Showing papers by "Chittagong Medical College Hospital published in 2020"

Clinical characteristics and short term outcomes after recovery from COVID-19 in patients with and without diabetes in Bangladesh.

Abstract: Background and aims This study investigated the clinical manifestations, outcomes and long-term complications of COVID-19 inpatients in southern part of Bangladesh while emphasizing on individuals having diabetes. Methods A cross-sectional study was conducted for a sample of COVID-19 inpatients across four different hospitals of Bangladesh between April 1and June 30, 2020. Variation in clinical characteristics, contact history, comorbidities, treatment patterns, and immediate post COVID complications were investigated. Results There were 734 COVID-19 presentations in this study of which 19.8% of patients had diabetes and 76% of the COVID-19 patients were male. Among biochemical parameters, plasma glucose, D-dimer, and Troponin-I levels were significantly elevated amidst the cohort with diabetes. The frequency of patients requiring insulin increased threefold during infection with SARS CoV-2. 1.4% patients developed new onset of diabetes mellitus. A number of COVID-19 patients with diabetes have been suffering from complications post-recovery including pain, discomfort, and sleep disturbance. Conclusion Individuals with diabetes have experienced a severe manifestation of COVID-19 and post disease complications. Further in-depth studies focused on larger sample sizes are entailed to assess the relationships elaborately.

Strategies to Prevent Healthcare-Associated Infections: A Narrative Overview.

Abstract: Healthcare-associated infections (HCAIs) are a major source of morbidity and mortality and are the second most prevalent cause of death. Furthermore, it has been reported that for every one-hundred patients admitted to hospital, seven patients in high-income economies and ten in emerging and low-income economies acquire at least one type of HCAI. Currently, almost all pathogenic microorganisms have developed antimicrobial resistance, and few new antimicrobials are being developed and brought to market. The literature search for this narrative review was performed by searching bibliographic databases (including Google Scholar and PubMed) using the search terms: "Strategies," "Prevention," and "Healthcare-Associated Infections," followed by snowballing references cited by critical articles. We found that although hand hygiene is a centuries-old concept, it is still the primary strategy used around the world to prevent HCAIs. It forms one of a bundle of approaches used to clean and maintain a safe hospital environment and to stop the transmission of contagious and infectious microorganisms, including multidrug-resistant microbes. Finally, antibiotic stewardship also has a crucial role in reducing the impact of HCAIs through conserving currently available antimicrobials.

Genetic surveillance in the Greater Mekong Subregion and South Asia to support malaria control and elimination

Abstract: The use of parasite genetic data by National Malaria Control Programmes (NMCPs) is currently limited, and typically focused on specific genetic features or a small number of study sites. We have developed GenRe-Mekong, a platform for genetic surveillance of malaria in the Greater Mekong Subregion (GMS). By integrating simple sample collection procedures in the routine operations of public health facilities, GenRe-Mekong enables NMCPs to conduct large-scale surveillance project in endemic regions. Samples are processed by the SpotMalaria platform, which uses high-throughput technologies to produce a broad set of genotypes, including most known drug resistance markers, species markers and a genomic barcode. Through the application of heuristics based on published evidence, GenRe-Mekong delivers Genetic Report Cards, a compendium of genotypes and phenotype predictions that are used to map prevalence of resistance to multiple drugs. To date, GenRe-Mekong has worked with NMCPs in five countries, and with several large-scale research projects, processing 9,645 samples from clinical cases. The monitoring of resistance markers has been especially valuable for NMCPs tracking the recent rapid spread of DHA-piperaquine resistant parasites across the region. In Vietnam and Laos, data from GenRe-Mekong have provided novel knowledge about the spread of these resistant strains in provinces previously thought to be unaffected. GenRe-Mekong facilitates data sharing by aggregating at regional level results from different countries, providing cross-border views of the spread of resistant strains.

Addressing economic and health challenges of COVID-19 in Bangladesh: Preparation and response.

Abstract: This article mainly explores the economic and health challenges faced by Bangladesh amid COVID-19 and the policies taken by the government of Bangladesh to tackle the economic and health issues. Bangladesh is ranked as one of the worst-hit countries in terms of total corona infections. Affecting the social, economic, and health sectors of the country, COVID-19 pandemic has dampened the overall economic well-being and thus GDP growth along with skyrocketing poverty, inequality, and unemployment nationwide. To tackle these crises, the government has initiated effective policy measures which, in turn, enhanced the recovery rate of COVID-19 positive patients and strengthened the recovery of economic indicators. Therefore, this article suggests other hard-hit COVID-19 affected countries following the recovery model of Bangladesh to encounter the economic and health challenges due to the coronavirus pandemic.

COVID-19 Pandemic: Adaptation in Antenatal Care for Better Pregnancy Outcomes.

Abstract: Department of Preventive & Community Dentistry, School of Dentistry, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda, Department of Nursing, School of Nursing and Midwifery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda, Department of Midwifery, School of Nursing and Midwifery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda, Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, United States, Department of Obstetrics & Gynecology, Chittagong Medical College

Chemotherapeutic resistance of head and neck squamous cell carcinoma is mediated by EpCAM induction driven by IL-6/p62 associated Nrf2-antioxidant pathway activation

Abstract: Overexpression of epithelial cell adhesion molecule (EpCAM) has been associated with chemotherapeutic resistance, leads to aggressive tumor behavior, and results in an adverse clinical outcome The molecular mechanism by which EpCAM enrichment is linked to therapeutic resistance via Nrf2, a key regulator of antioxidant genes is unknown We have investigated the link between EpCAM and the Nrf2 pathway in light of therapeutic resistance using head and neck squamous cell carcinoma (HNSCC) patient tumor samples and cell lines We report that EpCAM was highly expressed in Nrf2-positive and HPV-negative HNSCC cells In addition, cisplatin-resistant tumor cells consisted of a higher proportion of EpCAMhigh cells compared to the cisplatin sensitive counterpart EpCAMhigh populations exhibited resistance to cisplatin, a higher efficiency in colony formation, sphere growth and invasion capacity, and demonstrated reduced reactive oxygen species (ROS) activity Furthermore, Nrf2 expression was significantly higher in EpCAMhigh populations Mechanistically, expression of Nrf2 and its target genes were most prominently observed in EpCAMhigh populations Silencing of EpCAM expression resulted in the attenuation of expressions of Nrf2 and SOD1 concomitant with a reduction of Sox2 expression On the other hand, silencing of Nrf2 expression rendered EpCAMhigh populations sensitive to cisplatin treatment accompanied by the inhibition of colony formation, sphere formation, and invasion efficiency and increased ROS activity The molecular mechanistic link between EpCAM expression and activation of Nrf2 was found to be a concerted interaction of interleukin-6 (IL-6) and p62 Silencing of p62 expression in EpCAMhigh populations resulted in the attenuation of Nrf2 pathway activation suggesting that Nrf2 pathway activation promoted resistance to cisplatin in EpCAMhigh populations We propose that therapeutic targeting the Nrf2-EpCAM axis might be an excellent approach to modulate stress resistance and thereby survival of HNSCC patients enriched in EpCAMhigh populations

Knowledge and attitude towards COVID-19 in Bangladesh: Population-level estimation and a comparison of data obtained by phone and online survey methods

Abstract: Peoples’ adherence to the guidelines and measures suggested in fighting the ongoing COVID-19 pandemic is partly determined by the Knowledge, Attitude, and Practices (KAP) of the population. In this cross-sectional study, we primarily addressed two key issues. First, we tried to determine whether there is a significant difference in the estimated COVID-19 knowledge level from the online and phone survey methods. Second, we tried to quantify the knowledge and attitude of COVID-19 in Bangladeshi adult population. Data were collected through phone calls (April 14-23, 2020) and online survey (April 18-19, 2020) in Bangladesh. The questionnaire had 20 knowledge questions with each correct response getting one point and incorrect/don’t know response getting no point (maximum total knowledge score 20). Participants scoring >17 were categorized as having good knowledge. The percentages of good knowledge holders were 57.6%, 75.1%, and 95.8% in the phone (n=1426), online non-medical (n=1097), and online medical participants (n=382), respectively. Comparison between phone and online survey showed that, overall, online survey might overestimate knowledge level than that of phone survey, although there was no difference for elderly, poor, and rural people. Male gender, higher education, living in town/urban areas, good financial condition, and use of internet were positively associated with good knowledge. However, higher knowledge was associated with having less confidence in the final control of COVID-19. Our adult population-level estimates showed that only 32.6% (95% CI 30.1-35.2%) had good knowledge. This study provides crucial information that could be useful for the researchers and policymakers to develop effective strategies.

Convalescent Plasma Therapy for Management of COVID-19: Perspectives and Deployment in the Current Global Pandemic.

Abstract: The world is striving against the severe crisis of the COVID-19 pandemic. Healthcare professionals are struggling to treat their patients based on nonspecific therapies. Amidst this uncertainty, convalescent plasma therapy (CPT) has appeared to be an interim adjuvant therapy for severely ill patients of COVID-19 until long-term clinical trial treatment options are available. Considering the transfusion-related hazards, especially lung injuries and microbial transmission, where sensitivity is not ensured, rigorous trials should be conducted to determine this therapy's efficacy. Moreover, the ratio of recovered cases to plasma donors is not satisfying, which questioning this therapy's availability and accessibility. Although some countries are making the treatment free, the attributable cost mandates a justification for its suitability and sustainability. Our article aimed to review the published facts and findings of CPT's effectiveness in lowering the mortality rate of COVID-19. This pandemic showed that healthcare systems worldwide need core reform. A unified global collaboration must align and coordinate to face the current pandemic and enhance world readiness for future outbreaks based on health equity and equality.

Evaluation of anti-nociceptive and anti-inflammatory activities of Piper sylvaticum (Roxb.) stem by experimental and computational approaches

Abstract: Piper sylvaticum Roxb., (Family: Piperaceae), commonly known as pahaari peepal, is used in traditional medicine for the treatment of rheumatic pain, headache, asthma, chronic cough, diarrhea, and wounds. To provide scientific proof for its traditional use, the present study was designed to investigate the antinociceptive and anti-inflammatory properties of methanol extract of P. sylvaticum stem (MEPSS) in pain models. Additionally, computational studies viz. molecular docking, ADME and toxicological property predictions were performed to identify the potent phytochemicals of this plant for antinociceptive and anti-inflammatory activities with good oral bioavailability and safety features. Quantitative phytochemical analysis of MEPSS was performed using established protocols. The antinociceptive activity was determined using acetic acid and formalin test in mice at the doses of 200 and 400 mg/kg while paw edema induced by carrageenan used for anti-inflammatory activity. Molecular docking study was performed by Schrodinger Maestro 10.1 whereas the SwissADME and admetSAR were used for ADME and toxicity prediction respectively. The total phenolic and flavonoid contents of MEPSS were 93.39 and 53.74 mg gallic acid and quercetin equivalent/g of extract respectively. The methanol extract exhibited significant and dose-dependent antinociceptive and anti-inflammatory effects in experimental pain models. Also, our docking study showed that piperine, piperlonguminine, and sylvamide have the best binding affinities to cyclooxygenase enzymes with good ADME/T properties. This study confirmed that MEPSS possess significant antinociceptive and anti-inflammatory activities which could be due to the presence of phytochemicals and three bioactive compounds (piperine, piperlonguminine, and sylvamide) were found to be most effective in computational studies.

Insulin Injection Practice and Injection Complications - Results from the Bangladesh Insulin Injection Technique Survey.

Abstract: Introduction Diabetes mellitus is highly prevalent in Bangladesh and insulin is often needed for diabetes control. We lack sufficient data on the insulin injection technique and injection-related complications. Methods The Bangladesh Insulin Injection Technique Survey (BIITS) was conducted in 2018 in 18 centres throughout Bangladesh, involving 847 patients taking insulin for at least 6 months. All of the study subjects were interviewed using a structured questionnaire focusing on key insulin injection parameters. Results The mean duration of insulin use by the study subjects was 3.84 (± 4.05) years and the mean daily dose of insulin was 41 (± 25) units. A total of 71.6% participants performed ≤2 injections/day and premixed insulins were the most commonly used insulins. Mean glycated haemoglobin (HbA1c) was 9.5% (± 2%). The proportion of syringe users and pen-device users was 68.1% and 31.9%, respectively. Most of the participants injected in the abdomen and rotated the injection site(s). The majority lifted the skinfold correctly and inserted the needle at a 90-degree angle, but their dwell times after injections were not adequate. A total of 9.2% of the subjects had injection-site lipohypertrophy (LH) and among them, 38.5% injected into the lesion. Patients with LH had higher HbA1c. Higher duration of insulin use (≥5 years), reusing needles more often (>10 times), and injecting at angles other than 90 degrees were independent predictors of LH. The incidences of hypoglycaemia (36.7%) and hyperglycaemia (67.4%) were very high, and subjects with LH had higher chances of both hypoglycaemia and hyperglycaemia. Though most (92.1%) of the patients received education about insulin injection initially, it was not repeated in the recent follow-up and was found to be ineffective. Conclusion A huge gap between the insulin administration guidelines and current practice was observed in this study. Complications of insulin injections were also common. Healthcare providers should pay more attention to insulin education and re-evaluate injection practices from time to time.

Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study.

Abstract: Background Liberal fluid resuscitation has proved harmful in adults with severe malaria, but the level of restriction has not been defined. Methods In a prospective observational study in adults with severe falciparum malaria, restrictive fluid management was provided at the discretion of the treating physician. The relationships between the volume of fluid and changes in renal function or tissue perfusion were evaluated. Results A total of 154 patients were studied, 41 (26.6%) of whom died. Median total fluid intake during the first 6 and 24 hours from enrollment was 3.3 (interquartile range [IQR], 1.8-5.1) mL/kg per hour and 2.2 (IQR, 1.6-3.2) mL/kg per hour, respectively. Total fluid intake at 6 hours was not correlated with changes in plasma creatinine at 24 hours (n = 116; rs = 0.16; P = .089) or lactate at 6 hours (n = 94; rs = -0.05; P = .660). Development of hypotensive shock or pulmonary edema within 24 hours after enrollment were not related to the volume of fluid administration. Conclusions Restrictive fluid management did not worsen kidney function and tissue perfusion in adult patients with severe falciparum malaria. We suggest crystalloid administration of 2-3 mL/kg per hour during the first 24 hours without bolus therapy, unless the patient is hypotensive.

Leea macrophylla (Roxb.) root extract reverses CCl4 induced liver injury through upregulation of antioxidative gene expression: a molecular interaction for therapeutic inception

Abstract: This study investigated the restorative effect of Leea macrophylla ethanol root extract (LMERE) in carbon tetrachloride (CCl4) induced hepatic injury. It also tried to unfold the underlying mechanism through ligand-receptor interactions. Prior to conduct the CCl4 induced animal model study, the in vitro antioxidative capacities of LMERE were investigated. Gas chromatography mass spectroscopy (GC–MS) was accomplished to identify the prevalent bioactive compounds. The molecular docking was performed using Schrodinger Suites 2017-1. Results showed the promising antioxidative potentials of LMERE in in vitro models. Upon treatment of CCl4 intoxicated animals with LMERE, serum ALT and AST were found to be significantly (p < 0.05) reduced compared to the CCl4 control while LMERE50 was noted as the best dose in restoring the hepatic markers. Serum lipids and total protein were significantly restored compared to control. Remarkable changes of cell necrosis, apoptosis and sinusoidal dilution were noticed in histopathological assay of liver tissue. mRNA expression for superoxide dismutase (SOD1) and catalase was multifold increased which are statistically significant compared to reference drug, silymarin. In docking study, octadecanoic acid showed the lowest binding energy and highest binding affinity with the protein (ID: 1VKX) which is a crystallized structure of NF-κB p50/p65 heterodimer involved in cytokine production. The findings demonstrate that LMERE restores the hepatic damage by the mRNA expression of antioxidative enzymes while LMERE50, at a glance, seems the most suitable dose.

Widespread expression of Sonic hedgehog (Shh) and Nrf2 in patients treated with cisplatin predicts outcome in resected tumors and are potential therapeutic targets for HPV-negative head and neck cancer:

Abstract: Background:Sonic hedgehog (Shh) and Nrf2 play a critical role in chemotherapeutic resistance. These two genes have been found to be dysregulated in head and neck squamous cell carcinomas (HNSCC). T...

RT-PCR Mediated Identification of SARS-CoV-2 Patients from Particular Regions of Bangladesh and the Multi-factorial Analysis Considering Their Pre and Post Infection Health Conditions

Abstract: Background: SARS-CoV-2 is a type of coronavirus shows bizarre features with fatality rates at 34.4%. The clinical and non-clinical features of COVID-19 might be causative factors for more rapid community spreading compared to MERS and SARS-CoV-1. Objectives: To study the efficacy of RT-PCR based detection of SARS-CoV-2 patients. Besides, the patients' pre and post-infection health conditions depending on selective clinical and nonclinical parameters were analyzed. Materials and Methods: Clinical and nonclinical data were collected from 205 randomly selected COVID-19 patients, identified through RT-PCR from different areas of Bangladesh. The data were analyzed using statistical and analytical tools to illustrate the impact of the pandemic situation on the sufferers. Results: Molecular identification of the patients through RT-PCR has been observed as the most efficient option for detecting SARS-CoV-2 patients. Patients with the smoking habit have been reported to be more prone to the COVID-19 infection; surprisingly the non-smoker female was the worse suffers. The patients aged 60-69 years were the worst sufferers with every adverse health conditions mentioned. Professionally, 28% self-employed male and 8.19% female were infected. The most infected individuals were house wife (32.029%), as next to the health care workers (22.1%). With the increased age group, a decreased number of smokers were found. Nebulization of 5% home and 12% hospital treated patients were provided, with Oxygen for 26% of hospitalized patients. After recovery, combined physical and psychological complications were observed in 19% of male and 11% female. The socioeconomic, environmental and geographical annotations exposed a clear relationship with the rate of infection as revealed from the nonclinical data analysis. Conclusion: RT-PCR proved its specialty in COVID-19 detection. In addition, impacts of different clinical and nonclinical factors on the physical conditions of the nCoV patients were found significant in the research.

Characteristics, management and outcomes of critically ill covid-19 patients admitted to icu in hospitals in bangladesh: a retrospective study

Abstract: Objectives: This study aimed to analyse the epidemiological and clinical characteristics of critical COVID-19 cases and investigate risk factors including comorbidities and age in relation with the clinical aftermath of COVID-19 in critical cases in Bangladesh. Methods: In this retrospective study, epidemiological and clinical characteristics, complications, laboratory results, and clinical management of the patients were studied from data obtained from 168 individuals diagnosed with an advanced prognosis of COVID-19 admitted in two hospitals in Bangladesh. Results: Individuals in the study sample contracted COVID-19 through community transmission. 56.5% (n = 95) cases died in intensive care units (ICU) during the study period. The median age was 56 years and 79.2% (n=134) were male. Typical clinical manifestation included Acute respiratory distress syndrome (ARDS) related complications (79.2%), fever (54.2%) and cough (25.6%) while diabetes mellitus (52.4%), hypertension (41.1%) and heart diseases (16.7%) were the conventional comorbidities. Clinical outcomes were detrimental due to comorbidities rather than age and comorbid individuals over 50 were at more risk. In the sample, oxygen saturation was low (< 95% SpO2) in 135 patients (80.4%) and 158 (93.4%) patients received supplemental oxygen. Identical biochemical parameters were found in both deceased and surviving cases. Administration of antiviral drug Remdesivir and the glucocorticoid, Dexamethasone increased the proportion of surviving patients slightly. Conclusions: Susceptibility to developing critical illness due to COVID-19 was found more in comorbid males. These atypical patients require more clinical attention from the prospect of controlling mortality rate in Bangladesh.

Antibiotic resistance and sensitivity pattern of Metallo-β-Lactamase Producing Gram-Negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh.

Abstract: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), accounting for 25% of all ICU infections. Antimicrobial resistance is increasing and bec...

Mapping the travel patterns of people with malaria in Bangladesh

Abstract: Spread of malaria and antimalarial resistance through human movement present major threats to current goals to eliminate the disease. Bordering the Greater Mekong Subregion, southeast Bangladesh is a potentially important route of spread to India and beyond, but information on travel patterns in this area are lacking. Using a standardised short survey tool, 2090 patients with malaria were interviewed at 57 study sites in 2015–2016 about their demographics and travel patterns in the preceding 2 months. Most travel was in the south of the study region between Cox’s Bazar district (coastal region) to forested areas in Bandarban (31% by days and 45% by nights), forming a source-sink route. Less than 1% of travel reported was between the north and south forested areas of the study area. Farmers (21%) and students (19%) were the top two occupations recorded, with 67 and 47% reporting travel to the forest respectively. Males aged 25–49 years accounted for 43% of cases visiting forests but only 24% of the study population. Children did not travel. Women, forest dwellers and farmers did not travel beyond union boundaries. Military personnel travelled the furthest especially to remote forested areas. The approach demonstrated here provides a framework for identifying key traveller groups and their origins and destinations of travel in combination with knowledge of local epidemiology to inform malaria control and elimination efforts. Working with the NMEP, the findings were used to derive a set of policy recommendations to guide targeting of interventions for elimination.

Efficacy of oral methotrexate (MTX) monotherapy vs oral MTX plus narrowband ultraviolet light B phototherapy in palmoplantar psoriasis.

Abstract: Palmoplantar psoriasis (PPP) is a chronic, inflammatory dermatosis of the palms and/or soles with significant morbidity. It is notoriously difficult to treat and unresponsive to traditional topical agents. We aim to compare the effect of oral methotrexate (MTX) monotherapy vs MTX plus narrowband ultraviolet light B (NB-UVB) in the treatment of recalcitrant PPP. This was a comparative clinical trial involving 90 patients of PPP. Eligible patients were randomly assigned to one of the two treatment groups. We aim patients in group A received 10 mg oral MTX weekly, and patients in group B received oral MTX 10 mg weekly and NB-UVB sessions twice weekly for 12 weeks. There was a statistically significant difference in reduction of modified PPP Area Severity Index (m-PPPASI) of patients in MTX plus NB-UVB at week 12. The mean m-PPPASI at week 12 was 3.66 ± 2.11 in MTX plus NB-UVB group and 6.51 ± 2.04 in MTX only group (P < .001). Marked improvement (m-PPPASI 75) was achieved in 20 (44.44%) patients in MTX plus NB-UVB group compared with 6 (13.3%) in MTX monotherapy group (P < .001). Combination of MTX and NB-UVB phototherapy helps to attain a better clinical response (reduction in m-PPPASI score) than MTX monotherapy in the treatment of recalcitrant PPP.

Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey

Abstract: Nationally representative data on burden of musculoskeletal conditions (MSK) in Bangladesh are not available. The objective of this study was to determine the prevalence of MSK conditions and related disabilities in the adult population of Bangladesh. A total of 2000 individuals aged 18 years or older were targeted from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability. A total of 1843 (92.1%) participated. Among them, 892 men and 951 women participated from rural (n = 716) and urban (n = 1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3–32.5) had MSK conditions. Low back pain (18.6%, 16.9–20.5), knee osteoarthritis (7.3%, 6.1–8.5) and soft tissue rheumatism 3.8% (2.9–4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0–2.1), spondyloarthritis (1.2%, 7–1.8) and adhesive capsulitis (1.4%, 0.9–1.9) were relatively uncommon. Among those who had MSK conditions, 24.8% (21.3–28.6) had some degree of disability. Of them, 24.4% (21.0–28.1) had history of work loss during last 12 months. The high burden of MSK conditions and related disabilities in Bangladesh warrants greater attention of the health system. Further studies are needed to estimate the impact of this group of conditions particularly addressing related disabilities and loss of work.

Reduced Cardiac Index Reserve and Hypovolemia in Severe Falciparum Malaria

Abstract: Background: Impaired microvascular perfusion is central to the development of coma and lactic acidosis in severe falciparum malaria. Refractory hypotension is rare on admission but develops frequently in fatal cases. We assessed cardiac function and volume status in severe falciparum malaria and its prognostic significance. Methods: Patients with severe (N = 101) or acute uncomplicated falciparum malaria (N = 83) were recruited from 2 hospitals in India and Bangladesh, and healthy participants (N = 44) underwent echocardiography. Results: Patients with severe malaria had 38% shorter left ventricular (LV) filling times and 25% shorter LV ejection times than healthy participants because of tachycardia; however, stroke volume, LV internal diameter in diastole (LVIDd), and LV internal diameter in systole (LVIDs) indices were similar. A low endocardial fraction shortening (eFS) was present in 17% (9 of 52) of severe malaria patients. Adjusting for preload and afterload, eFS was similar in health and severe malaria. Fatal cases had smaller baseline LVIDd and LVIDs indices, more collapsible inferior vena cavae (IVC), and higher heart rates than survivors. The LVIDs and IVC collapsibility were independent predictors for mortality, together with base excess and Glasgow Coma Scale. Conclusions: Patients with severe malaria have rapid ejection of a normal stroke volume. Fatal cases had features of relative hypovolemia and reduced cardiac index reserve.

Safety and Security of Sexual-reproductive Health and Gender-based Violence among Rohingya Refugee Women in Bangladesh

Abstract: Rohingya refugee women and girls are from a vulnerable society taking shelter in Bangladesh for humanitarian assistance following the serious human rights violations in Myanmar. They are facing a number of challenges such as insecurity, violence, very limited freedom of movement or ability to speak up and influence decisions in their communities. They are most vulnerable to exploitation due to inadequate basic living facilities in the camp causing them to be physically or sexually abused, forced prostitution and human trafficking. Gender-based violence, abandonment by their husbands in the camps, early marriage, teenage pregnancies including lack of safer pregnancy and childbirth are all important issues and challenges faced by them. Access to basic amenities and educational opportunities with special attention about sexual and reproductive health including issues such as gender equality, relationships and conflict management and adequate community health care can help the Rohingya women to overcome the situation. Actually, the word “Rohingya” derived from the people who exist in from the British rule of the medieval period in the current “Rakhine” state, formerly known as “Roshang” later turned into “Rohang” due to colloquial usage. Although officially Myanmar is not using the term “Rohingya” as this might potentially endorse their indigenous origin, an international involvement is obligatory to find a solution for sustainable return of Rohingya refugees to Myanmar. International Journal of Human and Health Sciences Vol. 05 No. 02 April’21 Page: 163-170

Effects of alternate nostril breathing exercise on respiratory functions in healthy young adults leading stressful lifestyle.

Abstract: Alternate nostril breathing (ANB) is one of the best and easiest breathing exercises (pranayama) of yoga that are good for health and physical fitness. ANB exercise has beneficial and therapeutic effects on respiratory function in both normal as well as diseased humans. This study was conducted with the objective of assessing the physiological effects of short-term ANB exercise on respiratory function in healthy adult individuals leading a stressful life. This prospective interventional study was conducted in the Department of Physiology, Chittagong Medical College (CMC), Chattogram, Bangladesh from July 2017 to June 2018. A total of 100 participants aged 18-20 years, studying in the first year in CMC, were included by using a simple random sampling method. Among them, 50 participants were enrolled in the experimental group. Age- and BMI-matched 50 participants constituted the control group. Height, weight were measured, and BMI was calculated. The participants of the experimental group performed ANB exercise over 4 weeks for 10 min/day. The control participants were neither trained nor allowed to practice nostril breathing during the whole study period. Respiratory parameters like forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), and peak expiratory flow rate (PEFR) were measured by using a digital spirometer (Chest graph HI-101, Japan). Readings were taken in a healthy upright sitting posture in the control and experimental group initially and after 4 weeks. Student's t-test was conducted by using SPSS for windows version-23. The mean value of FVC, FEV1, PEFR were significantly (P < 0.001) changed after the ANB exercise when compared to the values before breathing exercise. The results of this study suggest that respiratory function is significantly improved after the ANB exercise. Therefore, ANB can be recommended for increasing respiratory efficiency.

Towards Developing A Mobile-Based Care for Children with Autism Spectrum Disorder (mCARE) in low and Middle-Income Countries (LMICs) Like Bangladesh

Abstract: This paper describes a mobile-based care system (mCARE), which is a novel tool to routinely and systematically collect behavior and developmental parameter children with Autism Spectrum Disorder (ASD) from the low-and middle-income countries (LMICs) like Bangladesh. It is the first clinical decision support system for the ASD children in LMICs that has been proved efficient to assist them in data-driven decision making by using a remote Experience Sampling Method (ESM). Unlike other ESM, instead of taking a report from patients, mCARE introduce caregivers as the reporter. mCARE has deployed Value Sensitive Design (VSD) and Human-Computer Interaction (HCI) in its design process as well as Fogg's Behavior Model (FBM) to assist caregivers in developing and sustain the habit of logging data regularly over a long period. mCARE has accumulated its goal by implementing three tools: mCARE-APP, mCARE-SMS, and mCARE-DMP. The successful completion of the project using this mCARE can ensure the overall quality of care (QoC) of ASD in LMICs, including Bangladesh. The usability and cost-benefit analysis have also shown the potential of mCARE to be scaled to serve a large population in Bangladesh and beyond.

Pre-Processing Data In Weather Monitoring Application By Using Big Data Quality Framework

Abstract: In this research, we are working with Big Data for obtaining, preparing and analyzing data-based information to make use of the data retrieved which will benefit any organization. It is a progressing part of all divisions of industry and business. All organizations in any field, for example, oil, money, fabricating hardware and so forth produce big data, which can show incredibly helpful designs to business directors to make and develop their organizations, when the information is gathered and analyzed accurately. It permits us to gather, store, and decipher immense measures of big data to produce useful outcomes. Data quality is affected by the information that is gathered to be analyzed as that data will make sure whether in the long run a specific method of conducting the ongoing process is useful or not. Consequently, the consistency of big data very important. Here, we propose that the various types of raw information should be analyzed to expand its precision in the pre-handling stage, as those pieces of information are not utilized later in the process. During investments, we break down and model the big data to decrease overhead expenses to create and add to a solid understanding of results to improve information consistency.

A comparison between short- and long-term D-J stent in Anderson-Hynes pyeloplasty for pelvi-ureteric junction obstruction.

Abstract: A double-J (D-J) stent is usually kept in situ during Anderson–Hynes (A–H) pyeloplasty for pelvi-ureteric junction (PUJ) obstruction. The aim of the study is to determine whether early removal of D-J stent is better than long-term stenting. In this prospective comparative study, conducted from January 2018 to April 2019 in Chittagong Medical College Hospital, patients with PUJ obstruction, age less than 12 years, were divided into group A (long-term stenting) and group B (short-term stenting) by simple randomization. Main outcome variables were urinary tract infection (UTI), stent colonization, encrustation, renal cortical thickness, differential renal function (DRF), glomerular filtration rate (GFR), and flow rate in DTPA renogram. There were 31 patients in each group. Median age was 5 years (IQR: 2.3 to 7 years) and male to female ratio was 2.1:1. Frequency of post-operative UTI and stent colonization were significantly higher in group A than group B (p < 0.001). All the patients of both groups had similar improvement in renal cortical thickness, DRF, GFR, and flow rate. The study was potentially limited by its small sample size and high median age (5 years). Early removal of D-J stent had lower incidence of UTI, stent colonization, encrustation, and stent migration.

Risk Factors of Premature Rupture of Membrane in A Tertiary Care Hospital, Bangladesh

Abstract: Background : Premature Rupture of Membrane (PROM) is one of the most common complication of pregnancy. A woman with premature rupture of membrane is at risk of perinatal morbidity and mortality and also associated with maternal morbidity and psychological stress. Objective of this study was to determine incidence and risk factors of pregnant woman with PROM admitted in a tertiary hospital at Chattogram, Bangladesh. Materials and methods : This prospective observational study conducted in the Department of Obstetrics and Gynaecology at Chattogram Maa-O-Shishu Hospital Medical College (CMOSHMC) Chattogram from 1stJanuary 2018 to 31st December 2018. In this period total admitted antenatal patients were 8117. Among the pregnant patients with PROM were 665 and their weeks of gestation were > 28 weeks. Data was collected by interviewer with semi structured questionnaire & check list. Results : Incidence of PROM was 8.2%. PROM was found to be frequent (53%) in younger age group between 20-24 years. It was also commonly in primigravida (61.8%). Term PROM was higher (69.2%) than pre-term PROM (30.8%). 93.3% were singleton pregnancies, 6.4% were twins and .3% were triplets. Analysis of risk factors revealed ectiology was unknown in 46 (6.8%) low socioeconomic condition (60.6%), anaemia (45 %), lower genital tract infection (35.6%) UTI (31%) previous history of PROM (27.9%) malpresentation (15%) multiple pregnancy (6.7%) polyhydramnios (6%) history of recent coitus (12%) DM and GDM (10.5%) were commonly associated with PROM. Conclusions : Early identification of various risk factors causing PROM and their management can prevent premature deliveries and its complications to some extent as well as serious maternal complication like Chorioamnionitis. Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 5-8

Epidemiology and clinical outcome of COVID-19: A multi-centre cross sectional study from Bangladesh

Abstract: Background COVID-19 turned into a global pandemic rapidly. This study was aimed to investigate SARS-CoV-2 associated epidemiology and clinical outcomes in Bangladesh in order to understand the future course of COVID-19 pandemic and develop prevention approaches. Design and Methods A cross-sectional retrospective study was conducted for a sample of 1,021 RT-PCR confirmed COVID-19 cases admitted in six different hospitals in Bangladesh and who recovered four weeks prior to the interview date. Results Of the total sample, 111 (10.9%) cases were asymptomatic while the number of symptomatic cases were 910 (89.1%). Higher prevalence of COVID-19 persisted in the male population (75%), cohorts having B (+) ve blood group (36.3%) and for the 31-40 age group. More than 85% of the sample reported a BCG vaccination mark. Common symptoms observed in our study samples were fever (72.4%), cough (55.9%), loss of taste (40.7%) and body ache (40%); whereas among the biochemical parameters, Neutrophil (46.4%), D-dimer (46.1%), and Ferritin (37.9%) levels were found elevated. Post-COVID complications including pain (31.8%), loss of concentration (24.4%) and anxiety or depression (23.1%) were also found significantly prevalent in the symptomatic cases with commodities. Conclusion Our study has shown that adult males aged in between 31-40 in Bangladesh are more vulnerable to being infected with COVID-19. The study also indicates a rising trend of the asymptomatic cases as the pandemic progresses deeper in time, and hence, deployment of interventions to curb further spread of community infection is necessary to avoid the grave outcomes of COVID-19 in Bangladesh.

Disinfection booth: blessing or curse for spreading of COVID-19 in Bangladesh.

Abstract: From the Document: Infectious disease models can help guide major policy decisions, such as how to allocate health care resources in the COVID-19 [coronavirus disease 2019] response However, limitations in data inputs and assumptions can lead to considerable uncertainty in model estimates Interpreting these estimates requires understanding their purpose, limitations, and assumptions COVID-19 (Disease);Infectious disease;Emerging infectious diseases;Public health