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Background: Alloimmunization is a known complication following repeated red blood cell transfusions. However, the associated factors of RBC alloimmunization are different among blood recipient groups. This study aimed to determine the associated factors of red blood cell alloimmunization among solid cancer patients in Hospital USM. Material and Methods: This cross-sectional study involved 322 adult solid cancer patients screened for red cell alloantibodies in our centre from October 2016 until February 2019. The clinical and transfusion data were obtained from the patient’s medical record and laboratory information system (My Transfusi). The multiple logistic regression was used for analysis of potential associated factors of red blood cells alloimmunization, and p-value of less than 0.050 was considered statistically significant. Results: The patient’s mean age was 52.0 years old, with the majority were Malays (91.0%) and females (61.2%). The most common cancers were breast (32.3%) followed by gastrointestinal (16.8%) and head and neck (14.3%). The presence of metastases (adjusted OR=13.53, p=0.017), numbers of packed red cell transfusions (adjusted OR=1.12, p= 0.015), and blood group A (adjusted OR=7.45, p=0.003) were the associated factors of alloimmunization. Conclusions: Solid cancer patients with metastases, received a higher number of packed red cell transfusions, and blood group A were at higher risk for alloimmunization. Strategies to provide phenotype RBC should focus on this type of patient to prevent red blood cells alloimmunization in solid cancer patients. Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 379-384

Background: The goal of this study is to illustrate an optimum variable selection method using established Multiple Linear Regression (MLR) models and to validate the variable using Multilayer Perceptron Neural Network (MLP) models. Initially, all selected variables will be passed through the bootstrap methodology, and they were screened for significant relationships. Objective: The goal of this work is to analyze and construct a model for the factor linked with total crime cases by combining an Applied Linear Regression Model (ALRM) and a Multilayer Perceptron (MLP). Material and Methods: Around 200 data was simulated to build the methodology. Advanced computational statistical modeling methodologies were used to evaluate data descriptions of several variables in this retrospective study, including the total victim, gender, age, marital status, social class, adult in the household, children in household, burglary’s victim, sexual’s victim, victim’s report, and household location. The case study was developed and implemented using the R-Studio program and syntax. Results: The statistical method demonstrated that regression modeling surpasses R-squared and mean square error test in most situations. Researchers observed that when data is divided into two datasets for training and testing, the hybrid model approach performs significantly better at predicting the experiment’s outcome. When it came time to determine variable validity, the well-established bootstrap-integrated MLR approach was applied. Ten characteristics are taken into consideration in this case: Gender (: -0.4369700; p< 0.25), age (: -0.0086757; p< 0.25), marital status (: 0.2646097; p< 0.25), social class ( : 0.0602540; p< 0.25), adult in household (: -0.0211293; p> 0.25), children in household (: -0.0025346; p> 0.25), burglary’s victim (: 1.3473593; p< 0.25), sexual’s victim (: 1.0382444; p< 0.25), victim’s report (: -0.3176104; p< 0.25), and location of household (: -0.1355046; p< 0.25).There is a 0.07745823 MSE for the linear model in this scenario. Conclusion: The neural network’s Predicted Mean Square Error (PMSE) was used to assess MLP’s performance (MSE-forecasts the Network). PMSE is used to determine how far our projections are from the actual data, and the lowest MSE from the MLP indicates the best achievement. The R syntax for MLR and MLP is also included in this research article.As a result, the study’s conclusion establishes the superiority of the hybrid model technique. Bangladesh Journal of Medical Science Vol. 22 No. 01 January’23 Page : 38-46

Objective: The purpose of this study is to find propotion of fractured orbital walls in the maxillofacial trauma cases and its associated maxillofacial fracture treated in the Oral Maxillofacial Clinic Oral Maxillofacial ward and operation theatre of Hospital USM in Kelantan, Malaysia. Materials and methods: From July 2013 to June 2018, records of patients who sustained maxillofacial fractures and presented them to the Accident and Emergency Department, Oral Maxillofacial Clinic, Hospital USM were reviewed, recorded, and analyzed. There are 294 patients whose data has been collected because they met the inclusion criteria. Each patient with a complete medical record was reviewed. Data were collected under the variables: Zygomatic Complex, Zygomatic Arch, Nasal, Maxillary Sinus, Le Fort I, Le Fort II, Le Fort III, Orbital Wall, Alveolar Process, Symphysis of Mandible, Condyle of Mandible, Ramus of Mandible, Maxillary Bone and Mandibular Bone of maxillofacial fracture. The fractured orbital walls in these cases was reviewed. At the first stage, all the selected variables will be screened for their important clinical point of view. The SPSS software version 26.0 was used to determine all possible factors contributing to orbital wall fracture. Results: This was a retrospective cross-sectional analysis of the medical records of 294 patients with maxillofacial fracture treated in the Oral Maxillofacial Clinic and Oral Maxillofacial ward, Hospital USM. There were 228 (77.3%) men and 66 (22.4%) women included in this study. The most common age range is 11-20 years (39.8%), 21-30 years (26.2%). Maxillary Bone Fracture (0.371; p

Background: Third molars positions and eruption patterns tend to be unpredictable in most cases. Substantial diversity exists globally among modern human races in the prevalence of third molar impaction. Aims and Method: This study aimed to investigate the prevalence and pattern of third molar impaction amongBangladeshi adults. Digital panoramic radiographs of 5923 patientswith the mean age of 35.90 ± 10.76 years olds were retrieved from database and evaluatedusingPlanmecaRomexis software.Demographics, gender and sidedifferences wereanalysed using SPSSversion 26.0. Result:Approximately, 46.2% of the adult population had third molar impaction where significant impaction occurred in the mandible compared to maxillary arch. However, no significant differences were observed among gender and side distribution. The most common type of third molar angulation in the maxilla and mandible was distoangular (55.9%) and mesioangular (36.6%), respectively.Comprehension of demographic and morphological variations in third molar impaction will lead to an understanding of third molar impaction assessment, which will aid in understanding the evolutionary origins of an important condition adversely affecting modern peoples. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 717-729

Autoimmune hemolyticanemia (AIHA) can be caused by a variety of etiologies. Approximately one-half of warm AIHAs are idiopathic, while the nonidiopathicetiologies include lymphoproliferative disorders, autoimmune disease, and infection-induced AIHA. AIHA may be frequently challenged by infectious complications, mainly as a result of immunosuppressive treatments administered. Here we reported an extraordinary case of Mycobacterium tuberculosis infection presented with high titer cold-agglutinin autoimmune hemolysis in an immunocompetent patient. Although being risk factors for mortality, infections are an underestimated issue in AIHA. No antecedent case of pulmonary tuberculosis associated with cold agglutinin disease has been reported from Malaysia. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 754-757

Background: Group O blood donor is more readily available and is frequently used as a universal red cell donor and emergency O whole blood (EM O) for exchange transfusion in neonates. Sera from group O donors contains two separable haemolysin antibodies, anti-A and anti-B, and a cross-reacting antibody called anti-A, B (mostly IgG). The presence of haemolysins in the donors may lead to haemolysis in the recipients. Objectives: This study aims to determine the prevalence of anti-A and anti B haemolysins and titer among group O donors that we screened for emergency group O (EM O) whole blood Methodology: A cross sectional study was done to determine the prevalence of anti-A and anti B haemolysin and titer among group O blood donors screened for EM O whole blood for exchange transfusion in neonates at a teaching hospital from January to December 2018. Samples of 350 voluntary group O regular donors were selected for ABO antibodies titration and haemolysin test using the conventional tube technique at room temperature. Donors were screened for titer of 1:50 and 1:100 only. ABO antibody titer of ≥1:100 was considered as a high titer and not suitable for exchange transfusion. Titer of ≤1:50 were labeled as EM O whole blood and will be suitable for exchange transfusion. Results: A total of 350 group O blood donors were screened for the anti A and anti B haemolysin and titer. The majority of blood group O donors were male (n=215, 61%) and were age from 18-30 years old (51%). Malay was the predominant group (83%). About 52.9% of the donors were low titer (≤1:50), and 47.1% were high titer (≥1:100). Low titer was seen predominantly among male donors (61.8%). The prevalence of haemolysins in group O donors was 5.4% (n=19). Anti A and anti B haemolysins were seen in 0.57% and 2.28% of the donors, respectively, while donors having both A and B haemolysins in their sera was 2.57%. Conclusion: Prevalence of anti-A and anti-B haemolysins were low among group O blood donors. However, a significant percentage of group O donors have high titer of anti-A or anti-B. Therefore, despite the labour intensiveness of haemolysis titration technique and the frequent transfusion of group O blood for exchange transfusion, there is the need to routinely screen our donors for haemolysins in order to identify those posing the greatest risk to recipients. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 368-372

Background:MNS glycophorin variants such as glycoprotein (GP.) Mur, GP.Hop, GP.Bun, GP.HF, GP.Hut, and GP.Vw are known to carry multiple antigens, including Mia (MNS7). In East and Southeast Asians, an antibody to Mia is not only commonly found, but also clinically significant. Purpose and Methods: In this study, deoxyribonucleic acid (DNA) samples from 47 patients suspected of having anti-Mia by serological screening were genotyped for GP.Mur, GP.Hop, GP.Bun, GP.HF, GP.Hut, and GP.Vw variants using polymerase chain reaction (PCR) assay. Results: All patients were found to be negative for the presence of Mia-positive glycophorin variants. Conclusions: The presence of anti-Mia cannot be excluded in patients studied, as genotyping shows that Mia-positive MNS glycophorin variants are not present. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 432-437

Introduction: The end product of purine metabolism in humans is uric acid (UA). Although uric acid can function as either an antioxidant or an oxidant depending on the surrounding environment, the chemical environment can also impact uric acid.The uric acid level in the serum can predict the development of diabetic nephropathy in type 1 diabetes. Objective: This study aims to determine factors that are perhaps having an association with acid uric. Method: Variables selection is basedon clinical importance. The most significant variable will be assigned and analyzed using Artificial Neural Network (ANN) through multilayer feed-forward and contour plot. Results: Through the architecture of MLFF with two hidden layers, it was found that Creatinine level, Urea level, Systolic Blood Pressure reading, Waist circumference reading, Gender play an essential role toward uric level with an accuracy of 97.7% and the predicted mean squared error (MSE.net) is 0.005. The combination of the selected variable showing the highest significance in predicting the level of uric acid. Conclusion: These findings offer useful future management action plans for patients with diabetes.By controlling these four variables can improve the level of health among diabetic patients. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.741-747

Background: COVID-19 outbreak is being studied throughout the world. Adding more analysis to date strengthening the information about the illness. Here, we analysis the data of Malaysian Ministry of Health from February 15, 2020 until January 10, 2021 was analysed using linear regression model statistical analysis with aim to forecast the trend. Materials and Methods: This study reviewed the data by Malaysia Ministry of Health from February 15, 2020, until January 10, 2021. Linear regression model statistical analysis was used for predictive modelling. The forecasting of the linear trend of the Covid-19 outbreak prediction is purposed to estimate the number of confirm cases according to the number of recoveries patients. Results: Malaysia is currently anticipating another lockdown restriction as new confirmed case of COVID-19 hit new record high. The cumulative confirmed Covid-19 cases in MCO predicted a sharp increase. At the first of March, 2021, the predicted cumulative confirmed Covid-19 cases are 319,477 cases. Conclusions: Covid-19 cases projected to 315766 by end of February 2021 with 3000- 4000 daily cases predicted. Initiative and proactive measurement by Malaysian government hopefully can reduce the number of cases and flatten the infection curve. Bangladesh Journal of Medical Science Vol.20(3) 2021 p.504-510

Kratom dependence among adolescent, even though underreported, is increasing in prevalence in Southeast Asia. Kratom can be simply misused with a great possible addiction and subsequently cause serious undesirable physical and mental health consequences, which is not something to be taken lightly. We present three case series of late adolescents who consumed kratom for more than six months, which leads to poor school performance and had already developed withdrawal symptoms. This case series illustrates the effectiveness of treating adolescents with kratom dependency using combination of medical therapy - Methadone as Drug Substitution Therapy (DST) and supportive therapy from their family members. Therefore, it is crucial for primary care practitioners to screen the adolescents and alert the withdrawal symptoms as well as initiating early discussion with psychiatrist in order to start the prompt treatment since DST is available in primary care clinic. Bangladesh Journal of Medical Science Vol.20(3) 2021 p.673-677

Background: This research was planned to search for a potential of modified hydrothermal nanotitania extract in inhibiting the growth of bacteria commonly known in medical field. It is also aims to test this substance against common medical bacteria,Escherichia coli. Materials and methods: In this test, suspension of modified hydrothermal nanotitania extract (together with 0.01%, 0.03% and 0.05% silver) and undoping (positive control contains TiO2 and no silver) were prepared by mixing of TiO2 in Mueller Hinton Broth (MH) agar. The platecontaining the bacteria and TiO2 were observed after 24 hour, 48 hours and 72 hours incubation at 37oC for any growth of bacteria. Results: There was no growth of Escherichia coliin the plates containing the bacteria and modified hydrothermal nanotitania extract except in the control media. Conclusions: The finding suggested the modified hydrothermal nanotitania extractioninterfered the growth of Escherichia coli. Bangladesh Journal of Medical Science Vol.19(4) 2020 p.705-709

Objective: Autologous peripheral blood haemopoietic stem cell (PBSC) transplantation is a standard therapeutic option for eligible patients with lymphoproliferative disease (LPD). The prerequisite for autologous PBSC transplantation is the successful stem cell mobilization. This study is aimed to determine the factors associated with poor PBSC mobilization in LPD patient at our center. Materials and methods: This retrospective record review involved 39 multiple myeloma (MM) and 92 of lymphoma patients who had undergone PBSC mobilization from January 2009 until December 2016. Patients were mobilized with combination chemotherapy and granulocyte colony stimulating factor. Factors affecting mobilization including patient’s, disease and treatment characteristics werestudied. Results: Majority of patients were Malay (93.9%) with the mean age at mobilization of 41.4 years. The mean of CD34+ cell dosage was 9.6x106 cells/kg. Successful and poor mobilization was found to be 90.8% and 9.2% respectively. Multivariate analysis showed that the significant risk factors for poor mobilization were age of ≥ 60 years (adjusted OR=38.43, p=0.005) and PB CD34+ cell count

Backgrounds: The mutagenic properties of modified hydrothermal nanotitania extract were carried out using the Ames test (genotoxicity). Materials and methods: The Ames test was performed on Salmonella strains (TA98, TA100, TA1535, TA1537 and TA 102) which contain mutations in several genes with and without S9 metabolic activation from rat liver using the standard assay. The materials were extracted in distilled water and the serial dilutions of concentration ranging from 313 to 5000 μg/mLwere used after the incubation period of 24 h at 37° C. Results: These results suggested that all tested concentrations of the material extracts did not produce mutagenic effect in all the strains tested. Conclusions: Findings from this study showed that the modified hydrothermal nanotitania extract was non-mutagenic under present conditions. Bangladesh Journal of Medical Science Vol.19(1) 2020 p.159-162

Introduction: Arterial stiffness is recognised as a significant cardiovascular risk factor and an independent predictor of all causes of cardiovascular death. Women are the largest population exposed to cigarette smoke either at work or from their partner. The objectives of this study are to compare the arterial stiffness (augmentation index and pulse wave velocity) between second hand smoke (SHS) and non second hand smoke (non-SHS). Designs and method: Comparative cross-sectional study was conducted among 118 healthy female subjects (64 SHS and 54 non- SHS). The women were in the SHS group if their spouse is a smoker and they had an exposure to cigarette smoke for at least three years, minimum of15 minutes two days a week. Pulse wave analysis and pulse wave velocity was used to study the arterial stiffness. Pulse wave analysis reported as percentage of augmentation index. Pulse wave velocity equal to carotid femoral distance (meter) divided by time (second) Results: The mean augmentation index (AIx) for SHS groups was 17.9 (SD7.06) and for non SHS groups was 20.7(SD6.11). The mean of Pulse wave velocity was 8.94 (SD1.36) in SHS groups and 9.02 (SD8.68) in non SHS groups. ANOVA and ANCOVA shown significance difference in crude mean (p = 0.047) and estimated marginal mean (p = 0.028) of augmentation index between SHS and non - SHS after controlling for age and BMI. However, there was no significant difference in crude mean (p = 0.795) and estimated marginal mean (p = 0.716) pulse wave velocity between SHS and non - SHS after controlling for age and BMI. Conclusion: An increase in augmentation index amongst non SHS in this study most probably due to exposure to environmental tobacco at work compared to exposure to spouse’s smoke Bangladesh Journal of Medical Science Vol.18(2) 2019 p.340-346

The comparative approach regarding the ethics of surrogacy from the Western secular and Islamic bioethical view reveals both commensurable and incommensurable relationship. It is not either straight forward ‘commensurable’ or straight forward ‘incommensurable.’ Islamic bioethics is straight-forward in prohibiting reproductive cloning on its own features and also guess social chaos and anarchy. Western secular bioethics has both arguments and counter arguments both for and against this scientific innovation. Both are eager to highlight the welfare of the society as a whole but the approaches are not always the same. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12595 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct’12