. The present study will help to increase the information pool on the length of vermiform appendix of Bangladeshi people.

Pattern of Disease among Patients Attending Cardiology Outpatient Department of a Private Hospital of Mymensingh, Bangladesh

Epidemiologic transition is taking place in every part of the world. Cardiovascular diseases became the most common cause of death accounting for 30% of deaths worldwide, with 80% of the burden now occurring in developing countries. The objective of the study was to assess the Pattern of disease among patients attending Cardiology outpatient department of a private hospital. The cross sectional descriptive type of observational study was conducted among 550 patients attending Cardiology outpatient department (COPD) of Sodesh Hospital, Mymensingh, Bangladesh from March 2016 to June 2016. All the new patients attending COPD of Sodesh Hospital were selected purposively for the study. Data were collected by interview, physical examination and laboratory investigations of patients using a case record form. Mean age of the patients was 45.1 years with a SD of 15.6 years. Among the patients male were 291(52.9%), a bit higher than the female 259(47.1%). It was observed that more than half of the patients (281, 51.1%) visited cardiologist with non-cardiac problems. Less than one third of the patients (169, 30.7%) attended with cardiac problems and 100(18.2%) patients visited with both cardiac and non-cardiac problems. Among the cardiac diseases and symptoms hypertension was on the top of the list 176(65.4%). Ischemic heart diseases was present in 35(13.0%) and palpitation was in 30(11.1%) patients. On the other hand among the non-cardiac diseases or presentations, 121(43.1%) patients had non-specific chest pain, 63(22.4%) had shortness of breath and 17(6.1%) had diabetes mellitus. Hypertension was found the most frequent cardiovascular disease (65.4%) followed by ischemic heart disease (13.0%). More than half (51.1%) of the patients visit cardiologist with non-cardiac problems. Screening at the level of general practitioner (GP) and appropriate referral system can reduce extreme burden of patients to the cardiologists in the Cardiology outpatient department.

Skin Biopsy and Histopathological Diagnosis of Dermatological Diseases

Microscopic examination of skin and mucous membrane is an established investigation in diagnosis and follow up of many dermatological conditions frequently encountered during practice. Histopathological examination is performed with biopsied specimen from skin and or mucous membrane where required. However neither do all skin biopsies produce neither a conclusive diagnosis nor the dermatologists routinely perform this procedure to every patient they consult. This cross sectional descriptive study conducted by reviewing the records of all biopsied cases studied for histopathology in Mymensingh Medical College, Mymensingh and Shaheed Mansur Ali Medical College, Dhaka, Bangladesh from January 2012 to December 2016. The aim of this study was to investigate the favourable clinical diagnoses set by dermatologists when performing skin biopsy, the diagnoses reached by the dermatopathologists after microscopic examination, and the relationship between them and finally to comment on the instances that skin biopsy fails to fulfill the diagnostic task. Fourteen hundred and thirty six (1436) cases of skin biopsy were reviewed and descriptive statistics were performed. Maximum cases 39.1% (562) were in 2nd decade with almost equal sex distribution. The most frequently proposed clinical diagnoses included papulosquamous dermatoses 28.6% (410), whereas histological confirmation was in 13.1% (188). Histological diagnosis was more as nonspecific dermatitis 31.6% (454). After microscopic examination, a specific histological diagnosis was found in 83.5% (1199) of the cases and a consensus between clinical and histological diagnoses was observed in 69.2% (994). Neither histological diagnosis nor any feature consistent with clinical suspicion was observed in 10.1% (145) cases. Histopathological examination of skin biopsy is still a valuable diagnostic tool in many skin diseases and dermatoses with diagnostic dilemma. There are cases in which diagnostic inefficiency are being faced even after skin biopsy examination.

Clinicopathological Assessment of Colorectal Carcinoma in Mymensingh Medical College Hospital, Bangladesh

Colorectal carcinoma (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer death in both men and women in the US. It is mainly a disease of the developed countries with a western culture, yet the disease is not uncommon in developing countries. There is substantial geographical variation in the incidence and demographic characteristics of the disease. Variations are also observed in the risk factors, mode of presentation, sub site distribution and stage of the disease at presentation. This cross-sectional, descriptive study was intended to explore the age and sex distribution, pattern of presentation, sites and histological types of colorectal carcinoma. This cross-sectional, descriptive study was conducted in the department of surgery, Mymensingh Medical College Hospital, Bangladesh from October 2011 to September 2012. Purposively selected sixty patients irrespective of age and sex with histologically proven colorectal cancer were included in the study. A pre-tested, structured case record form was used for collection of data. Most of the patients (80.0%) were above 50 years of age. Mean age was 60.83 years with an SD of 11.2 years. Male to female ratio was almost equal (1.3:1). Positive family history was present in 3.3% cases. More than half of the patients (53.3%) were smokers, 76.7% patients had the history of taking fresh fruits irregularly. Pain in abdomen was the leading symptom followed by alteration of bowel habit and weight loss. Anaemia was found in 71.6% patients followed by wasting in 70.0% cases. Proctosigmoidoscopy was the principal diagnostic modality (61.7%) followed by double contrast barium enema (30.0%). Patients with rectal growth were detected by digital rectal examination (23.3%). Rectum was the principal site of cancer (36.7%) followed by sigmoid colon (33.3%). Cancer in caecum and ascending colon were in 15.0% and 6.7% patients respectively. Adenocarcinoma was the principal histological type (88.0%) and 36.7% were well differentiated carcinoma. Majority of the patients (63.3%) were in advanced stage (stage III and stage IV). Some forms of palliative surgical treatment were offered to all colorectal cancer patients in the study. Postoperative outcome was uneventful in most of the patients. However, there was wound infection in (13.3%) patients. Colorectal cancer was found mainly in elderly. Male and females were affected almost equally. Smoking was the most commonly found risk factor. Colorectal carcinoma involved rectum and sigmoid colon in majority of the patients. Adenocarcinoma was the principal histological type and the most of which were well differentiated. Majority of the patients were diagnosed at an advanced stage and palliative treatment was offered to them. Postoperative period was uneventful in most of them. Policies should be taken to promote health education & screening programmes which will lead to early diagnosis, affordable and effective treatment and better prognosis.

Disease Pattern among Children attending Pediatric Outpatient Department in Community Based Medical College Hospital, Bangladesh

Disease pattern is based on socio-demographic characteristics, comprehensive health care services, and environmental variables like water supply, basic sanitation and housing, illness behavior like quick decision to arrive at health care facility, and treatment behavior like the modality of treatment they receive. The descriptive cross-sectional study was conducted during the period of January 2014 to December 2015. The study was carried out among 310 purposively selected children attended at Pediatric Outpatient department of Community Based Medical College Hospital, Bangladesh. Data were collected by face to face interview of the parents and clinical examination and anthropometric measurement of children using case record form. Mean age of the children was 4.11 years with a SD of 4.35 years, male-female ratio was 1.25:1 with predominance 201(64.84%) of under-five children. The common diseases were 121(39.03%) with Acute Respiratory Infections (ARI), while 43(13.87%) diarrheal diseases, 25(8.06%) each with bronchial asthma and helminthiasis. Other diseases 96(30.97%) include anemia 17(5.48%), urinary tract infection 15 (4.84%), peptic ulcer disease 9(2.90%), enteric fever, oral candidiasis, apthous ulcer of mouth, scabies and vulvovaginitis. Average number of children per family was 2.2 including 251(80.97%) children having sanitary latrine in the family, 297(95.81%) with safe drinking water facilities and 270(87.10%) were fully vaccinated under EPI. More than three fourth 76(24.52%) of the children were underweight, 114(36.77%) were from poor families and 136(43.87%) lived in Kancha house. With the improvement of safe water supply and use of sanitary latrine diseases like diarrhoeal disease and helminthiasis are showing a decreasing trend.

Quality of Life in Children with Asthma in Bangladesh

Asthma is a public health problem that adversely affects different aspects of quality of life. Childhood asthma is common in Bangladesh affecting their lifestyle. The objective of the study was to assess health-related quality of life in children with bronchial asthma. A descriptive, cross-sectional study was carried out from January 2014 to December 2014 at the Outpatient Department of National Asthma Centre, Mohakhali, Dhaka among hundred sixty-two purposively selected children of both sexes with bronchial asthma aged from 7 to 17 years. Data were collected through interview with children or their parents using an interviewer-administered questionnaire based on Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Data were analyzed by computer software SPSS version 16.0. The mean age was 12.5 years with a standard deviation (SD) of 2.9 years. Overwhelming majority 157(96.9%) of children were literate, while only 5(3.1%) children were illiterate. Eighty (49.4%) children were male, while 82(50.6%) female. As many as 148(91.4%) children were students, while 10(6.2%) children were engaged in some type of job and 4(2.5%) children had no occupation. Parents of 145(89.5%) children were currently married, while 10(6.2%) children had single parent and 7(4.3%) children's parents were divorced or separated. Quality of life in children with asthma decreases with age as the disease intensity increases with age. Female asthmatic children had lower overall score of Quality of life (p=0.017), as well as lower activity domain score (p<0.001). Emotional domain score was found lower in children with single parent (p=0.021) and low monthly family income (p<0.001). Furthermore, children with lower monthly family income and working children had lower Quality of life score in all domains.

Mucinous Adenocarcinoma of the Appendix: A Case Report

Primary tumors of the appendix are unusual and most of them are carcinoids. Their main presentation is that of an acute appendicitis or as a palpable mass, mainly in the right lower quadrant. A 40 years old male patient presented in Dhaka Community Medical College Hospital, Dhaka, Bangladesh on 31st October 2013 with mucous adenocarcinoma of the appendix, which primarily presented as heaviness in right lower abdomen and atypical abdominal pain. Diagnosis of the disease was made after right hemicolectomy and histopathological analysis of the specimen. Mucin producing adenocarcinomas of the appendix are a category of rare cancers of the gastrointestinal tract. Although at present they are a well studied pathological entity, the crucial issue of their preoperative diagnosis remains unsolved.

An Evaluation of Faculty Wise Teaching Performance in a Public Medical College of Bangladesh

Teaching is a complex and demanding activity that involves Mastery of content, classroom control and techniques of organization and command of teaching skills. Teachers' continuous engagement in learning, skill acquisition and refinement to practice is essential for meeting student learning needs. Medical education is principally centered on the transmission of medical knowledge and assisting medical students to acquire the necessary skills and attitudes associated with medical practice. Evaluation of teaching is important in the teaching-learning process. The medical profession demands to be increasingly concerned with evaluation of teachers' performance as a part of its accountability. This study was designed to evaluate teaching performance in the department of Pharmacology, Forensic Medicine, Microbiology, Community Medicine and Pathology in Mymensingh Medical College and this descriptive cross sectional study was conducted among 94 students of 5th year MBBS students (session 2011-2012) of Mymensingh Medical College, Bangladesh from January 2016 to June 2016. A semi-structured self-administered questionnaire was used for collection of data. All the respondents provided opinion regarding scholarship of teachers, methods of presentation, communication and interaction, learning, coverage of contents and approachability by a 5 points rating scale. Attained score was variable in the context of different statements and different faculties. Students were also asked to provide suggestions for improvement of teachers' performance in each subject. Remarkable number of the students demanded for deployment of subject-specific teachers in adequate number. A significant number of students called for more practical classes in Pathology, Microbiology and Pharmacology. They also desired for the improvement of teaching quality and student friendly attitude from the teachers. A significant number of students opined that teaching materials and other logistics in the class rooms and even the class rooms were inadequate and need improvement in this regards. Regular conduction of classes by adequate number of teachers having post-graduate degree in the relevant faculty with adequate skill in teaching, student-friendly attitude of the teachers, adequate physical facilities and teaching materials help in improvement of teaching quality.