Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study

BACKGROUND

Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients' experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme.

OBJECTIVE

We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh.

METHODS

A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients' socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed.

RESULTS

We found that 55.1% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians' behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses' behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ≤15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services.

CONCLUSIONS

More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility.

Dumbbell shaped structure loaded modified circular ring resonator based perfect metamaterial absorber for S, X and Ku band microwave sensing applications

In this paper, a new metamaterial absorber (MMA) is presented that exhibits peak absorptions at 3.26 GHz, 11.6 GHz, and 17.13 GHz within S, X, and Ku bands. The unit cell of the proposed MMA is constructed on an FR4 substrate having an electrical dimension of 0.144λ × 0.144λ, where wavelength, λ is calculated at the lowest absorption frequency. The unique structural design of the unit cell consists of two concentric copper rings with which dumbbell-shaped structures are attached. The rotating symmetrical structural design of this MMA provides around 93.8%, 96.47%, and 99.95% peak absorptance in the mentioned frequencies, which is invariable with the change of incident angle as well as polarization angle. The metamaterial properties of the proposed absorber are studied along with the surface current analysis. The MMA shows single negative behaviour and it also exhibits high-quality factors (Q factor) of 21.73, 41.42, and 51.90 at maximum absorptance frequencies. The MMA is analysed by it's equivalent circuit to understand the resonance phenomenon, which is verified through simulation in Advanced Design Systems (ADS) software. The testing is done on the developed prototype of the proposed MMA. Measurement results are in close proximity to the simulation results. Due to its high Q factor, high EMR, and insensitivity to polarization and angle of incidence, it can be utilized as a part of miniaturized microwave device. In addition, the proposed MMA can exhibit high sensing performance and flexibility to differentiate different oils in S, X, and Ku bands.

Estimation of 10-Year Fracture Risk with and without Bone Mineral Density in Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is the most common inflammatory arthritis affecting 0.5-1.0% of the general population worldwide and although RA is properly considered a disease of the joints, it can cause a variety of extra-articular manifestations. This study was performed to find out any discrepancy in fracture risk estimates with and without bone mineral density (BMD) in rheumatoid arthritis (RA) patients. This observational cross-sectional study was carried out in the Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from July 2013 to July 2015. Total 65 consecutive patients with RA fulfilling ACR/EULAR criteria aged 40-90 year were recruited. Ten year fracture risk of these patients was evaluated by the FRAX score with and without BMD and differences were observed. FRAX score without BMD revealed that major fracture risk was low in 58(89.2%) patients, moderate in 7(10.8%) patients but re-estimation with BMD revealed that 55(84.6%) patients remained in low risk group, 8(12.3%) patients in moderate risk group and 2(3.1%) patients went to the high risk group. In case of hip fracture risk without BMD, risk was low in 58(89.2%) patients, high in 7(10.8%) patients; but with BMD, 50(76.9%) patients remained in low risk group but risk of 15(23.1%) patients became high. Almost all the high risk patients (93.3%) were ≥55 years of age. Increasing age, female sex, disease duration and use of steroid were positively correlated with increased FRAX score where as high BMI and high BMD were associated with low FRAX score. But in multivariate analysis it was found that only relation with age was at statistically significant level. Significant numbers of patients with rheumatoid arthritis have high risk of fracture especially hip fracture. The mean of FRAX score increased in both major & hip osteoporotic fracture risk after adding BMD. More than half of the patients above fifty five years or more had high risk of fracture. So, BMD should be done in patients aged more than fifty five.

Professional Relationship Between Physicians and Journalists in Bangladesh: Web-Based Cross-Sectional Study

BACKGROUND

A health care system is intertwined with multiple stakeholders, including government institutions, pharmaceutical companies, patients, hospitals and clinics, health care professionals, health researchers and scientific medical experts, patients and consumer organizations, and media organizations. Physicians and journalists are the key actors who play a significant role in making health care services and health information accessible to the people of a country.

OBJECTIVE

The aim of this study was to explore the tensions and alliances between physicians and journalists in Bangladesh, along with identifying strategies that could potentially improve the often contentious relationship and quality of medical journalism.

METHODS

We conducted a web-based cross-sectional survey using the snowball sampling technique from September 2021 to March 2022. Adult Bangladeshi citizens belonging to the two selected professional groups (physicians and journalists), who understood the survey content, and agreed to participate in the survey were considered eligible for inclusion in the study. Both descriptive and logistic regression analyses, including the Mann-Whitney U test and Wilcoxon signed-rank test, were performed to determine the differences between groups concerning selected perception-related variables, and the associations of perceptions about lack of trust in each other's knowledge, skills, and professional integrity with background characteristics.

RESULTS

A total of 419 participants completed the survey, including 219 physicians and 200 journalists. Among physicians, 53.4% (117/219) reported lower trust toward journalists' professional domain and expertise, whereas 43.5% (87/200) of journalists had lower trust toward physicians' professional domain and expertise. In terms of perception about not having respect for each other, the median value for the physicians was 5 (strongly agree), whereas it was only 3 (agree) for the journalists. We also found that male physicians (adjusted odds ratio [AOR] 0.45, compared with female physicians) and medical officers (AOR 0.30, compared with specialists) had significantly higher odds of lacking trust in journalists' knowledge, skills, and professional integrity. When rating the statement "Regular professional interaction between journalists and doctors may improve the relationship between the professional groups," most physicians (186/219, 84.9%) chose "neither agree nor disagree," whereas most journalists (106/200, 53.0%) stated that they "slightly agree."

CONCLUSIONS

Both physicians and journalists in Bangladesh have negative perceptions of each other's professions. However, physicians have a more negative perception of journalists than journalists have of the physicians. Strategies such as a legal framework to identify medical-legal issues in reporting, constructive discussion, professional interaction, and capacity-building training programs may significantly improve the relationship between physicians and journalists.

Effect of leisure-time physical activity on blood pressure in people with hypertension: a systematic review and meta-analysis

High blood pressure is a major risk factor for premature death. Leisure-time physical activities have been recommended to control hypertension. Studies examining how leisure-time physical activity affects blood pressure have found mixed results. We aimed to conduct a systematic review examining the effect of leisure-time physical activity (LTPA) on lowering blood pressure among adults living with hypertension. We searched studies in Embase, Medline/PubMed, Web of Science, Physical Education Index, Scopus and CENTRAL (the Cochrane Library). The primary outcome variables were systolic blood pressure (SBP) and diastolic blood pressure (DBP). This systematic review is registered on PROSPERO (CRD42021260751). We included 17 studies out of 12,046 screened articles in this review. Moderate-intensity LTPA (all types) reduced SBP compared to the non-intervention control group (MD -5.35 mm Hg, 95% CI -8.06 to -2.65, nine trials, n = 531, low certainty of the evidence). Mean DBP was reduced by -4.76 mm Hg (95% CI -8.35 to -1.17, nine trials, n = 531, low certainty of the evidence) in all types of LTPA (moderate intensity) group compared to the non-intervention control group. Leisure-time walking reduced mean SBP by -8.36 mmHg, 95% CI -13.39 to -3.32, three trials, n = 128, low certainty of the evidence). Walking during leisure time reduced -5.03 mmHg mean DBP, 95% CI -8.23 to -1.84, three trials, n = 128, low certainty of the evidence). Performing physical activity during free time probably reduces SBP and DBP (low certainty of the evidence) among adults with hypertension.

Costs of services and funding gap of the Bangladesh National Tuberculosis Control Programme 2016-2022: An ingredient based approach

BACKGROUND

Bangladesh National Tuberculosis (TB) Control Programme (NTP) has deployed improved diagnostic technologies which may drive up the programme costs. We aimed to estimate the supply-side costs associated with the delivery of the NTP and the funding gap between the cost of implementation and available funding for the Bangladesh NTP.

METHODS

An ingredient-based costing approach was applied using WHO's OneHealth Tool software. We considered 2016, as the base year and projected cost estimates up to 2022 using information on NTP planned activities. Data were collected through consultative meetings with experts and officials/managers, review of documents and databases, and visits to five purposively selected TB healthcare facilities. The estimated costs were compared with the funds allocated to the NTP between 2018 and 2022 to estimate the funding gap.

FINDINGS

The estimated total cost of NTP was US$ 49.22 million in 2016, which would increase to US$ 146.93 million in 2022. Human resources (41.1%) and medicines and investigations/ supplies (38.0%) were the major two cost components. Unit costs were highest for treating extensively drug-resistant TB at US$ 7,422.4 in 2016. Between 2018-2022, NTP would incur US$ 536.8 million, which is US$ 235.18 million higher than the current allocation for NTP.

CONCLUSION

Our results indicated a funding gap associated with the NTP in each of the years between 2018-2022. Policy planners should advocate for additional funding to ensure smooth delivery of TB services in the upcoming years. The cost estimates of TB services can also be used for planning and budgeting for delivering TB services in similar country contexts.

Knowledge, attitude, and practice of Bangladeshi urban slum dwellers towards COVID-19 transmission-prevention: A cross-sectional study

The first COVID-19 case in Bangladesh was detected on March 8, 2020. Since then, efforts are being made across the country to raise awareness among the population for preventing the spread of this virus. We aimed to examine the urban slum dwellers' knowledge, attitude, and practice (KAP) towards COVID-19 transmission-prevention. A phone-based cross-sectional survey was conducted in five slums of Dhaka City. Total 476 adult slum dwellers were interviewed between October 31 to December 1, 2020 using a pre-tested questionnaire. During an interview, information was collected on participants' demographic characteristics and KAP items towards COVID-19. We used quartiles for categorization of knowledge and practice score where the first quartile represents poor, the second and third quartiles represent average while the fourth quartile represents good. Attitude score was standardized using z-score and identified as positive and negative attitude. Multiple linear regression models were used separately to identify the socioeconomic predictors of the KAP scores. The results showed that 25% of the respondents had good knowledge and 25% had poor knowledge, 48% had a positive attitude and 52% had a negative attitude, and 21% maintained good practice and 33% maintained poor practice towards COVID-19 transmission-prevention. About 75% respondents relied on television for COVID-19 related information. Regression results showed that knowledge and attitude scores were significantly higher if respondents had primary or secondary and above level of education compared to the uneducated group. Female respondents maintained significantly good practice compared to their male counterparts (β = 6.841; p<0.01). This study has found that one third of the studied slum dwellers maintained poor practice and one fourth had poor knowledge towards COVID-19 transmission-prevention. As KAP domains are significantly correlated, efforts are needed to raise awareness of COVID-19 particularly targeting individuals with average and lower knowledge to improve attitude and practice for the prevention of COVID-19.

Prevalence of and factors associated with tobacco smoking in the Gambia: a national cross-sectional study

OBJECTIVES

To examine the prevalence of and risk factors associated with tobacco smoking in the Gambia.

DESIGN

A nationwide cross-sectional study.

SETTING

The Gambia.

PARTICIPANTS

The study participants were both women and men aged between 15 and 49 years old. We included 16,066 men and women in our final analysis.

DATA ANALYSIS

We analysed data from the Gambia Demographic and Health Survey (DHS), 2019-2020. DHS collected nationally stratified data from local government areas and rural-urban areas. The outcome variable was the prevalence of tobacco smoking. Descriptive analysis, prevalence and logistic regression methods were used to analyse data to identify the potential determinants of tobacco smoking.

RESULTS

The response rate was 93%. The prevalence of current tobacco smoking was 9.92% in the Gambia in 2019-2020, of which, 81% of the consumers smoked tobacco daily. Men (19.3%) smoked tobacco much higher than women (0.65%) (p<0.001). People aged 40-49 years, with lower education, and manual workers were the most prevalent group of smoking in the Gambia (p<0.001).Men were 33 times more likely to smoke tobacco than women. The chance of consuming smoked tobacco increased with the increase of age (adjusted OR (AOR) 9.08, 95% CI 5.08 to 16.22 among adults aged 40-49 years, p<0.001). The strength of association was the highest among primary educated individuals (AOR 5.35, 95% CI 3.35 to 8.54).Manual workers (AOR 2.73) and people from the poorest households (AOR 1.86) were the risk groups for smoking. However, place of residency and region were insignificantly associated with smoking in the Gambia.

CONCLUSIONS

Men, older people, manual workers, individuals with lower education and lower wealth status were the vulnerable groups to tobacco smoking in the Gambia. Government should intensify awareness programmes on the harmful effects of smoking, and introduce proper cessation support services among tobacco smoking users prioritising these risk groups.

Association Between Hair Diseases and COVID-19 Pandemic-Related Stress: A Cross-Sectional Study Analysis

Introduction:

Psychological stress from the ongoing coronavirus disease 2019 (COVID-19) pandemic can potentially aggravate the course of several stress-sensitive skin and hair diseases. This study aimed to determine the potential association of COVID-19 stress with hair diseases, such as telogen effluvium (TE), alopecia areata (AA), and seborrheic dermatitis (SD), among medical students in Bangladesh.

Methods

This online-based cross-sectional study was conducted among 404 medical students of Bangladesh using a self-administered questionnaire, including sociodemographic information, status of hair diseases (i.e., TE, AA, and SD), COVID-19 fear scale, impact of event scale specific for COVID-19 (IES-COVID-19), and COVID-19 student stress questionnaire (CSSQ) scale, to determine pandemic-related stress. The logistic regression model was used to analyze the association.

Results

Overall prevalence of TE, AA, and SD was 61.1, 24.7, and 57.7%, respectively, with female predominance in case of TE and male predominance in case of AA and SD. More than half of the participants had COVID-19-related fear and traumatic stress symptoms. In the multiple logistic regression model, smoking [adjusted odds ratio (aOR) 2.93, 95% CI 1.29–6.65 for AA and aOR 4.19, 95% CI 1.83–9.56 for TE], COVID-19-related fear (aOR 1.70, 95% CI 1.01–2.89 for AA and aOR 2.620, 95% CI 1.25–5.48 for TE), and COVID-19-related traumatic stress symptoms (aOR 1.84, 95% CI 1.08–3.13 for AA, aOR 2.61, 95% CI 1.19–5.68 for TE, and aOR 1.92, 95% CI 1.14–3.25 for SD) were the risk factors of hair fall disorders.

Conclusion

Our study showed that a large number of medical students experienced TE, AA, and SD during the pandemic era. COVID-19-related stress and fear potentially have an association with these diseases.

Phytonutrients, Colorant Pigments, Phytochemicals, and Antioxidant Potential of Orphan Leafy Amaranthus Species

The underutilized Amaranthus leafy vegetables are a unique basis of pigments such as β-cyanins, β-xanthins, and betalains with radical scavenging capacity (RSC). They have abundant phytonutrients and antioxidant components, such as pigments, vitamins, phenolics, and flavonoids. Eight selected genotypes (four genotypes from each species) of underutilized Amaranthus leafy vegetables were evaluated for phytonutrients, pigments, vitamins, phenolics, flavonoids, and antioxidants in a randomized complete block design under ambient field conditions with three replicates. The studied traits showed a wide range of variations across eight genotypes of two species of Amaranthus leafy vegetables. The highest fat, β-xanthins, K, dietary fiber, Mg, β-cyanins, Mn, chlorophyll ab, Zn, TP, TF, betalains, chlorophyll a content, and (RSC) (DPPH) and RSC (ABTS+) were obtained from A. tricolor accessions. Conversely, the highest protein, Cu, carbohydrates, Ca, and chlorophyll b content were obtained from A. lividus accessions. The highest dry matter, carotenoids, Fe, energy, and ash were obtained from A. tricolor and A. lividus. The accession AT2 confirmed the highest vit. C and RSC (DPPH) and RSC (ABTS+); AT5 had the highest TP content; and AT12 had the highest TF content. A. tricolor accessions had high phytochemicals across the two species, such as phytopigments, vitamins, phenolics, antioxidants, and flavonoids, with considerable nutrients and protein. Hence, A. tricolor accessions can be used as high-yielding cultivars comprising ample antioxidants. The correlation study revealed that vitamin C, pigments, flavonoids, β-carotene, and phenolics demonstrated a strong RSC, and showed a substantial contribution to the antioxidant potential (AP) of A. tricolor. The investigation exposed that the accessions displayed a plentiful origin of nutritional values, phytochemicals, and AP with good quenching ability of reactive oxygen species (ROS) that provide enormous prospects for nourishing the mineral-, antioxidant-, and vitamin-threatened community.

Health system impact of COVID-19 on urban slum population of Bangladesh: a mixed-method rapid assessment study

OBJECTIVE

We aimed to rapidly assess the health system impact of COVID-19 in the urban slums of Bangladesh.

DESIGN

Setting and participantsA cross-sectional survey among 476 households was conducted during October-December 2020 in five selected urban slums of Dhaka North, Dhaka South and Gazipur City Corporation. In-depth interviews with purposively selected 22 slum dwellers and key informant interviews with 16 local healthcare providers and four policymakers and technical experts were also conducted.

OUTCOME MEASURES

Percentage of people suffering from general illness, percentage of people suffering from chronic illness, percentage of people seeking healthcare, percentage of people seeking maternal care, health system challenges resulting from COVID-19.

RESULTS

About 12% of members suffered from general illness and 25% reported chronic illness. Over 80% sought healthcare and the majority sought care from informal healthcare providers. 39% of the recently delivered women sought healthcare in 3 months preceding the survey. An overall reduction in healthcare use was reported during the lockdown period compared with prepandemic time. Mismanagement and inefficient use of resources were reported as challenges of health financing during the pandemic. Health information sharing was inadequate at the urban slums, resulting from the lack of community and stakeholder engagement (51% received COVID-19-related information, 49% of respondents knew about the national hotline number for COVID-19 treatment). Shortage of human resources for health was reported to be acute during the pandemic, resulting from the shortage of specialist doctors and uneven distribution of health workforce. COVID-19 test was inadequate due to the lack of adequate test facilities and stigma associated with COVID-19. Lack of strong leadership and stakeholder engagement was seen as the barriers to effective pandemic management.

CONCLUSION

The findings of the current study are expected to support the government in tailoring interventions and allocating resources more efficiently and timely during a pandemic.

Effect of leisure-time physical activity in controlling hypertension: a systematic review and meta-analysis protocol

INTRODUCTION

Hypertension is a major risk factor for cardiovascular diseases. In 2015, over 1.13 billion individuals worldwide had hypertension. Globally, it results in 10.8 million deaths every year. Around half of the individuals do not continue treatment with medicine to control blood pressure. Physical activity, a non-pharmacological option of treatment, reduces blood pressure. We aim in this research to examine the effect of leisure-time physical activity in controlling blood pressure.

METHODS AND ANALYSIS

We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to conduct this study. We will perform a systematic search in Medline/PubMed, Embase, Scopus, Web of Science, Physical Education Index (ProQuest) and CENTRAL (the Cochrane Library). Both experimental and observational studies will be included. The study population would be people with hypertension. Two reviewers will perform screening of the articles, bias assessment and data extraction independently. We will use the Joanna Briggs Institute Critical Appraisal Tools to assess the risk of bias. We will conduct a meta-analysis if it is applicable.

ETHICS AND DISSEMINATION

The results will be published in peer-reviewed journals and presented at relevant scientific seminars and conferences. Ethical approval is not applicable.

PROSPERO REGISTRATION NUMBER

CRD42021260751.

COVID-19 Knowledge, Attitudes, and Practices Among People in Bangladesh: Telephone-Based Cross-sectional Survey

Background

The world has been grappling with the COVID-19 pandemic, a dire public health crisis, since December 2019. Preventive and control measures have been adopted to reduce the spread of COVID-19. To date, the public’s knowledge, attitudes, and practices regarding COVID-19 across Bangladesh have been poorly understood. Therefore, it is important to assess people’s knowledge, attitudes, and practices (KAP) toward the disease and suggest appropriate strategies to combat COVID-19 effectively.

Objective

This study aimed to assess the KAP of Bangladeshi people toward COVID-19 and to identify their determinants.

Methods

We conducted a country-wide cross-sectional telephonic survey from May 7 to 29, 2020. A purposive sampling method was applied, and adult Bangladeshi citizens who have mobile phones were approached to participate in the survey. Interviews were conducted based on verbal consent. Multiple logistic regression analyses and several tests were performed to identify the factors associated with KAP related to COVID-19.

Results

A total of 492 of 576 Bangladeshi adults aged 18 years and above completed the interview, with a response rate of 85.4% (492/576). Of the 492 participants, 321 (65.2%) were male, and 304 (61.8%) lived in a rural area. Mean scores for knowledge, attitudes, and practices were 10.56 (SD 2.86), 1.24 (SD 0.83), and 3.17 (SD 1.5), respectively. Among the 492 respondents, 273 (55.5%) had poor knowledge, and 251 (49%) expressed a negative attitude; 192 out of 359 respondents (53.5%) had poor practices toward COVID-19. Mean scores of knowledge, attitudes, and practices differed significantly across various demographic and socioeconomic groups. Rural residents had lower mean scores of knowledge (mean 9.8, SD 3.1, P<.001) and adherence to appropriate practice measures (mean 4, SD 1.4, P<.001) compared to their urban counterparts. Positive and statistically strong correlations between knowledge and attitudes (r=0.21, P<.001), knowledge and practices (r=0.45, P<.001), and attitudes and practices (r=0.27, P<.001) were observed. Television (53.7%) was identified as the major source of knowledge regarding COVID-19. Almost three-quarters of the respondents (359/492, 73%) went outside the home during the lockdown period. Furthermore, the study found that good knowledge (odds ratio [OR] 3.13, 95% CI 2.03-4.83, and adjusted OR 2.33, 95% CI 1.16-4.68) and a positive attitude (OR 2.43, 95% CI 1.59-3.72, and adjusted OR 3.87, 95% CI 1.95-7.68) are significantly associated with better practice of COVID-19 health measures.

Conclusions

Evidence-informed and context-specific risk communication and community engagement, and a social and behavior change communication strategy against COVID-19 should be developed in Bangladesh based on the findings of this study, targeting different socioeconomic groups.

Correlation of eGFR By MDRD and CKD-EPI Formula with Creatinine Clearance Estimation in CKD Patients and Healthy Subjects

This cross sectional comparative study was conducted in the Nephrology and Medicine outdoor and in-patients department of Mymensingh Medical College Hospital, Bangladesh from April 2014 to March 2015. A total of 100 patients with CKD and 100 healthy subjects were included in the study. Data were collected by interview of the patients, clinical examination and laboratory investigations using a semi-structured case record form. Among all subjects, 50.0% had no CKD and 50.0% patients had CKD: Stage 3 CKD were 8.5%, CKD Stage 4 CKD were 21.0%, CKD Stage 5 CKD were 20.5%. Serum creatinine was 4.32±3.08mg/dl in patients with CKD and 1.00±0.22mg/dl was in healthy subjects. Mean±SD of CCR/ml/min was found 17.67±11.63ml/min in patients with CKD and 79.31±13.31ml/min was found in healthy subjects. On the other hand, Mean±SD CCCR/ml/m/1.73m² was found 19.79±12.85 ml/m/1.73m² in patient with CKD and healthy subjects had 83.83±13.33 ml/m/1.73m². Urinary creatinine was 45.59±15.63 & 57.66±11.45mg/dl respectively. CKD-EPI eGFR was 22.10±15.02 & 90.61±23.27ml/m/1.73m²; MDRD eGFR was 22.15±14.18 & 89.35±26.19 ml/m/1.73m² respectively. Difference between all the variables between CKD group and healthy group was found statistically significant (p<0.001). CKD-EPIeGFR and MDRDeGFR were increased both in CKD patients and healthy subjects in respect to CCR and CCCR. There was a strong positive correlation between CCCR (ml/m/1.73m2) and CKD-EPI (ml/m/1.73m²) among all patients (r=0.934 and p<0.001) and also a positive correlation of CCCR with MDRD among all patients (r=0.913 and p<0.001). A positive correlation of CCCR was found with CKD-EPIeGFR among CKD patients (r=0.848 and p<0.001). A positive correlation of CCCR was also found with MDRDeGFR among CKD patients (r=0.841, p<0.001). There are positive correlations between CCCR and CKD/EPI among healthy subjects (r=0.616 and p<0.05) and between CCCR with MDRD among healthy subjects (r=0.568 and p<0.05). Various formulae were used to calculate GFR on the basis of serum creatinine levels. The Overall correlation of population (healthy and CKD patients) between CCCR and CKD EPI and MDRD formula was (r=0.93 and 0.91) respectively, among CKD patients it was (r=0.848 and r=0.841) in healthy subjects it was (r=0.616 and r=0.568) respectively. CKD EPI eGFR and MDRD eGFR formula had fairly good correlation with conventional 24 hours creatinine clearance in both CKD patient and healthy subjects, there was even more strong correlation especially in CKD patients. The performance of CKD-EPI equation is better than MDRD equation to estimate the eGFR in both CKD patients and healthy subjects.

Patterns of long acting injectable antipsychotic use and associated clinical factors in schizophrenia among 15 Asian countries and region

INTRODUCTION

Patterns of clinical use of long-acting injectable (LAI) antipsychotic drugs in many countries, especially in Asia, for treatment of patients diagnosed with chronic psychotic disorders including schizophrenia are not well established.

METHODS

Within an extensive research consortium, we evaluated prescription rates for first- (FGA) and second-generation antipsychotic (SGA) LAI drugs and their clinical correlates among 3557 subjects diagnosed with schizophrenia across 15 Asian countries and region.

RESULTS

Overall, an average of 17.9% (638/3557; range: 0.0%-44.9%) of treated subjects were prescribed LAI antipsychotics. Those given LAI vs orally administered agents were significantly older, had multiple hospitalizations, received multiple antipsychotics more often, at 32.4% higher doses, were more likely to manifest disorganized behavior or aggression, had somewhat superior psychosocial functioning and less negative symptoms, but were more likely to be hospitalized, with higher BMI, and more tremor. Being prescribed an FGA vs SGA LAI agent was associated with male sex, aggression, disorganization, hospitalization, multiple antipsychotics, higher doses, with similar risks of adverse neurological or metabolic effects. Rates of use of LAI antipsychotic drugs to treat patients diagnosed with schizophrenia varied by more than 40-fold among Asian countries and given to an average of 17.9% of treated schizophrenia patients. We identified the differences in the clinical profiles and treatment characteristics of patients who were receiving FGA-LAI and SGA-LAI medications.

DISCUSSION

These findings behoove clinicians to be mindful when evaluating patients' need to be on LAI antipsychotics amidst multifaceted considerations, especially downstream adverse events such as metabolic and extrapyramidal side effects.

Coprescription of mood stabilizers in schizophrenia, dosing, and clinical correlates: An international study

OBJECTIVE

Studies examining coprescription and dosages of mood stabilizers (MSs) with antipsychotics for psychotic disorders are infrequent. Based on sparse extant data and clinical experience, we hypothesized that adjunctive MS use would be associated with certain demographic (e.g., younger age), clinical factors (e.g., longer illness duration), and characteristics of antipsychotic treatment (e.g., multiple or high antipsychotic doses).

METHODS

Within an Asian research consortium focusing on pharmaco-epidemiological factors in schizophrenia, we evaluated rates of MS coprescription, including high doses (>1000 mg/day lithium-equivalents) and clinical correlates.

RESULTS

Among 3557 subjects diagnosed with schizophrenia in 14 Asian countries, MSs were coprescribed with antipsychotics in 13.6% (n = 485) of the sample, with 10.9% (n = 53) on a high dose. Adjunctive MS treatment was associated (all p < 0.005) with demographic (female sex and younger age), setting (country and hospitalization), illness (longer duration, more hospitalizations, non-remission of illness, behavioral disorganization, aggression, affective symptoms, and social-occupational dysfunction), and treatment-related factors (higher antipsychotic dose, multiple antipsychotics, higher body mass index, and greater sedation). Patients given high doses of MSs had a less favorable illness course, more behavioral disorganization, poorer functioning, and higher antipsychotic doses.

CONCLUSIONS

Schizophrenia patients receiving adjunctive MS treatment in Asian psychiatric centers are more severely ill and less responsive to simpler treatment regimens.

Comparison of Serum Amylase and Lipase Levels between Predialysis and Maintenance Haemodialysis CKD Patients

This cross sectional study was done to compare serum levels of amylase and lipase between predialysis and maintenance haemodialysis chronic kidney disease (CKD) patients and also to find out their relationship between degrees of renal impairment in Mymensingh Medical College Hospital and National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh from May 2016 to April 2017. A total of 80 patients were included purposively as study subjects and made into two groups namely predialysis CKD group comprising 50 patients and other as maintenance haemodialysis group comprising of 30 patients. Among the predialysis group majority of the CKD was caused by glomerulonephritis (48%) followed by diabetes (26%), HTN (2%) and large portion undiagnosed (24%) whereas in the haemodialysis group ESRD was caused by diabetes (46%) followed by glomerulonephritis (16%), HTN (13%) and undiagnosed (23%). This study showed that mean serum amylase (158±718U/L vs. 111±41U/L) did not significantly differ between study groups except being above reference level but serum lipase (739±888U/L vs. 434±214U/L) was significantly higher in the predialysis group. There was a correlation between rising serum creatinine with serum amylase and lipase.

Idiopathic Sclerosing Encapsulating Peritonitis: Abdominal Cocoon in a 50 year old male

Idiopathic Sclerosing Encapsulating Peritonitis (or abdominal cocoon) is a rare cause of small bowel obstruction, especially in adult population. Diagnosis is usually incidental at laparotomy. We report one such rare case, outlining the fact that an intra-operative surprise diagnosis could have been facilitated by previous investigations. Journal of Surgical Sciences (2015) Vol. 19 (2) : 75-79

Domestic violence and decision-making power of married women in Myanmar: analysis of a nationally representative sample

BACKGROUND

Women in Myanmar are not considered decision makers in the community and the physical and psychological effect of violence makes them more vulnerable. There is a strong negative reaction, usually violent, to any economic activity generated by women among poorer and middle-class families in Myanmar because a woman's income is not considered necessary for basic survival.

OBJECTIVE

Explore the relationship between domestic violence on the decision-making power of married women in Myanmar.

DESIGN

Cross-sectional.

SETTING

National, both urban and rural areas of Myanmar.

PATIENTS AND METHODS

Data from the Myanmar Demographic and Health Survey 2015-16 were used in this analysis. In that survey, married women aged between 15 to 49 years were selected for interview using a multistage cluster sampling technique. The dependent variables were domestic violence and the decision-making power of women. Independent variables were age of the respondents, educational level, place of residence, employment status, number of children younger than 5 years of age and wealth index.

MAIN OUTCOME MEASURES

Domestic violence and decision-making power of women.

SAMPLE SIZE

7870 currently married women.

RESULTS

About 50% respondents were 35 to 49 years of age and the mean (SD) age was 35 (8.4) years. Women's place of residence and employment status had a significant impact on decision-making power whereas age group and decision-making power of women had a relationship with domestic violence.

CONCLUSION

Giving women decision making power will be indispensable for the achievement of sustainable development goals. Government and other stakeholders should emphasize this to eliminate violence against women.

LIMITATIONS

Use of secondary data analysis of cross-sectional study design and cross-sectional studies are not suitable design to assess this causality. Secondly the self-reported data on violence may be subject to recall bias.

CONFLICT OF INTEREST

None.

Prevalence of Microalbuminuria and Overt Proteinuria in Diabetes Mellitus and their Association with Renal Function

This cross sectional observational study was conducted in the Department of Nephrology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from April 2009 to March 2010. Samples were collectedfrom rural area of Khalishaur union of Purbadhala upazilla in Netrakona District, 30km away from Mymensingh Town. The main objective of the study was to find out the prevalence of microalbuminuria as well as overt proteinuria in diabetes mellitus in a rural population and to observe their association with renal function. In this study 1048 adult participants of 18 to 65 years in a rural area of Netrakona were included purposively as study subjects. Among them 54% were male and 46% were female. Mean age of study subjects was 42.4±13.4 years. Prevalence of microalbuminuria among diabetic participants was 29.72% where as in non diabetic non hypertensive participants it was 6.62%. Diabetic persons 9.45% and 3.9% of non diabetic participants showed overt proteinuria by dipstick test. Prevalence of hypertension in diabetic and non diabetic participants was 45.94% and 16.52% respectively. The mean eCCr of the diabetic patients and non-microalbuminuric healthy persons was 78.4±25.4 ml/min/1.73m² and 94.67±24.8 ml/min/l.73m² respectively according to Cock Croft-Gault equation. The mean eCCr of diabetic participants with overt proteinuria was 57.44±28.33 ml/min/l.73m² but diabetic patients with microalbuminuria had better mean eCCr 80.62±21.17 ml/min/1.73m² which justifies the importance of detection of microalbuminuria for early intervention. By regression analysis it was found that degree of microalbuminuria had linear relation with renal function and random blood sugar level. Neither BMI nor duration of diabetes showed any correlation with urine microalbumin. There was no effect of sex on the prevalence of microalbuminuria in diabetes mellitus. Microalbuminuria is the first sign of renal involvement in diabetic patients which is a risk factor for overt nephropathy. Monitoring of this condition is important because early treatment of microalbuminuria can prevent or postpone overt nephropathy.

Acute Kidney Injury in Patients with Acute Viral Hepatitis: A Study in a Tertiary Care Hospital

This cross sectional observational study was done in the Department of Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from May 2013 to April 2014 to find out the proportion of acute kidney injury among patients with acute viral hepatitis and to identify risk factors associated with development of acute kidney injury (AKI). A total of 100 patients with acute viral hepatitis were included purposively as study subjects. Among them 61 were male and 39 were female. They were divided into AKI group (n=6) and non-AKI group (n=94) on the basis of development of AKI. There was no significant difference in mean age (39.0±13.1 years vs. 32.2±10.8 years, p=0.335) and sex (67% vs. 61% & 33.0% vs. 39.0%) p=0.769) between AKI group and non-AKI group. There were 27% acute viral hepatitis A, 21% acute viral hepatitis B and 52% acute viral hepatitis E but no case of acute viral hepatitis C was found in this study. Acute kidney injury (AKI) developed in 6 of 27 patients with acute viral hepatitis A. This study showed that 22.2% patients with acute viral hepatitis A developed acute kidney injury but patients with acute viral hepatitis B (HBV) and hepatitis E (HEV) did not develop acute kidney injury. Majority of the patients with acute kidney injury were smokers and hypertensive with elevated mean arterial pressure (p=0.0001) at presentation and had higher total bilirubin (p=0.0001), alanine aminotranseferase values (p=0.040), prolonged prothrombin time (INR) {p=0.0001}, lower albumin (p=0.0001), lower haematocrit level (p=0.0001), high CRP concentration (p=0.0001), leucocytosis (p=0.0001) and thrombocytopenia (p=0.0001) at presentation than patients without acute kidney injury. It is evident from the study that acute kidney injury is not a rare complication in patients with acute viral hepatitis.

Outcome of Pregnancy Related Acute Kidney Injury Observed in a Tertiary Care Hospital

This prospective case control study was carried out in Mymensingh Medical College Hospital (MMCH) from April 2011 to March 2012. The main objective of the study was to determine the short term maternal outcome of pregnancy related Acute Kidney Injury and to identify aetiological factors and to observe clinical features of pregnancy related Acute Kidney Injury. Total 60 pregnant women with AKI were included in the study as sample and equal (60) number of pregnant women with normal renal function was taken as control. Mean ages (±SD) of study and control group were observed 31.6±6.9 years and 25.5±4.7 years respectively. It was observed that most patients were from rural area with low income group. Most women were multiparous and presented in third trimester and postpartum period. Majority of the study subjects did not receive antenatal care at any stage of pregnancy. Fifty (86.7%) of the study subjects were oligo-anuric, forty-nine (81.7%) were edematous and fifty one (85%) were anaemic. Twenty-five (41.7%) patients presented with abnormal vaginal bleeding. Sepsis (including septic abortion and puerperal sepsis) was responsible for of Pregnancy Related AKI (PR-AKI) in more than two fifths of cases. Haemorrhage (APH & PPH combined) was the next common cause of Pregnancy Related AKI (PR-AKI). Toxemia of Pregnancy was responsible in one fourth of cases. Dialysis (HD & IPD combined) was required for two fifths of the patients. Rest patients were treated conservatively with antibiotics, blood transfusion, maintenance of fluid and electrolytes balance etc. Maternal outcome of Pregnancy related acute kidney injury was considered for the period of patient's hospital staying. 56.6% patients recovered completely, 15.0% patients recovered partially, 6.7% did not recover at the time of hospital discharge; while 21.7% died. So it can be concluded that, pregnancy related acute kidney injury is a critical condition, associated with worse prognosis.

Assessment of depression, anxiety and stress among first year MBBS students of a public medical college, Bangladesh

Medical students confront significant academic, psychosocial and existential stressors for coping with new college and schedule,. So assessment of the symptoms of depression, anxiety and stress among medical students are essential to take necessary steps to treat or prevent any psychiatric morbidity. The objective of the study was to assess depression, anxiety and stress among the first year MBBS students. This was a cross sectional and descriptive study conducted in Khulna Medical College, Bangladesh from December 2009 to July 2010. For this purpose, 105 students fulfilling inclusion and exclusion criteria were taken as sample. They filled up personal data and the short-form Bangla version of DASS (DASS-21 BV) scale. The results showed that, the mean age of students was 18.8 years with male predominance (54.3%). Symptoms of depression, anxiety and stress were found among 54.3%, 64.8% and 59.0% of students respectively. Eighty five (81%) students either had depression, anxiety or stress alone or in combination. Combination of depression, anxiety and stress was highest (36.2%). No significant association was found between gender difference and depression, anxiety or stress. Age was positively correlated with depression (p=0.004) and stress (p=0.001). Percentage of 1st year MBBS students suffering from depression, anxiety and stress were very high. Adequate psychiatric services should be provided to manage these symptoms among medical students.Bang J Psychiatry June 2015; 29(1): 23-29

Efficiency of Marine Dry Fish Marketing in Bangladesh: A Supply Chain Analysis

The marine dried fishes have the demand both in domestic and international market. Bangladesh has a great potentiality to earn huge foreign exchange by exporting marine dry fishes. The present study was designed to analyze the supply chain and to examine marketing efficiency of marine dry fish in Bangladesh. Data were collected from 170 stakeholders and 9 export oriented firms/agencies using face to face semi-structured interviews considering 9 major species of marine fishes. A number of FGDs were conducted to supplement the information collected through survey method. The study areas were purposively selected. Three types of market such as primary market, secondary market and consumer market were considered for data gathering. High priced fish demanded high marketing cost resulting higher marketing margin and profit compared to low priced fish. Processing and transportation costs were also higher for high valued species compared to the low valued ones. Marketing margin and marketing profit were very high in export market compared to domestic market. However, shorter supply chains (channels) were more efficient than longer supply chains.The Agriculturists 2015; 13(1) 53-66

Differentials in the prevalence of anemia among non-pregnant, ever-married women in Bangladesh: multilevel logistic regression analysis of data from the 2011 Bangladesh Demographic and Health Survey

Background

Anemia is one of the most common public health problems globally, and high prevalence has been reported among women of reproductive age, especially in developing countries. This study was conducted to evaluate differentials in the prevalence of anemia among non-pregnant, ever-married women of reproductive age in Bangladesh, and to examine associations with demographic, socioeconomic, and nutritional factors.

Methods

Data for this cross-sectional study were taken from the 2011 Bangladesh Demographic and Health Survey (BDHS). In a sub-sample of one-third of the households, all ever-married women of reproductive age (15 to 49 years) were selected for the biomarker component of the survey, including anemia. The sample size for our study was 5,293. Data were analyzed using multilevel logistic regression analysis.

Results

The prevalence of anemia among non-pregnant, ever-married women was 41.3 % (urban: 37.2 % and rural: 43.5 %). Among anemic women, 35.5 % had mild anemia, 5.6 % had moderate anemia, and 0.2 % had severe anemia. Women with no education were more likely to be anemic than those with secondary education (p < 0.01) or higher education (p < 0.01). Undernourished women (BMI < 18.5) were at greater risk of anemia (p < 0.01) compared with normal women, overweight women, and obese women. Anemia was less pronounced among non-pregnant women using contraception (p < 0.05), Muslim women (p < 0.01), and women living in rich households (p < 0.01).

Conclusions

The prevalence of anemia among non-pregnant, ever-married women in Bangladesh is high. Illiteracy, poverty, and undernutrition are contributing factors.

Risk Factors of Suicide and Para Suicide in Rural Bangladesh

Background: Suicide is a public health problem too often neglected by researchers, health policy makers and the medical profession. In the year 2000, approximately one million people died of suicide which represents a global mortality rate of 16 per 100,000. According to WHO estimates for the year 2020 and based on current trends approximately 1.53 million people will die from suicide and 10-20 times more people will attempt suicide worldwide. This represents on average 1 death per 20 seconds and 1 attempt every 1-2 seconds. No nationwide survey on suicidal risk factors has yet been conducted in Bangladesh. Reports from police records, Media, court, hospitals and the focused study on selected population indicate that suicide is a public health problem in Bangladesh. The aim of this study was to unearth the potential risk factors of suicide or suicidal attempts and to assess psychiatric illness, non psychiatric co-morbidity, individual’s behavioral and physical factor, familial risk factors and socio-demographic risk factors of suicide and its attempts. Study Design and Setting: A case control study was carried out by members of the Department of Medicine, Shaheed Suhrawardi Medical College and Hospital at Mominpur,Haowlee and Jibonnagar unions under three Upazilla of district Chuadanga,. Statistical analyses were performed using SPSS 16. Results: A total 230 subjects (113 cases and 117 controls) were interviewed. Mean age among cases was 29.6±12.8 years and controls were 29.7±12.9 years.Majority of the participants, 65.5% of cases and 63.2% of controls were aged between 20-39 years. Among cases 38.9% were male and among the controls 42.7% were male.Among cases 30.1% and among controls 27.4% had less than 4 family members. More than half of the participants, among cases (58.4%) and among controls (55.6%) had between 4- 6 members in the family. Economic status was also similar in two groups.Problem of love affair (OR 5.2), Personal problem (OR 11.9), Feeling of economic hardship (OR 2.4) appeared to have statistically significant association with suicidal attempt. Problem with relatives (OR 3.8), death of near relative (OR 0.9) and poor academic performance (OR 1.6) didn’t appear to have any association with risk of suicidal attempt. History of chronic disease (OR 2.9) showed statistically significant association but long term physical disability (OR 4.4) and physical problems didn’t appear to have any significant association with suicidal attempt. History of suicidal attempt by any relative (OR 4.2) and previous attempt to suicide (OR 7.4) appeared as highly significant factor for suicide. Not being reared by biological parents (OR 3.2), marital disharmony (OR 4.0), Conflict within the family (OR 6.9) appeared to be strongly associated with suicidal attempts. Suicidal attempts of participants were significantly associated with sleeping disturbance (OR 2.3), uncertainty about future (7.2), impulsivity (OR 13.8), and history of criminal behavior (OR 2.1). Conclusion: Case control study on the risk factors of suicide in rural area of South-West Bangladesh revealed that the married female especially the younger age from unitary family of low income group are more vulnerable to commit suicide or parasuicide. Several emotional factors, presence of chronic diseases, familial suicidal predisposition, individual factor and mental state, premorbid persionality and psychiatric syndrome appeared to have significant association with suicidal attempts. DOI: http://dx.doi.org/10.3329/jom.v14i2.19653 J Medicine 2013, 14(2): 123-129

Plant regeneration and somatic embryogenesis from immature embryos derived through interspecific hybridization among different Carica species

Plant regeneration and somatic embryogenesis through interspecific hybridization among different Carica species were studied for the development of a papaya ringspot virus-resistant variety. The maximum fruit sets were recorded from the cross of the native variety C. papaya cv. Shahi with the wild species C. cauliflora. The highest hybrid embryos were recorded at 90 days after pollination and the embryos were aborted at 150 days after pollination. The immature hybrid embryos were used for plant regeneration and somatic embryogenesis. The 90-day-old hybrid embryos from the cross of C. papaya cv. Shahi × C. cauliflora showed the highest percentage of germination, as well as plant regeneration on growth regulators free culture medium after 7 days pre-incubation on half-strength MS medium supplemented with 0.2 mg/L BAP, 0.5 mg/L NAA and 60 g/L sucrose. The 90-day-old hybrid embryos from the cross of C. papaya cv. Shahi × C. cauliflora produced maximum callus, as well as somatic embryos when cultured on half-strength MS medium containing 5 mg/L 2,4-D, 100 mg/L glutamine, 100 mg/L casein hydrolysate and 60 g/L sucrose. The somatic embryos were transferred into half-strength MS medium containing 0.5 mg/L BAP and 0.2 mg/L NAA and 60 g/L sucrose for maturation. The highest number of regenerated plants per hybrid embryo (10.33) was recorded from the cross of C. papaya cv. Shahi × C. cauliflora. Isoenzyme and dendrogram cluster analysis using UPGMA of the regenerated F₁ plantlets confirmed the presence of the hybrid plantlets.

Penile agenesis in adult

Penile agenesis (PA) is an extremely rare congenital anomaly with profound surgical and psychosocial consequences. Only seventy five cases have been reported in the literature, the highest age of presentation known seven years. We present a twenty six years old otherwise normal aphallic male with attraction to female sex and night emission through anus. The patient did not agree to the female gender assignment and functioning phallic reconstruction is practically unavailable. Early female gender assignment and feminizing perineal reconstruction (Vaginoplasty) in neonatal cases is the technically easier goal of treatment. Late presenting cases add difficulty to debated decision making of gender assignment.

Smoking enhances age related brain atrophy--a quantitative study with computed tomography

This is a prospective study done on Bangladeshi people during the period from January 1999 to December 2002. Cases were collected from the department of Medicine in Sir Salimullah Medical College, Dhaka; Sher-e-Bangla Medical College, Barisal and Bangabandhu Sheikh Mujib Medical University, Dhaka. We examined the chronic effect of smoking on brain atrophy quantitatively with Computed Tomography (CT). Study was performed on 219 smokers and same numbers of non-smokers from 40 to 70 years old with neither neurological nor focal abnormality in brain CT. Brain atrophy index (BAI) which was a quantitative marker of brain atrophy reported previously, was calculated from each brain CT. Smokers showed a significant increase in BAI compared to non-smokers in groups 50-54 years (p<0.01), 55-59 years (p<0.01), 60-64 years (p<0.05) and 65-70 years (p<0.05). It was suggested that age-related brain atrophy was increased by chronic smoking through advanced atherosclerosis.

Depression after stroke-analysis of 297 stroke patients

Stroke is commonly followed by some form of psychiatric disturbance. Association and severity of depression at the 3rd and 12th months after stroke in patients and controls were compared. Two registers of stroke patients were maintained over 2 years period in two different centers--one in Barisal Town and other in Mitford Hospital, Dhaka. A total of 297 first-ever strokes were registered. These patients were called back at the 3rd and 12th month interview and assessment. Beck's Depression Inventory (BDI), with 10 as the cut off point for depression, was applied to 161 of 212 survivors at the 3rd month and to 156 of 195 survivors at the 12th month. At the 3rd month, 41% of patients and 18% of controls were depressed (P<.001) and the difference was maintained at the 12th month 42% versus 19% (P<.05). Univariate risk factors for depression at the 3rd month were female sex, severe prognostic score at the onset of stroke, age more than 70 years, family history of stroke and living alone after stroke. Depression was common among stroke survivors at the 3rd months and its rate did not decrease at 1 year follow-up. Depression could be decreased if post-stroke rehabilitation services are improved. After the development of depression earlier diagnosis and management help a lot to the patients and care givers.

Behaviour disorders in urban primary school children in Dhaka, Bangladesh

Data on the prevalence and correlates of behaviour disorders in children are scanty or absent in many countries, including Bangladesh. A sample of primary school children in Dhaka city, Bangladesh, was screened during February to April 1994 with the Rutter B2 Scale to estimate the prevalences of different types of behaviour disorders and to assess whether and how these prevalences were associated with the children's age and gender, and gender segregation at school. Of the 1288 children in grades 1 to 5 screened, 13.4% had some type of behaviour disorder, with males more than twice as commonly affected as females (20.4 vs 9.9%). Emotional, conduct, and undifferentiated disorders were detected in 3.2, 8.9 and 1.2%, respectively, of the children. All three disorders were more prevalent in males than in females. In multivariate logistic regression analyses, significant positive correlates were male gender (odds ratio (OR):3.1) and higher grades (reference:grades 1-2; OR for grade 3:9.1; OR for grade 5:4.2) for conduct disorder, and male gender (OR:3.1) and higher grade (OR for grade 3:6.2) for all disorders combined. None of the three independent variables examined was significantly associated with emotional disorder. Separate analyses could not be done for undifferentiated disorder because of the small numbers involved. The high prevalence of behaviour disorders in Dhaka city primary school children suggest that a mental health care programme for these children comprising screening and, if indicated, full evaluation and expert care would be worthwhile.

Analysis of psychiatric morbidity of outpatient children in Mitford Hospital, Dhaka

The objective of this study was to describe the pattern of psychiatric morbidity among 97 child patients who, for the first time attended the psychiatric outpatient department of Sir Salimullah Medical College & Mitford Hospital, Dhaka, in the year 1994. Dissociative disorder (Hysteria) comprised the largest group (21.65%), followed by epilepsy (19.59%). Majority of the cases were within 7-10 years age group with mean age 9.74 (+/- 2.39) years. Male outnumbered female patients and 53.61% cases came from rural background. The findings of the study indicate the need for establishment of child psychiatric treatment centres in different parts of the country including rural areas.

Computer simulation of the effectiveness of male-linked translocations for the control of Anopheles albimanus Wiedemann

A deterministic simulation model was used to establish the potential value of releasing male-linked translocation heterozygotes as a control measure for Anopheles albimanus Wiedemann. Theoretical population reductions exceeding 90% were obtained within 90 and 120 days after releases at initial ratios of 5 translocation males (TM): 1 normal male (NM) and 1 TM: 1 NM, respectively. Additional simulations emphasized the importance of the need for a method that would eliminate females from the release material. Releases containing 15% females were less effective than those with none. When a malaria subroutine was included in the model, the calculations showed that all the theoretical releases greatly reduced the number of malaria-infective females and therefore would have a profound effect on transmission of the disease. The number of malaria-infective females present was eliminated completely when only translocation males were released; however, a small number were present when the releases contained 15% females. Male-linked translocation males required longer periods of time to bring about population control than males that were completely sterile.

X-ray induced pericentric inversions in Anopheles albimanus

Sixteen different pericentric inversions, ten on chromosome 2 and six on chromosome 3, have been isolated and characterized. The partial sterility in the inversion heterozygotes ranged from about 28 to 50%. Contrary to theoretical considerations, a curvilinear relationship exists between inversion length and partial sterility, whereby a reduction in sterility was noted for progressively longer inversions. The break-points are distributed randomly over the autosomes, but are observed more frequently in the areas of the salivary gland chromosomes where diffuse and broken bands of variable stainability are located.

The genetics of black larva, an autosomal recessive lethal mutation located on chromosome 3 in the mosquito Anopheles albimanus

A spontaneous autosomal recessive lethal mutation, black larva (bl), producing black pigmented larvae that die during the 4th larval instar has been discovered in the mosquito Anopheles albimanus Wiedemann. Genetic investigations using two Y-autosome translocations and a 3rd chromosome dominant marker, St indicate that bl is located on chromosome 3 at a distance of 15 map units from St.

Studies on x-ray induced chromosomal translocations in Anopheles albimanus. III. Effect of the release of translocation males on the dynamics of cage populations

Anopheles albimanus males carrying an Y-autosome translocation were continuously released into a cage population at a ratio of 1:5 in favor of translocation males. The release caused a significant decrease in the absolute density of cage populations. Virtually complete replacement of wild type Y chromosome by translocated Y chromosome was observed after four generations. The results obtained from the cage experiments encourage actual field trials for the control of this vector species.

Molecular Characterization of 28 Mango Germplasm Using RAPD

Genetic variation and relationship among 28 mango germplasm were analyzed using Random Amplified Polymorphic DNA (RAPD). Out of 20 primers screened, four were selected, which gave 50 clear and bright fragments, out of which 48 fragments were considered polymorphic. The proportion of polymorphic loci and gene diversity values across all loci were 96% and 0.29, respectively. The UPGMA dendrogram based on genetic distance segregated the 28 mango germplasm into two main clusters. Sukul alone formed one cluster and the rest germplasm were grouped together into another cluster. Mallika and Amrapali cultivar pair was very close to each other with the highest intervarietal similarity index (87.30%) and lowest genetic distance (0.08). On the other hand, Sukul and Meghnath pair was more distant to each other with the lowest intervarietal similarity index (14.29%) and highest genetic distance (0.87). The results of the present study indicated that the RAPD analysis could be utilized by breeders for further improvement of mango varieties.Key words: Germplasm, Characterization, Mango, RAPDDOI = 10.3329/ptcb.v17i1.1123Plant Tissue Cult. & Biotech. 17(1): 71-77, 2007 (June)