Search

Background: Cirrhosis is a common problem and is a leading cause of chronic liver disease. Early diagnosis with assessment of severity of diseases may help prevent the associated complications and patients’ sufferings. Now a days Hepatic venous Doppler can be a tool for diagnosis of cirrhosis and to assess correlation between waveform changes and severity of diseases. Objective: The purposes of this study was to determine the significance of hepatic vein waveform changes on doppler ultrasound in cirrhotic patients and to correlate with liver dysfunction. Materials and methods: This study was carried out in the department of Radiology and Imaging of Enam Medical College and Hospital during January 2017 to May 2018. Doppler waveforms were obtained from right hepatic vein in all the cases and classified as triphasic, biphasic and monophasic. Waveform comparisons were made among patients with differing grades of cirrhosis. Child- Pugh class was used to assess severity of cirrhosis. Doppler sonography was done in 80 patients suspecting of having liver cirrhosis. Data on clinical findings, B mode sonographic findings and hepatic vein doppler ultrasound findings were collected and documented in structured forms. Analysis was done using SPSS - 20. Results: Total of 80 patients who met the inclusion criteria are included in the study with mean age of 45.37±7.64 (range 25-75) years. Among these 57 (71%) were males while 23(29%) were females. On the basis of hepatic function 25 (31%) patients presented in Child-Pugh Class A, 31(39%) with Class B and 24(30%) patients had Class C. Hepatic venous waveform was triphasic in 22 (27.5%), biphasic in 28(35%), and monophasic in 30 (37.5%) cases. Our study revealed 88% (21) of Child- Pugh Class C, 23% (7) of Class B and 8% (2) of class A patients had monophasic HV waveform. The hepatic venous waveform progressively changed from triphasic to biphasic to monophasic with advancing grade of cirrhosis. The relationship of these waveforms change had significant relation with hepatic dysfunction (p < 0.022). Conclusion: Hepatic vein wave form changes reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of severity of liver cirrhosis. Thus, alteration in hepatic venous blood flow pattern on doppler ultrasound can be a useful noninvasive tool for evaluating diseases severity in patients with cirrhosis. J MEDICINE 2021; 22: 100-106

Denture stomatitis, mainly caused by Candida albicans, often affect denture wearers. To manage these patients, denture hygiene is of utmost importance. There is a need for low cost, easily accessible denture disinfectants. To investigate the efficacy of rice vinegar and other disinfecting solutions in removing C. albicans from acrylic resins. Hundred and eighty acrylic resin plates were contaminated with C. albicans strains and divided into five groups. These were immersed in apple cider vinegar (ACV), white wine vinegar (WWV), rice vinegar (RV), chlorhexidine (CHX), and sterile distilled H2O (control). The plates were incubated at room temperature for 30 minutes, 1 hour and 8 hours. Candida removing ability of the disinfecting solutions was evaluated, and data was analyzed using two-way ANOVAwith Tukey post-test. Significance level of p< 0.05 was used. RV, ACV, WWV and CHX showed the highest efficacy (100%) in removing both C. albicans strains at 8 hours (p>0.05). CHX was the most effective disinfectant in removing both C. albicans strains at 30 minutes, 1 hour, and 8 hours (99%-100%). RV was as effective as ACV, WWV and CHX in removing C. albicans from acrylic plates at 8 hours.

Methicillin resistant Staphylococcus aureus (MRSA) is major cause of nosocomial and community infections. Its prevalence varies with country and with hospitals within a country. Therefore, it is important for continuous surveillance in hospitals and other healthcare facilities in order to limit the spread of infections caused by MRSA. To determine the antibiogram of Staphylococcus aureus in a tertiary care hospital and to determine the change in trends in the antimicrobial susceptibility pattern of Staphylococcus aureus. To determine the prevalence of MRSA in a tertiary care hospital. This cross- sectional study was conducted at the Department of Microbiology, SMSR, Sharda University and Hospital. A total of 100 strains identified by morphological and biochemical characteristics were tested for antibiotic susceptibility using Kirby-Bauer disc diffusion method and the Prevalence of Inducible Clindamycin Resistance among the isolates. 100 out of 13,639 isolates clinical comprising samples were obtained Pus (78.6%), Blood (7%), Swab (4.1%), Sputum (4.1%), Urine (4.1%), Semen (2%). Maximum MRSA were obtained from pus samples (81%). However, out of total 7 isolates of Staphylococcus aureus obtained from blood 4 were MRSA and 3 were MSSA. The prevalence of MRSA that is (40%) infections was a high in our setup and is comparable to studies done earlier. This trend is particularly alarming for Staphylococcus aureus because of the severity and diversity of disease caused by this uniquely versatile pathogen.

Background: Coronavirus disease-2019 (COVID-19) is a recently emerged viral disease, for which there’s currently no definitive treatment. It is, therefore, necessary to determine biomarkers to know the extent of disease severity so that timely action can be taken to reduce mortality. We aimed to determine the usefulness of C-reactive protein (CRP) levels in assessing COVID-19 disease severity and correlate them with mortality due to the same. Methods: Data for COVID-19 were retrospectively collected and analyzed from May 2020 to October 2020. The CRP value was correlated with disease severity using Karl Pearson’s correlation coefficient. A logistic regression model was adopted to analyze the association between mortality and related factors. Results: Out of 642 patients enrolled, 22 died while 620 recovered. Most of the non-survivors were male. Multivariate analysis showed that age, diabetes, hypertension, and CRP values were significantly associated with mortality. CRP showed a strong positive correlation with disease severity and, hence, mortality. Conclusion: In patients with COVID-19, CRP correlated with disease severity and tended to be a good predictor of adverse outcome.

Objective assessment of grit and its association with burnout in obstetrics and gynaecology (OG) training is underexplored.This study utilises the Short Grit Scale and the Oldenburg Burnout Inventory to investigate the association of grit with burnout, thriving and career progression among OG trainees and Fellows in Australia/New Zealand.A cross-sectional survey of the RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) members was conducted. Participants were categorised by seniority level (core trainees, advanced trainees and Fellows). Mean grit and burnout scores were compared with one-way analyses of variance. Correlation between grit and burnout was estimated using Pearson's correlation coefficient. Logistic regression models were used to determine factors associated with high vs low burnout. Grit was categorised as low/medium/high for regression models.A total of 751 (26%) participants completed the survey. Fellows reported higher mean grit than core (P = 0.02) and advanced trainees (P = 0.03), and lower mean burnout than core trainees (P 0.001). Moderate negative correlation was demonstrated between grit and burnout scores (r = -0.34). In the multivariable model, only seniority (adjusted adds ratio (OR): 0.40 for Fellows vs core trainees, P = 0.008) and grit levels (adjusted OR:4.52 for low versus high, P 0.001; 2.32 for low vs medium, P = 0.001) were significantly associated with burnout.This study demonstrates the protective role of grit in combating burnout among RANZCOG trainees and Fellows. While further well-designed studies are warranted, findings from our study are expected to help the College in developing targeted interventions and subsequently minimise burnout-related adverse outcomes in high-risk groups.

The aim of the study was to determine the compliance of the existing medical care system in Ukraine for pregnant and married couples planning a pregnancy (its organizational and financial capabilities), the need to reduce the high level of reproductive losses. Materials and methods. Methods of statistical and system analysis are used. The national programs of reproductive health, demographic data, data on morbidity (received from the national medical statistics for the period 2017–2018), reports of the national survey “Health Index of Ukraine” (2018), data on appeals for obstetric-gynecological, genetic care (in connection of reproductive losses, fertility) are analyzed. A comparison between the indicators of Ukraine and the Kharkiv region, as well as with other countries, according to the cost of the survey, requests for medical care for the examination of genetic and infectious diseases associated with reproductive losses, was made. The organization of outpatient care for pregnant and married couples who are planning a pregnancy has been analyzed in terms of availability and sources of payment for services. Results. The number of Ukrainian women planning their first pregnancy aged 35 and over is increasing. Naturally, the number of genetic pathologies increases. Indicators of infectious pathology remain high. At the same time, women visit less gynecologists and family doctors, which is due to the high cost of the part of medical care that patients have to pay for themselves. Insufficiently developed genetic screening programs for genetic diseases. The professional contacts of physician of various specialties need to be improved. These facts negatively affect the level of reproductive losses, complicate their prevention. Conclusions. To reduce reproductive losses, it is necessary to create a national disease monitoring center, increase the availability of obstetric-gynecological and genetic care for the population, increase coverage of genetic screening programs, and give birth to children at the optimal age of 20–34.

Acute upper gastrointestinal (UGI) bleed is an emergency requiring immediate intervention. Recent data have shown peptic ulcer disease (PUD) to be the commonest cause of UGI bleed. We aimed to evaluate all patients with UGI bleed reporting in the emergency department. A cross-sectional, observational study from a tertiary care center; evaluated all patients with UGI bleed presenting to the outpatient and emergency departments between December 2017 and December 2018. A total of 356 patients with UGI bleed were enlisted for diagnostic and therapeutic endoscopy. Variceal bleed was present in 231 (65%) [cir-rhosis 217 (61%) vs noncirrhotic 14 (4%)] patients, nonvariceal bleed was present in 93 (26%) [cirrhosis 22(6%) vs noncirrhotic 71(20%)] patients, and no cause was determined in 32 (9%) patients. Among cirrhotic patients, alcoholic liver disease (n = 172) was the most common, followed by cryptogenic cirrhosis (n = 32), and cirrhosis related to Hepatitis B (n =7) and hepatitis C virus (n =22), and AIH (n = 6). Among variceal noncirrhotic causes, noncirrhotic portal hypertension was present in 14 patients. In the noncirrhotic, nonvariceal group, causes of UGI bleed included esophagitis (n = 26), erosive gastritis (n = 9), and Mallory Weiss Tear (n = 7), followed by PUD (n = 23), carcinoma stomach (n = 3), carcinoma esophagus (n = 2), and duodenal polyp (n= 1). Nonvariceal cirrhotic patients had portal hypertensive gastropathy (n = 8), PUD (n = 5), duodenal erosions (n = 1), esophagitis (n= 7), and antral varix (n = 1). Interestingly, even in the nonvariceal group, alcohol was the underlying cause of UGI bleed in majority of the patients with esophagitis and erosive gastritis. Alcohol was the commonest cause of UGI bleed in majority of the cases with or without chronic liver disease, followed by PUD in small numbers in the emergency department.

Non-fermenting Gram-negative bacilli (NFGNB) are emerging as important cause of blood stream infections. We aimed to determine the prevalence and antibiotic susceptibility pattern of NFGNB isolated from blood of patients with sepsis. We found, in 176 patients, the most common to be Pseudomonas aeruginosa (74) and Acinetobacter baumanii complex (39) followed by Stenotrophomonas maltophilia (16), Sphingomonas paucimobilis (6), Burkholderia cepacia (5) and Ochrobactrum anthropic (1). Generally, organisms showed a good sensitivity towards colistin, carbapenems and fluoroquinolones, whereas cephalosporins were ineffective.

Background Existing data on safety of non-obstetric surgery during pregnancy appear limited and conflicting. This study aimed to assess perinatal outcomes and complications in pregnant women undergoing non-obstetric surgeries. Methods A single-site Australian study was performed utilizing a 10-year data (2009-2018) collected retrospectively. Descriptive statistics were used to summarize the characteristics of the study population. Statistical analyses between groups were conducted by independent t-test or Mann-Whitney (for means between groups) and by chi-squared/Fisher's exact test (for categorical variables). Results A total of 108 pregnant women underwent non-obstetric surgery, with an increasing trend in annual numbers since 2014. The majority of women (91%) underwent surgeries as an emergency procedure, and under general anaesthesia (69.8%). Procedures during the first trimester comprised 45%, making it the most common trimester for non-obstetric surgeries. The most common cause for surgery arose in the gastrointestinal/digestive tract (39%). Overall perinatal complication rate was 19% with the rate of miscarriage/foetal loss, preterm birth and intrauterine growth restriction/small for gestational age being 4.7%, 10.4% and 3.8%, respectively. A total of 46 patients underwent intra-abdominal surgery. The most common surgery in the laparoscopy group was appendicectomy (56%), whereas adnexal pathology (54%) contributed to the majority of laparotomies. Subgroup comparison showed no significant difference in perinatal outcomes except for caesarean delivery rate (24% versus 67% for laparoscopy versus open, respectively (P = 0.04)). Conclusion With an overall perinatal complication rate of 19%, the rate of adverse perinatal outcomes following non-obstetric surgery during pregnancy in our study was low and comparable to those of the general population.

Background: COVID-19 has now become a pandemic. Objective: The aim of this study was to characterize the demographic features with infection rate of SARS-CoV-2 in 4/5 divisions of Bangladesh. Methodology: This cross-sectional study was conducted at National institute of Laboratory Medicine and Referral Center, Dhaka, Bangladesh from 15th April to 30th April, 2020. It was performed RT-PCR for 2462 cases within the time frame and 1082 samples were positive for SARS CoV-2. Patient demographic characteristics including age, gender, occupation and blood group was investigated. Results: The mean age of positive cases was 40.2 ± 15.33 years, 426 (39%) cases were 25-39 years of age. The majority of cases were male (71%) and the predominant blood group was B positive (37%). Conclusions: In conclusion male gender, younger age and blood group B positive are more commonly suffering from COVID-19 infection. Bangladesh Journal of Infectious Diseases, October 2020;7(suppl_2):S22-S26

During the staphylococcal infection, changes in the interaction of glandular cells, dystrophic and disorganizing pathologies in tissues, especially acute structural and hemodynamic changes in the stroma of the glands in the pituitary-adrenal-thyroid system, develop from the first day of the experiment. At the end of the experiment, on the background of a decrease in exudative processes, fibroplastic reactions are significantly activated, resulting in signs of incomplete regeneration – mainly sclerotic processes and cystic-atrophic changes in the parenchyma. Structural changes in tissues in the early stages of staphylococcal infection and the dynamics of development are characterized by specific symptoms in each of the glands. Since the pituitary gland is exposed to endogenous and exogenous factors earlier and more often than the adrenal glands, and the adrenal glands are earlier than the thyroid gland, dystrophic and destructive changes in the pituitary and adrenal glands are more pronounced at the early stage of the experiment. These morphological changes can change the hormonal status of the body and lead to dysfunction of the endocrine system as a whole – a decrease in the functional activity of the glands to some extent, and even inhibition of adenohypophyseal cells. Key words: staphylococcal infection, peritonitis, pituitary, adrenal and thyroid glands

Background Guidelines are critical for facilitating cost-effective COPD care. Development and implementation in low-and middle-income countries (LMICs) is challenging. To guide future strategy, an overview of current global COPD guidelines is required. Research Question We systematically reviewed national COPD guidelines, focusing on worldwide availability and identification of potential development, content, context, and quality gaps that may hamper effective implementation. Study Design and Methods Scoping review of national COPD management guidelines. We assessed: (1) global guideline coverage; (2) guideline information (authors, target audience, dissemination plans); (3) content (prevention, diagnosis, treatments); (4) ethical, legal, and socio-economic aspects; and (5) compliance with the eight Institute of Medicine (IOM) guideline standards. LMICs guidelines were compared with those from high-income countries (HICs). Results Of the 61 national COPD guidelines identified, 30 were from LMICs. Guidelines did not cover 1.93 billion (30.2%) people living in LMICs, whereas only 0.02 billion (1.9%) in HICs were without national guidelines. Compared with HICs, LMIC guidelines targeted fewer health-care professional groups and less often addressed case finding and co-morbidities. More than 90% of all guidelines included smoking cessation advice. Air pollution reduction strategies were less frequently mentioned in both LMICs (47%) and HICs (42%). LMIC guidelines fulfilled on average 3.37 (42%) of IOM standards, compared with 5.29 (66%) in HICs (P < .05). LMICs scored significantly lower compared with HICs regarding conflicts of interest management, updates, articulation of recommendations, and funding transparency (all, P < .05). Interpretation Several development, content, context, and quality gaps exist in COPD guidelines from LMICs that may hamper effective implementation. Overall, COPD guidelines in LMICs should be more widely available and should be transparently developed and updated. Guidelines may be further enhanced by better inclusion of local risk factors, case findings, and co-morbidity management, preferably tailored to available financial and staff resources.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. Chronic liver disease due to viral hepatitis, alcohol, non-alcoholic fatty liver disease, etc are risk factors for HCC development. Triphasic contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) abdomen are modalities for HCC diagnosis best for lesions >2 cm size. For lesions

Introduction: Bloodstream Infections (BSIs) are one of the major cause of morbidity and mortality worldwide. To decrease the mortality from septicaemia early diagnosis and appropriate treatment of BSIs is most important. Early diagnosis of a BSI will markedly improve patient management. Aim: To identify various pathogenic organisms causing BSIs and determine their susceptibility to various antibiotics. Materials and Methods: A total of 1367 blood samples were received in the bacteriology laboratory for culture out of which 274 samples showed culture positivity. Among the positive cases 32 cases of Multidrug Resistance (MDR) were found. MDR cases show resistance to ≥3 classes of antibiotics. Enterobacteriaceaefamily showed highest MDR cases. Blood cultures were repeated for confirmation of results. Simple descriptive analysis of data was done and results presented in frequencies and percentages. Results: Out of 274 positive samples obtained, Coagulase Negative Staphylococci (CoNS) constituted maximum proportion of isolates (66%) followed by Pseudomonas species(12%),Escherachia coli(6.2%),Klebsiella species(3.2%),Citrobacter spp.(2.9%),Staphylococcus aureus(2.9%) andEnterococcus(2.9%). Conclusion: The present study highlighted the bacteriological aetiology of BSIs along with their antibiogram that may provide necessary information for the formulation of antibiotic policy in effective management of such cases.

Objective The aim of the study is to determine the effects of scribes on efficiency in an academic ophthalmology practice. Design This is a quality improvement study conducted by two ophthalmologists at an academic ophthalmology practice at UT Health San Antonio from January 2018 to April 2018. Implementation of scribes in practice was the primary intervention. Session time, patient encounter time, and template time adherence were recorded pre- and post-intervention. A second retrospective arm of the study at the same institution was performed to evaluate long-term effects of scribes on efficiency in ophthalmology practice on session times and patient volume 12 to 18 months after intervention. Main Outcome Measures Primary study outcomes and measures were the effect of scribes in academic ophthalmology practice on physician efficiency in terms of clinic session time, individual encounter time, and amount of patients seen per session, in addition to time adherence based on type of patient encounter. Results Eighty-three patients and 17 half-day clinic sessions and 169 patients and 21 half-day clinic sessions were included in the preintervention and post-intervention datasets, respectively. Number of patients per session was approximately 15 and was kept similar pre- and post-intervention (p = 0.45). Mean preintervention session time was 265.0 ± 31.4 minutes, in contrast to 223.4 ± 19.9 minutes after intervention (p Conclusion Utilizing scribes in an ophthalmology practice can increase efficiency, allowing more patients to be seen or allowing time for other activities such as teaching or research.

Studied clinical and hemodynamic efficacy of complex use heparin,Сyто-Mас, propranolol (obzidan), fosinopril (monopril) with and PCI; PCI conducted separately on hemodynamics on cardiohemodynamics on ekoendotoksikoz (AMP) and the clinical course of patients working in environmentally stressful conditions in the acute phase and follow-up of MI. Comparison of the results of complex mediakamentoz and mechanical revascularization with PCI conducted separately. Investigated 50 patients with STMI in the age of 30 to 70 years (56,7 ± 1,20 years). Of the 50 patients 25 were treated Cyto-Mac, foznopril, propranolol with heparin and PCI (group 1); 25 patients were treated with PCI alone (group 2). In both groups, blood was determined by the degree ekoendotoksikoza (AMP) by EchoCG and Doppler EchoCG studied ESV, EDV, EF, SI, CI , an local contractility violation index of left ventricle (LCVI) , with the aid of restenosis koronorografii. A well established dynamics of systolic and diastolic blood pressure, clinical features of MI during follow-up. Patients treatedheparin,Cуто-мас, propranolol, foznopril and PCIindicators of central hemodynamics stabilizis. The reduced ЕSV,EDV, LCVI and decreased degree ofekoendotoksikoza (АMP), improves left ventricular systolic function of demand , increases PV. However, in this group, one patient on the third day was recorded AHF and one recurrent MI. İn The group spent only 2 PCI in relapse developed MI, 1 - restenosis, 2 -AHF and 1 patients died. The results show that the combined application of drug therapy with PCI provides a positive result in comparsionwiththan separately conducted PCI in ACS with elevation ST.

BackgroundThe WHO reports excessive rates of ill-defined neurological diagnoses and ineffective and potentially harmful drug treatments in children in the Commonwealth of Independent States (CIS). Collectively termed perinatal encephalopathy and the syndrome of intracranial hypertension (PE-SIH), these diagnoses are important contributors to perceived childhood morbidity and disability in the CIS. A systematic compilation of information on PE-SIH is lacking.MethodsWe systematically reviewed publications between 1970 and 2020 on PE-SIH in Azerbaijani, English, Russian and Ukrainian languages and summarised information on PE-SIH.ResultsWe identified 30 publications (70% in Russian) published 1976–2017. The diagnosis of PE-SIH was either based on unreported criteria (67% of reports), non-specific clinical features of typically developing children or those with common developmental disorders (20% of reports) or cranial ultrasound (13% of reports). The reported proportion of children with PE-SIH in the study samples ranged from 31% to 99%. There were few published studies on reassessments of children diagnosed with PE-SIH, and these did not confirm neurological disease in the majority of children. Treatments included multiple unlicenced drugs without established effectiveness and with potential unwanted effects.ConclusionThis review suggests that PE-SIH is a medical diagnostic label that is used in numerous children without substantive associated disease. The diagnosis and treatment of PE-SIH is a multidimensional, iatrogenic, clinical and public health problem in the CIS. With increasing use of evidence-based medicine guidelines in the region, it is hoped that PE-SIH will gradually disappear, but actions to accelerate this change are nevertheless needed.

About millions of households depend on fishing for livelihood though it is associated with different types of hazards. Working time does not allow fishermen to get health care for hazards from facilities. Data on occupational hazards and health care seeking is inconclusive in Bangladesh. This study was undertaken to assess the occupational hazards, associated factors and health seeking of fisherman. A cross sectional study involving 300 fishermen conducted from some selected communities of Patuakhali and Vhola districts from January to June, 2018. A pretested questionnaire used to collect information on socio-demography, occupational detail, types of hazards and health seeking behavior of fishermen. The results revealed that 69 faced different occupational problems during last 6 months. Participants suffered mainly from skin disease (31.7%), musculoskeletal pain (29.7%) and fever (24.3%). Age and duration of profession identified were associated (P=

Background Community engagement (CE) interventions include a range of approaches to involve communities in the improvement of their health and wellbeing. Working with communities defined by location or some other shared interest, these interventions may be important in assisting equity and reach of communicable disease control (CDC) in low and lower-middle income countries (LLMIC). We conducted an umbrella review to identify approaches to CE in communicable disease control, effectiveness of these approaches, mechanisms and factors influencing success. Methods We included systematic reviews that: i) focussed on CE interventions; ii) involved adult community members; iii) included outcomes relevant to communicable diseases in LLMIC; iv) were written in English. Quantitative results were extracted and synthesised narratively. A qualitative synthesis process enabled identification of mechanisms of effect and influencing factors. We followed guidance from the Joanna Briggs Institute, assessed quality with the DARE tool and reported according to standard systematic review methodology. Results Thirteen systematic reviews of medium-to-high quality were identified between June and July 2017. Reviews covered the following outcomes: HIV and STIs (6); malaria (2); TB (1); child and maternal health (3) and mixed (1). Approaches included: CE through peer education and community health workers, community empowerment interventions and more general community participation or mobilisation. Techniques included sensitisation with the community and involvement in the identification of resources, intervention development and delivery. Evidence of effectiveness of CE on health outcomes was mixed and quality of primary studies variable. We found: i) significantly reduced neonatal mortality following women’s participatory learning and action groups; ii) significant reductions in HIV and other STIs with empowerment and mobilisation interventions with marginalised groups; iii) significant reductions in malaria incidence or prevalence in a small number of primary studies; iv) significant reductions in infant diarrhoea following community health worker interventions. Mechanisms of impact commonly occurred through social and behavioural processes, particularly: changing social norms, increasing social cohesion and social capacity. Factors influencing effectiveness of CE interventions included extent of population coverage, shared leadership and community control over outcomes. Conclusion Community engagement interventions may be effective in supporting CDC in LLMIC. Careful design of CE interventions appropriate to context, disease and community is vital.

IntroductionExposure to secondhand smoke (SHS) is a health risk to non-smokers. Indoor particulate matter (PM2.5) is associated with SHS exposure and is used as a proxy measure. However, PM2.5 is non-specific and influenced by a number of environmental factors, which are subject to geographical variation. The nature of association between SHS exposure and indoor PM2.5—studied primarily in high-income countries (HICs) context—may not be globally applicable. We set out to explore this association in a low/middle-income country setting, Dhaka, Bangladesh.MethodsA cross-sectional study was conducted among households with at least one resident smoker. We inquired whether smoking was permitted inside the home (smoking-permitted homes, SPH) or not (smoke-free homes, SFH), and measured indoor PM2.5 concentrations using a low-cost instrument (Dylos DC1700) for at least 22 hours. We describe and compare SPH and SFH and use multiple linear regression to evaluate which variables are associated with PM2.5 level among all households.ResultsWe surveyed 1746 households between April and August 2018; 967 (55%) were SPH and 779 (45%) were SFH. The difference between PM2.5 values for SFH (median 27 µg/m3, IQR 25) and SPH (median 32 µg/m3, IQR 31) was 5 µg/m3 (p2.5.ConclusionsWe found a small but significant difference between PM2.5 concentrations in SPH compared with SFH in Dhaka, Bangladesh—a value much lower than observed in HICs.

Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6–23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post‐natal combinations of lipid‐based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet‐based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age‐appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24‐h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2–0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99–1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11–0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01–27) at 12 months of age. The intervention effect was non‐significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11–1.57) in 6–23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06–0.49) and 0.16 (0.05–27), respectively, but not with food‐secure and severely food‐insecure households. Although the study did not evaluate the impact of digital job aid alone, the findings indicate the utility of nutrition counselling by CHWs using a digital job aid to improve child feeding practices in broader programmes.

Background: Use of Duplex Color Doppler Sonography is gaining increasing popularity for assessment of blood vessels in various disease processes around the world. The past 20 years have seen an enormous growth in both technical aspects of Doppler ultrasound and its application in obstetric and fetal medicine. Objective: This cross-sectional study was carried out to observe Doppler wave form in subjects with preeclampsia. Specific objective was to see RI and PI in different groups of study subjects from 24th to 37th weeks and find out significant difference of different Doppler indices between two groups (i.e., to calculate the proportion of subjects having early diastolic notch in two groups). Materials and Methods: Enrolling 40 subjects with preeclampsia, this study was done in the Department of Radiology & Imaging, Dhaka Medical College Hospital, Dhaka, over a period of six months from 20th June 2014 to 19th December 2014. A total number of 40 normal pregnancies were also included for comparison. Results: Majority (35% in normal and 37.5% in preeclampsia) of the respondents were found in the age group of 21−30 years. Unpaired t-test revealed no significant difference between mean age of two groups. Among normal group, mean±SD of PI and RI were 1.12±0.0846 and 0.571±0.058 respectively and in preeclamptic group mean PI and RI were 2.497±0.369 and 0.8255±0.087. There was statistically significant (by unpaired t-test) difference in mean Doppler indices between these two groups. Early diastolic notch was found in 90% subjects with preeclampsia and 5% subjects with normal pregnancy. Chi-square test showed that there was statistically significant difference regarding presence of early diastolic notch between normal regarding subjects and subjects with preeclampsia. Conclusion: From the study result it was concluded that Doppler indices with presence of early diastolic notch are reliable indicators for early detection of preeclampsia. J Enam Med Col 2020; 10(1): 33-38

Background Genotype 3 increases fibrosis in chronic hepatitis C (CHC). Aim To evaluate the effect of the hepatitis C virus (HCV) genotype on prevalence and severity of liver disease in CHC. Materials and methods Nine hundred and forty-nine individuals with positive anti-HCV from June 2016 to May 2017 were enrolled in the study. We compared biochemical and hematological parameters, HCV RNA load, transient elastography, and ultrasound, in genotype 3 and nongenotype 3 patients. Cirrhosis was diagnosed in patients with liver stiffness measurement (LSM) ≥13 kPa. Results Out of 835 CHC patients, overall, genotype 3 had higher LSM (11.3 vs 7.62, p = 0.01), higher aspartate aminotransferase (AST) (88.4 vs 68.6, p = 0.02), and low platelets (228.4 vs 261, p = 0.03) with higher prevalence of cirrhosis (115/415 vs 25/245, p = 0.01) than nongenotype 3. However, decompensation rates were not significantly different between two groups (32/115 vs 7/25, p = 0.98). The subgroup analysis revealed that cirrhotic genotype 3 had advanced age (50 vs 35, p < 0.01), male predominance, and higher AST (74.4 vs 57, p = 0.01) as compared to noncirrhotic genotype 3 patients. On multivariate analysis, age and AST values were higher in cirrhotic than noncirrhotic genotype 3 patients. Conclusion Genotype 3 patients have higher prevalence of cirrhosis and fibrosis compared to nongenotype 3 patients; however, decompensation was not different between two groups. How to cite this article Gupta T, Aggarwal HK, Goyal S, et al. Prediction of Cirrhosis in Patients with Chronic Hepatitis C by Genotype 3. Euroasian J Hepato-Gastroenterol 2020;10(1):7–10.

Background: Tuberculosis is a highly infectious disease and has the highest burden with it. Diagnosis of tuberculosis in many countries is still dependent on microscopy. For developing countries with a large number of cases and financial constraints, evaluation of rapid and inexpensive diagnostic methods has great importance. Culture of Mycobacterium tuberculosis complex (MtbC) is the accepted reference standard for confirmation of TB infection and is necessary for drug susceptibility testing (DST). There are several methods for culturing MtbC using solid and liquid media. Although solid media has been used for over 100 years, liquid culture media is increasingly being introduced in low and middle income countries (LMIC). Objective: The purpose of the present study was to compare the efficacy of solid culture and liquid culture in the diagnosis of pulmonary tuberculosis. Methodology: This cross sectional study was done in the Department of Microbiology at Sir Salimullah Medical College, Dhaka and National Institute of Chest Disease & Hospital (NIDCH), Dhaka during the period of January 2016 to December 2016 for a period of 1(one) year. Sputum samples from suspected MDR-TB patients were collected by purposive sampling technique from OPD of Sir Salimullah Medical College (SSMC) and NIDCH. Microscopy, liquid culture in liquid MGIT 960 media were done for MTB diagnosis. Result: This study shows the comparison of results of microscopic examination of solid culture and liquid culture (MGIT 960). The liquid MGIT 960 method detected more positive samples than solid culture 68% vs 67%. The mean turnaround time of detection (TTD) of MTB was 34.3±5.2 days for Lowenstein-Jensen media and 17.5±3.8 days for MGIT 960 (p value