Mediating effect of BMI on the association of economic status and coexistence of hypertension and diabetes in Bangladesh: A counterfactual framework-based weighting approach

Background and Aims

Non-communicable diseases such as hypertension and diabetes are matters of huge concern worldwide, with an increasing trend in prevalence over the previous decade. First of all, this study aimed to evaluate the association between economic status (ES) and body mass index (BMI), ES and comorbidity of hypertension and diabetes, and BMI and comorbidity independently. Second, it explored the mediating role of BMI in the association between ES and comorbidity of hypertension and diabetes. Finally, it investigated whether the mediating effect differs with the place of residence, gender, and education levels.

Methods

A total of 11,291 complete cases from the Bangladesh demographic and health survey 2017-18 were utilized for this study. Survey-based binary logistic regression or multiple logistic regression was used to find the association among outcome, exposure, and mediator variables, and a counterfactual framework-based weighting approach was utilized for mediation analysis.

Results

Middle-income (adjusted odds ratio [AOR]: 1.696, 95% confidence interval [CI]: 1.219, 2.360) and rich (AOR: 2.770, CI: 2.054, 3.736) respondents were more likely to have comorbidity of hypertension and diabetes compared to the poor. The odds of comorbidity increased with the increase in BMI. A positive association was observed between ES and BMI. A significant mediating role of BMI in the association between ES and comorbidity was found. We observed that 19.85% (95% CI: 11.50%, 49.6%) and 20.35% (95% CI: 14.9%, 29.3%) of total effect was mediated by BMI for middle and rich respondents, respectively, compared to the poor.

Conclusions

The mediating role of BMI was greater for female, no or primary educated respondents, and respondents from rural areas. Therefore, the study will facilitate policymakers of Bangladesh and other countries with a similar set-up to decide on health policies regarding hypertension and diabetes.

Chemico-pharmacological evaluation of the methanolic leaf extract of Catharanthus ovalis: GC-MS/MS, in vivo, in vitro, and in silico approaches

Introduction: Natural plant-based medicines have gained popularity recently as a major source of inventive, risk-free, and more potent secondary bioactive compounds with medicinal potential. Catharanthus ovalis is a perennial shrub containing various indole alkaloids cultivated extensively for local medical purposes. Methods: This research is conducted to identify the phytocompounds present in the leaves of C. ovalis and its central and peripheral analgesic, thrombolytic, and membrane-stabilizing activities through tail immersion, acetic acid-induced writhing, human blood clot lysis, and erythrocyte lysis by heat and hypotonic solution methods, respectively. Results and discussion: A total of 39 compounds were identified using GC-MS/MS techniques, including hexadecanoic acid, methyl ester (56.749%), methyl stearate (29.782%), carvacrol and its TBDMS derivative (12.586%), and 9-octadecenoic acid, methyl ester, (E)-] (9.297%) presented in high quantity. The highest tail immersion latency was observed for the 600 mg/kg extract of C. ovalis crude extract. Both 400 and 600 mg/kg doses of C. ovalis crude extract exhibited prominent peripheral analgesic activity. The maximum thrombolytic effect was observed by DCM soluble fraction extract by inhibiting 54.87% of the clot. However, the aqueous-soluble fraction of this extract manifested an excellent membrane-stabilizing effect by showing 73.98% and 87.51% hemolysis against heat- and hypotonic-induced hemolysis, respectively. Some of the compounds were identified as active agents against different receptors related to these diseases, which supported the findings of in vitro and in vivo tests. Conclusion: Further investigation needs to be conducted to specify and identify the exact mechanism of action of these compounds.

Assessing the Self-reported After Events Following Immunization of COVID-19 Vaccines in Turkey and Bangladesh

Though mass vaccination programs helped to reduce the severity of the ongoing pandemic, various unwanted effects were reported in Turkey and Bangladesh after taking vaccines. The purpose of this study was to evaluate and compare the adverse effects of several vaccines in Turkey and Bangladesh and how the population of both countries prioritizes the continuation of vaccination compared to the side effects. An online survey with a pretest was conducted to gather data over the research period from July 10, 2021 to December 10, 2021. Finally, the questionnaire was shared with the mass population of Turkey and Bangladesh who have received at least one or two doses of the COVID-19 vaccines. The quality of the questionnaire was evaluated with Cronbach's alpha test. The study consisted of 1508 respondents from Bangladesh and 602 respondents from Turkey. Among the total 2110 respondents, 50.0% were male 66.8% were from the 18-30 years age range, and 77.5% reported living in the city area. Among all the respondents, 64.99% of those vaccinated in Bangladesh and 67.28% of those vaccinated in Turkey reported side effects after vaccinations. Participants receiving mRNA vaccines (Pfizer and Moderna) experienced the most side effects, with many reporting pain at the injection site in both nations. Following that, fever, body pain, and headache were common in Bangladesh, whereas body pain, fatigue, and arm numbness were common in Turkey. The study found no significant adverse events reported in Turkey and Bangladesh following the first and second doses of COVID-19 vaccination. These COVID-19 vaccines showed similar patterns of efficacy and safety during the short period of analysis. Vaccines from different manufacturers showed a non-significant level of adverse events during this binational AEFI approach to COVID-19 vaccines. More studies are recommended on the efficacy and safety of several vaccines to discover unexpected effects.

Role of Intraoperative Coeliac Plexus Neurolysis on Postoperative Pain Management for Chronic Pancreatitis

Control of pain in patients with chronic pancreatitis is difficult because 30.0% to 50.0% of patients still experience persistence or recurrence of pain even after surgery. So a combined approach of surgery and coeliac plexus neurolysis was carried out in this study to see the relief of pain and reduce the requirement of analgesics in these patients. This prospective observational comparative study was carried out in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from November 2017 to October 2018. Forty one (41) study participants with the diagnosis of chronic pancreatitis were included consecutively in this study. The participants were divided into two groups. Group I (n=18) underwent pancreatic surgery with coeliac plexus neurolysis by infiltration of 20ml of 100% alcohol in the loose areolar tissue 10ml each into right and left para-aortic space at the level of coeliac trunk and Group II (n=23) underwent pancreatic surgery only. Participants' preoperative data were collected from patient record file. Number, frequency and intensity of pain and requirement of amount of analgesics for the last 3 months were recorded from patients' history. The intensity of pain was categorized by visual analog scale (VAS) preoperatively. The participants of both groups were followed up at 1, 2 and 3 months interval and asked for disappearance or reduction of pain, frequency of attack and requirement of analgesics. Again visual analog scale was used for categorization of pain. Pain free period was recorded after the end of follow up period. Pain reduction occurred after surgery in both groups. But when pain relief was compared on the basis of VAS (Visual Analogue Scale), it was significantly better in Group I after 1 month of surgery than Group II (p=0.05). But 2 and 3 months after surgery this difference became insignificant (p=0.246 and 0.264). No statistical difference was found in terms of analgesic usage, severe acute attack or hospital admission (p=0.511, 0.439 and 0.495) at the end of 3 months follow up. Participants in Group I had significantly longer pain free period than Group II (p=0.025). Regarding complications, postural hypotension developed in 5.6% (1) patients. Diarrhea developed in 11.1% (2) patients in Group I and wound infection developed in 2 patients in each groups respectively. No patients developed any major complications like anastomotic leakage, deep or organ or space infection. Intraoperative coeliac plexus neurolysis reduces pain immediately after surgery and provides longer pain free period in patients with chronic pancreatitis after surgery.

Factors Associated With Underprivileged E-Learning, Session Jam Phobia, and the Subsequent Mental Distress Among Students Following the Extended University Closure in Bangladesh

Severe session jam phobia (SJP), the extent of underprivileged online education, and subsequent mental health disorders among students have emerged as distinguished global problems due to the overwhelming effects of coronavirus disease 2019 (COVID-19). The purpose of this research was to evaluate the impact of extended COVID-19 lockdown and its mediating factors on current e-Learning activities, the prevalence of severe SJP and psychological distress among university students in Bangladesh. A web-based cross-sectional study was conducted to assemble responses through Google Form by applying a simple snowball sampling technique among university students aged 18 years or above in Bangladesh. All ethical considerations were maintained, and univariate, bivariate, and multivariate analyses were employed to analyze the acquired data set. Among the total analyzed data (n = 1,122), the male and female ratio was almost 1:1, and a remarkable segment (63.7%) was aged between 21-24 years. Alarmingly, around 50-60% of the students were suffering from severe SJP, prevailing underprivileged education in the e-Learning platform, and severe mental distress. Logistic regression analyses demonstrated that the students from public universities, lower- and mid-income families, lower-aged, and junior years education groups were significantly (p < 0.05) more underprivileged than their counter groups. Besides, the monthly family income and university type significantly influenced the extent of severe SJP. Finally, the students who were female, rustic, come from low-income families (below 25,000 BDT), who had academic uncertainty, job insecurity, online exam phobia, and dissatisfaction with e-Learning education, were significantly suffering from moderate to severe mental distress. The current evidence demonstrates that a substantial number of Bangladeshi university students are struggling with extreme session jam phobia, underprivileged e-Learning education, and subsequent psychological distress, which need to be immediately addressed through concerted efforts by the government, parents, and university authorities.

ANTi-Vax: a novel Twitter dataset for COVID-19 vaccine misinformation detection

OBJECTIVES

COVID-19 (SARS-CoV-2) pandemic has infected hundreds of millions and inflicted millions of deaths around the globe. Fortunately, the introduction of COVID-19 vaccines provided a glimmer of hope and a pathway to recovery. However, owing to misinformation being spread on social media and other platforms, there has been a rise in vaccine hesitancy which can lead to a negative impact on vaccine uptake in the population. The goal of this research is to introduce a novel machine learning-based COVID-19 vaccine misinformation detection framework.

STUDY DESIGN

We collected and annotated COVID-19 vaccine tweets and trained machine learning algorithms to classify vaccine misinformation.

METHODS

More than 15,000 tweets were annotated as misinformation or general vaccine tweets using reliable sources and validated by medical experts. The classification models explored were XGBoost, LSTM, and BERT transformer model.

RESULTS

The best classification performance was obtained using BERT, resulting in 0.98 F1-score on the test set. The precision and recall scores were 0.97 and 0.98, respectively.

CONCLUSION

Machine learning-based models are effective in detecting misinformation regarding COVID-19 vaccines on social media platforms.

Chemical, biological and protein-receptor binding profiling of Bauhinia scandens L. stems provide new insights into the management of pain, inflammation, pyrexia and thrombosis

Bauhinia scandens L. (Family, Fabaceae) is a medicinal plant used for conventional and societal medication in Ayurveda. The present study has been conducted to screen the chemical, pharmacological and biochemical potentiality of the methanol extracts of B. scandens stems (MEBS) along with its related fractions including carbon tetrachloride (CTBS), di-chloromethane (DMBS) and n-butanol (BTBS). UPLC-QTOF-MS has been implemented to analyze the chemical compounds of the methanol extracts of Bauhinia scandens stems. Additionally, antinociceptive and anti-inflammatory effects were performed by following the acetic acid-induced writhing test and formalin-mediated paw licking test in the mice model. The antipyretic investigation was performed by Brewer Yeast induced pyrexia method. The clot lysis method was implemented to screen the thrombolytic activity in human serum. Besides, the in silico study was performed for the five selected chemical compounds of Bauhinia scandens, found by UPLC-QTOF-MS By using Discover Studio 2020, UCSF Chimera, PyRx autodock vina and online tools. The MEBS and its fractions exhibited remarkable inhibition in dose dependant manner in the antinociceptive and antiinflammatory investigations. The antipyretic results of MEBS and DMBS were close to the standard drug indomethacin. Investigation of the thrombolytic effect of MEBS, CTBS, DMBS, and BTBS revealed notable clot-lytic potentials. Besides, the phenolic compounds of the plant extracts revealed strong binding affinity to the COX-1, COX-2, mPGES-1 and plasminogen activator enzymes. To recapitulate, based on the research work, Bauhinia scandens L. stem and its phytochemicals can be considered as prospective wellsprings for novel drug development and discovery by future researchers.

COMEDICATION OF RABEPRAZOLE SODIUM CAUSES POTENTIAL DRUG-DRUG INTERACTION WITH DIABETIC DRUG LINAGLIPTIN: In-vitro AND In-silico APPROACHES

Drug-drug interaction is a notable concern among physicians when prescribing multi-therapy to the patients as concomitant administration of multi-drugs might cause unexpected adverse drug reactions. The main objective of this research is to predict a potential drug-drug interaction between two frequently used drugs by diabetic patients, an antidiabetic drug (linagliptin) and a proton pump inhibitor (rabeprazole sodium). Here, several in vitro techniques, including thermal (melting point, thermogravimetric analysis [TGA]), morphological (scanning electron microscopy [SEM] and X-ray powder diffraction [XRPD] analysis), highly sophisticated synchronous fluorescence, and in silico methods were applied to anticipate the potential drug-drug interaction between these stated drugs quickly. The melting point and TGA study revealed thermochemical properties, thermal stability profiles, and degradation patterns upon temperature rising of the formed complex and these precursor drugs. The SEM and XRPD have provided the morphological changes like particle shape and size distribution of the desired molecule that might be caused due to the potential drug-drug interactions. Besides, the drastic reduction of the quenching rate constant of linagliptin during interaction with bovine serum albumin in synchronous fluorescence also endorsed the potential drug-drug interaction. Furthermore, the drug-receptor docking analysis demonstrated that the binding affinity of the precursor ligands might be reduced due to the predicted drug-drug interaction. However, the current evidence warrants extensive investigation to confirm the above-stated potential drug-drug interaction in the larger animal model. Finally, clinical data need to be closely monitored during the treatment of diabetic patients prescribed with linagliptin and rabeprazole sodium.

COVID-19: Epidemiology, Pathology, Diagnosis, Treatment, and Impact

The pandemic, well-known as COVID-19, has been brought about by the coronavirus SARS-CoV-2 and it has distinct characteristics from other coronavirus-related epidemics. This pandemic has been ravaging the whole world for more than a year now and no drugs or vaccines have been found to eliminate this virus from the infected people effectively; only physical measures like social distancing, hand washing and face-mask wearing have been taken to reduce its spreading and very recently Veklury (remdesivir) has been permitted by the USFDA to manage the critical patients. This disease can be asymptomatic but when it is symptomatic, it presents with respiratory problems and cold- or flu-like symptoms which can be diagnosed with a chest CT and confirmed with RT-PCR tests. In this review, the taxonomy and structure of SARS-CoV-2 and history, transmission, epidemiology, pathology, clinical features and impacts of the COVID-19 have been discussed. A summary of possible drug targets, attempted physical and chemical measures, as well as vaccine candidates, have also been provided. How this coronavirus is different from other coronaviruses, the obstacles in managing this disease and the possibility of a second wave have also been reviewed. This review represents a wide range of information regarding COVID-19 and intends to be used as a comprehensive overview in this regard.

Pharmacological and computer-aided studies provide new insights into Millettia peguensis Ali (Fabaceae)

Millettia peguensis, popular for its ethnopharmacological uses, was employed to evaluate its different pharmacological properties in this study. The analgesic studies of the plant have been performed by acetic acid-induced writhing and formalin-induced licking tests respectively, whereas the antidiarrheal experiment was done by castor oil-induced diarrheal test. Besides, antioxidant, cytotoxic, antimicrobial, thrombolytic evaluations were performed by DPPH scavenging with phenol content determination, brine shrimp lethality, disc diffusion and clot lysis methods respectively. Moreover, in silico study of the phytoconstituents was carried out by molecular docking and ADME/T analysis.

The methanol extract of Millettia peguensis (MEMP) revealed significant biological activity in the analgesic and antidiarrheal test (p < 0.001) compared to the standards. Antioxidant assay displayed promising IC₅₀ values (15.96 μg/mL) with the total phenol content (65.27 ± 1.24 mg GAE/g). In the cytotoxicity study, the LC₅₀ value was found to be 1.094 μg/mL. Besides, MEMP was highly sensitive to the bacteria but less liable to clot lysis. Furthermore, phytoconstituents exposed potential binding affinity towards the selected receptors, whereas the ADME/T properties indicated the drug likeliness of the plant. The outcomes of these findings suggest the therapeutic potential of this plant against pain, diarrhea, inflammation, and tissue toxicity.

A Rare Case of Insulinoma: A Case Report

Insulinoma is a rare variety of endocrine neoplasm and is usually benign, solitary, and small in size. The hallmark of this disorder is high endogenous insulin secretion resulting in development of symptoms of hypoglycemia. Insulinomas account for 60% of islet cell tumors (ICT) of the pancreas. Ninety percent (90%) of the insulinomas measure less than 2cm. Early localization of the disease is essential to prevent lethal hypoglycemia. Here we report a case of insulinoma in a 28 year old female who subsequently underwent distal pancreatectomy with splenectomy on February 2017 in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Single Sitting Surgery for Concomitant Hydatid Cyst of Lung and Liver: A Case Report

Hydatid disease is one of the diseases that have been discovered in the ancient times. Liver and lung are the most commonly affected organs, though it can involve any organs. Hydatid disease involving both the liver and the lung is reported about 10% of the cases. Here we report a case of 34 year old male presented with upper abdominal pain and intermittent fever for 3 months admitted in October 2016. His chest radiograph and computed tomography scan revealed large cystic lesion at right lung and another similar large lesion in the right lobe of liver. Echinococcus antibody was found positive. We treated him surgically. Histopathology reports confirmed concomitant hydatid cyst of both the lung and the liver.

Surgical Treatment of Hepatolithiasis: Our Experience in Bangabandhu Sheikh Mujib Medical University

Recurrent cholangitis and sepsis are common complications after surgical treatment for hepatolithiasis as total clearance is not always possible. This retrospective study is designed to see the effect of our treatment for hepatolithiasis on stone clearance and post operative complications. We have treated 60 patients with hepatolithiasis surgically from September 2010 to September 2016 in the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Various operative procedures were applied on the basis of location of stone and status of biliary tree. Choledocoscopic examination was performed during surgery for checking and cleaning of intrahepatic duct. Regular follow up was given and outcome was assessed. The chronological changes of treatment methods for patients with hepatolithiasis were analyzed for appropriate treatments for particular type. There were 22 males and 38 females with age ranges from 15 to 60 years. The stone were located in left duct (56.6%), right duct (10%) and both duct (33.4%). The most commonly performed operation was extended choledocholithotomy and hepatolithotomy and it was performed in 28 patients (46.7%). Segmentectomy and lobectomy was performed in 17 patients (28.3%). Common bile duct (CBD) excision, hepatolithotomy and hepaticojejunostomy with or without segmentectomy, lobectomy and Houston access loop formation was performed in rest of the patients. Stones could be removed completely in all patients who underwent lobectomy or segmentectomy. In contrast stone clearance was possible only in 57.2% and 55.5% who underwent extended choledocholithotomy and hepatolithotomy, and excision of CBD, hepatolithiasis with hepaticojejunostomy for unilateral or bilateral hepatolithiasis respectively. Houston's access loop to stomach was made in 2 patients for future endoscopic removal of stone. There was no mortality in the present series but morbidity occurred in 18 patients; wound infection (n=15, 25%), bile leakage (n=1, 1.7%), and renal dysfunction (n=1, 1.7%), septicemia (n=1, 1.7%). Patients who underwent lobectomy or segmentectomy did not develop cholangitis or sepsis on 1 to 3 years follow up. In contrast who underwent extended choledocholithotomy and hepatolithotomy, 70.8% patients developed cholangitis and sepsis, and the patients who underwent excision of CBD, hepatolithotomy with hepaticojejunostomy 50% developed cholangitis and sepsis within 1 to 3 years of follow up, required re-operations or conservative treatment. The difference of developing postoperative cholangitis and sepsis is significant (p<0.05) between patient who underwent extended choledocolithotomy and hepatolithotomy, and who underwent excision of CBD, hepatolithotomy and Roux-en-Y hepaticojejunostomy. In conclusion, lobectomy or segmentectomy is the best option for hepatolithiasis if the stones are limited to a lobe or segment. Excision of CBD, hepatolithotomy with hepaticojejunostomy is better than extended choledocholithotomy and hepatolithotomy for bilateral hepatolithiasis. Huston's access loop formation associated with other procedures may be considered for bilateral hepatolithiasis for future minimal invasive stone retrieval procedure as residual stones and recurrent stone formation is common.