The Impact of COVID-19 on The Teaching of Non-Medical Healthcare Professionals in Bangladesh: Observations and Implications From A Pilot Study

Objective: At the start of the Covid-19 pandemic, educational establishments, including universities, were closed. Educators in high-income countries quickly shifted all education online, building on available infrastructures and approaches. However, there were concerns in developing countries regarding the necessary skills among students and faculty as well as financial support for equipment and the internet. Consequently, a pilot was undertaken in Bangladesh to determine the impact of Covid-19 on the non-medical education system, building on similar research with healthcare professionals. Materials and Methods: A purposively designed questionnaire was disseminated among eight non-medical healthcare educators in private and public universities in Bangladesh. Results and Discussion: Private university educators reported their universities readily adopted e-learning systems and resumed classes more quickly than public universities. Both private and public university educators shared similar challenges, including a lack of training on e-learning initially, variable internet connections, affordability of internet bundles, concerns with available devices, as well as mental stress of faculty and students. Private universities reduced their tuition fees, extended submission deadlines, and shared class recordings to address challenges. Public universities arranged student loans, established Covid-19 testing centers, and the trained students in biosafety practices and molecular tests to volunteer in testing facilities. Conclusion: Lessons learned from the pandemic emphasize introducing hybrid education systems with full technological and financial support, alongside biosafety education in the curriculum. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 731-743

Prevalence of COVID-19 vaccine reactogenicity among Bangladeshi physicians

Increased COVID-19 vaccine hesitancy presents a major hurdle in global efforts to contain the COVID-19 pandemic. This study was designed to estimate the prevalence of adverse events after the first dose of the Covishield (AstraZeneca) vaccine among physicians in Bangladesh. A cross-sectional study was conducted using an online questionnaire for physicians (n = 916) in Bangladesh. Physicians who received at least one dose of the COVID-19 vaccine were included. The study was carried out from April 12 to May 31, 2021. More than 58% of respondents (n = 533) reported one or more adverse events. Soreness of the injected arm (71.9%), tiredness (56.1%), fever (54.4%), soreness of muscles (48.4%), headache (41.5%) and sleeping more than usual (26.8%) were the most commonly reported adverse events. Most vaccine-related reactogenicities were reported by the younger cohorts (<45 years). The majority of respondents reported severity of reactogenicity as "mild," experienced on the day of vaccination, and lasting for 1-3 days. The most common reactogenicity was pain at the injection site; the second most common was tiredness. Almost half (49.2%) of the physicians took acetaminophen (paracetamol) to minimize the effects of vaccine reactogenicity. Multivariate logistic regression analyses showed that physicians with diabetes and hypertension (OR = 2.729 95% CI: 1.282-5.089) and asthma with other comorbidities (OR = 1.885 95% CI: 1.001-3.551) had a significantly higher risk of vaccine-related reactogenicities than physicians without comorbidities. Further safety studies with larger cohorts are required to monitor vaccine safety and provide assurance to potential vaccine recipients.

Impact of the COVID-19 pandemic on dental and medical education in Bangladesh: a pilot study and the implications

Objective: Lockdown and other measures, including the closure of universities, introduced by Governments across countries in response to the COVID-19 pandemic have appreciably impacted on the education of dental and medical students across countries. Key challenges included the need to rapidly move to e-learning as well as instigate new approaches to practicals for health science students. This involves lecturers and students necessarily needing to rapidly adapt to e-learning and other approaches. There have also been affordability issues among students to regularly access the Internet, and purchase the necessary equipment, particularly among those from low- and middle-income countries such as Bangladesh. Consequently, there is an urgent need to assess current challenges among senior level physicians and educators in Bangladesh regarding the education of dental and medical students arising from the current pandemic, and how these are being addressed, to provide future direction. This is particularly important in Bangladesh with high rates of both infectious and non-infectious diseases. Materials and Methods: Pragmatic investigation involving a purposely developed questionnaire based on previous studies and the experience of the co-authors. The questionnaire was distributed to 15 senior-level educators with the findings analysed by themes. Results: Key issues included little experience with e-learning at the start of the pandemic among both staff and students, poor internet access and cost of internet bundles. In addition, fear and anxieties among both students and staff. The colleges responded by instigating teaching classes for educators on e-learning and providing adequate personal protective equipment for staff and students during teaching and practical sessions. These formed the basis of future recommendations. Other recommendations included increased flexibility among staff and students. Conclusion: The pandemic posed appreciable challenges to both staff and students attending dental and medical colleges in Bangladesh. Some of the key issues are starting to be addressed. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 444-454

Management of Children Admitted to Hospitals across Bangladesh with Suspected or Confirmed COVID-19 and the Implications for the Future: A Nationwide Cross-Sectional Study

There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO ‘Watch’ list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.

Pilot Study on the Current Management of Children with COVID-19 In Hospitals in Bangladesh; Findings and Implications

Objective: The focus on COVID-19 in children in low- and middle-income countries including Bangladesh has been on addressing key issues including poor vaccination rates as well as mental health issues, domestic violence and child labour. However, the focus on optimally managing children in hospitals is changing with new variants and concerns with the development of hyperinflammatory syndromes. There are also concerns with the overuse of antimicrobials to treat patients with COVID-19 in hospitals enhancing resistance rates. The Bangladesh Paediatric Association have developed guidelines to improve patient care building on national guidance. Consequently, there is a need to document the current management of children with COVID-19 in Bangladesh and use the findings for future guidance. Methods: Rapid analysis of the management of children with COVID-19 among eight private and public hospitals in Bangladesh with varying numbers of in-patient beds using purposely developed case report forms (CRFs). The CRFs were piloted before full roll-out. Results: Overall low numbers of children in hospital with COVID-19 (4.3% of in-patient beds). The majority were male (59.6%) and aged 5 years or under (63.5%). Reasons for admission included respiratory distress/ breathing difficulties with 94.2% of COVID-19 cases confirmed. All children were prescribed antibiotics empirically, typically those on the Watch list of antibiotics and administered parenterally, with only a small minority switched to oral therapy before discharge. There was appreciable prescribing of Vitamins (C and D) and zinc and encouragingly limited prescribing of other antimicrobials (antivirals, antimalarials and antiparasitic medicines). Length of stay was typically 5 to 10 days. Conclusion: Encouraging to see low hospitalisation rates and limited use of antimicrobials apart from antibiotics. Concerns with high empiric use of antibiotics and limited switching to oral formulations can be addressed by instigating antimicrobial stewardship programmes. We will be monitoring this. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.188-198

Nocardia infection causing non-healing surgical wounds: A case series from Bangladesh

OBJECTIVE

Nocardia can be introduced accidentally causing non-healing surgical wounds.

METHOD

From February 2017 to January 2021 samples from wounds were collected. Nocardia identification and susceptibility testing were carried out by standard procedure.

RESULTS

Seventeen (35.4 %) Nocardia spp. and 20 other pathogens (41.7%) were recovered by culture. Drug susceptibility among Nocardia was >70% to amikacin, amoxicillin-clavulanic acid, levofloxacin, linezolid, and imipenem, 47% to cephalosporins and 41% to trimethoprim/sulfamethoxazole.

CONCLUSIONS

Infections with Nocardia spp. should be considered in non-healing surgical wounds.

Diagnosis of Kala-azar by rK39 based ELISA and KAtex

This cross sectional study was carried out in SSMC for a period of one year from July 2007 to June 2008 to evaluate rK39 based ELISA and KAtex tests for diagnosis of Kala-azar. Total 150 patients were selected clinically. For this study rK39 ICT was regarded as confirmatory test according to national guideline. Among 150, total 100 cases were confirmed to be positive for Kala-azar by rK39 ICT test. Age and sex matched 25 healthy persons each from endemic and non-endemic area were taken as control. Among the 100 sero confirmed cases KAtex was positive in 87 (sensitivity of 87%) while ELISA was positive in 98 cases (sensitivity 98%). Among the 50 controls none were positive by KAtex test while 1 (one) ELISA test was positive resulting in specificity of these tests 100% and 98% respectively. The result of the study clearly showed superiority of rK39 antigen based ELISA in respect of sensitivity and KAtex in respect of specificity.KYAMC Journal Vol. 6, No.-1, Jul 2015, Page 574-578

Pulmonary tuberculosis and drug resistance in Dhaka central jail, the largest prison in Bangladesh

Background

There are limited data on TB among prison inmates in Bangladesh. The aim of the study was to determine the prevalence of pulmonary tuberculosis (TB), its drug resistance and risk factors in Dhaka Central Jail, the largest prison in Bangladesh.

Methods

Cross sectional survey with, active screening of a total number of 11,001 inmates over a period of 2 years. Sputum samples from TB suspects were taken for acid- fast bacilli (AFB) microscopy, culture and drug susceptibility testing.

Results

Among 1,781 TB suspects 245 (13.8%) were positive for AFB on microscopy and/or culture. The prevalence rate of sputum- positive pulmonary TB was 2,227/100,000. Fifty three cases (21.6% of 245 cases) were AFB- negative on microscopy but were found positive on culture. Resistance to isoniazid, rifampicin, streptomycin and ethambutol was 11.4%, 0.8%, 22.4% and 6.5% respectively. No multidrug resistance was observed. The main risk factors of TB in prison were exposure to TB patients (adjusted odds ratio 3.16, 95% CI 2.36–4.21), previous imprisonment (1.86, 1.38–2.50), longer duration of stay in prison (17.5 months for TB cases; 1.004, 1.001–1.006) and low body mass index which is less than 18.5 kg/m² (5.37, 4.02–7.16).

Conclusions

The study results revealed a very high prevalence of TB in the prison population in Dhaka Central Jail. Entry examinations and active symptom screening among inmates are important to control TB transmission inside the prison. Identifying undiagnosed smear-negative TB cases remains a challenge to combat this deadly disease in this difficult setting.

Seropositivity of Helicobacter Pylori among the fish handlers

This case control study was done to study the seropositivity of helicobacter pylori among the fish handlers and to find out rapid urease test (RUT) & haematoxillin and eosin staining report correlation of seropositive cases. It was performed among fish handlers in the period of July 2005 to June 2006. Blood samples were collected from fish handlers (Group I) and some non-fish handler control subjects (Group II) to perform Anti-H. Pylori IgG test by ELISA method. Samples were collected from both the sea water area (Paikgacha, Khulna) and fresh water area (Derai, Sunamgonj and Dhaka). Seropositive cases having complaints and treatment history of peptic ulcer diseases were motivated for endoscopic examination to collect biopsy from upper GIT and rapid urease test (RUT) hematoxillin & eosin (H & E) staining were performed. A total of 235 respondents were included in this study, among them 163 were fish handlers (80 sea water and 83 fresh water) and 72 were non fish handler control (25 sea water, 22 fresh water from Sunamgonj, 25 fresh water from Dhaka city). Serum anti- H. pylori test was positive in 126(77.30%) cases in fish handler group (a) and 27(37.5%) cases in the control group (b). Seropositive cases were observed more among the higher age group (>40 years) than in lower age group (<40 years) which was 86% and 67% respectively. Endoscopic examination was done among the seropositive cases having positive PUD features. Total seropositive cases were 153 and among them 81 have positive PUD features, among them 48 cases were selected for endoscopic examination. Among the fish handlers out of 34 cases, 31(91.17%) were RUT positive and out of 14 non-fish handlers 6(42.85%) were RUT positive. Among the fish handlers, 28(82.35%) of the 34-biopsy specimens were H & E positive and among the non-fish handlers, out of 14 samples, 5(35.71%) were H & E positive. Fish handlers have more association of H. Pylori infection than non fish handlers and higher age group persons are more prone to H. Pylori infection. A significant number of seropositive persons have association with positive RUT and H & E staining report.

Genetic characterization of Staphylococcus aureus isolates carrying Panton-Valentine leukocidin genes in Bangladesh

To assess the spread and genetic characteristics of Panton-Valentine leukocidin (PVL) gene-carrying Staphylococcus aureus in Bangladesh, we investigated 59 strains (49 isolates from clinical specimens and 10 isolates colonized in the nasal cavities of medical staff), including 26 methicillin-resistant S. aureus (MRSA) strains. The PVL gene was detected only in methicillin-susceptible S. aureus (MSSA) strains (7 clinical strains and 2 colonizing strains). PVL gene-positive MSSA strains were found to belong to coagulase serotypes III or VI and were classified into sequence types ST88 (CC88), ST772, and ST573 (CC1) by multilocus sequence typing, and agr types 2 or 3. These types were different from those determined for MRSA (coagulase serotypes I and IV, ST240 and ST361, and agr type 1). PVL gene-positive MSSA possessed a larger number of virulence factor genes than MRSA, although they were susceptible to more antimicrobials. These findings suggest that the PVL gene is distributed to limited populations of S. aureus clones with specific genetic traits that are distinct from MRSA in Bangladesh, but genetically close to CA-MRSA clones in the CC1 lineage reported in the United States and European countries.

Salmonella-a new threat to neonates

Hospital admitted 582 neonates with suspected septicaemia were studied in Microbiology Department of Dhaka Medical College, Dhaka, Bangladesh. Samples being taken from neonatal unit of Dhaka Medical College Hospital and a Neonatal Private Hospital in one year (January to December 2004). Blood culture was done by Lytic-centrifugation method. The isolated organisms were identified using standard laboratory procedures. Among 582 sick neonates 59(10.14%) were culture positive and the predominant organisms were Gram Negative Bacteria (89.83%). Among the isolates Klebsiella spp. was the prime organism (33.90%). Salmonella was observed as the 2nd most common cause (22.03%) for sepsis of neonates. Of these isolated Salmonella strains 46.15% were Salmonella typhi and 53.85% were Salmonella spp. Next to Imipenem, Ciprofloxacin was observed as the drug of choice for treatment of Sepsis neonatorum.

Comparative in vitro activity of vancomycin and other antimicrobial agents against methicillin-resistant staphylococcus aureus and enterococcus faecium in the Tohoku district of Japan

Susceptibility patterns of methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecium obtained from various hospitals of the Tohoku district were documented. MICs of 6 antimicrobial agents against a total of 480 strains (380 strains were MRSA and 100 were E. faecium) were estimated. All MRSAs were susceptible to vancomycin, teicoplanin and quinupristin/dalfopristin, but all of them were resistant to ampicillin and benzylpenicillin. None of the E. faecium strains were found to be resistant to vancomycin, teicoplanin and quinupristin/dalfopristin. Excluding these, almost all strains of E. faecium were resistant to the remaining drugs. These data suggest that despite the emergence of vancomycin resistance to E. faecium in Europe and in the United States, vancomycin, teicoplanin and quinupristin/dalfopristin will nevertheless provide effective bactericidal activity in the Tohoku area of Japan.

Characterization of gyrA, gyrB, grlA and grlB mutations in fluoroquinolone-resistant clinical isolates of Staphylococcus aureus

The distribution of fluoroquinolone resistance-associated point mutations in genes encoding the subunits of DNA gyrase and DNA topoisomerase i.v. was examined in 110 clinical isolates of Staphylococcus aureus. Point mutations were detected by polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis and mutations were further characterized by sequencing of PCR products. Mutations at Ser84 of GyrA were widely distributed among isolates exhibiting various degrees of fluoroquinolone resistance, and border zones between mutant and non-mutant strains based on drug susceptibility were generally distinct. Mutations at Ser80 of GrlA were also widely distributed, but border zones between mutant and non-mutant isolates were in this case less distinct and several GrlA mutants were highly susceptible to sparfloxacin and tosufloxacin. Only two gyrB mutants and one grlB mutant were observed among the isolates: all contained a previously unreported mutation. GyrA and grlA mutations thus appear to impart high levels of fluoroquinolone resistance in many S. aureus clinical isolates.