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Background: Crush-syndrome usually resulting from earthquake and other natural disaster causes mortality and morbidity. A multistoried garment factory collapsed in Savar, Dhaka, Bangladesh on 24th April 2013 with about 4000 workers. Among the rescued victims, many of them develop crush – syndrome and AKI that led to a man-made renal disaster in Bangladesh. We analyzed outcome of severe AKI patient who required renal replacement therapy. Methods: Victims from accident site were first treated in primarily local hospital and primary care center. Suspected crush syndrome patients were rapidly transferred to tertiary hospital for dialysis and ICU support. We collect data of severe AKI patient by a standard questionnairebased onrenal disaster relief force – crush syndrome patient questionnaire. Results: We had experienced many AKI and crush syndrome after collapsed garment factory with 3500 workers which created a manmade renal disaster. We observed 27 severe AKI due to crush syndrome of Rana plaza with mean age 25.12 years, most of them were female (51.85%). Victims rescued as early as possible, average rescue time was 20.30 hours, 62.96% developed compartment syndrome and required fasciotomy. All of them got dialysis treatment; some of them required ICU support. Among all, 67% recovered completely and 26% died. Main causes of death were infection and DIC with MOF. Conclusions: Crush injury victims who developed severe AKI, required dialysis. Severe AKI patients who required dialysis had high mortality and morbidity. Early intervention to prevent AKI and complications may reduce mortality and morbidity. Bangladesh J Medicine July 2021; 32(2) : 107-112

Background Drowning is the leading cause of childhood death in Bangladesh. In order to minimize the number of casualties Centre for Injury Prevention and Research, Bangladesh (CIPRB) incorporated a ‘first responder’ program which includes Cardio Pulmonary Resuscitation (CPR), in community based drowning prevention program, SwimSafe. Along with swimming lessons, swimming instructors provide first responder services in the community. The objective of this study was to describe the results of the volunteer based first responder services for the management of drowned casualties between 2012 and 2015 in the rural communities of Bangladesh. Methods Adolescents and youths who volunteered as community swimming instructors were trained as first responders to provide first aid and resuscitation in the community. Trainers from the International Drowning Research Centre Bangladesh (IDRC-B) of CIPRB delivered the training. The first responders were also trained on the documentation of the first responder services they provided in the community. The documented records were collected from the volunteers on a regular basis; when drowning cases were reported CIPRB management followed up with an in depth data collection, using a structured form. Results 2,305 community volunteers were trained between 2012 and 2015. Of them 1,461 reported providing first responder services among 6,773 casualties, including 184 drowning casualties. Of the drowning casualties, volunteers treated 31 casualties with Cardiopulmonary Resuscitation (CPR), 51 casualties by putting into the recovery position and 102 casualties were treated for the shock on site. Of those given CPR, 22 (71%) survived and 9 (29%) died. After receiving treatment from the first responder 104 (56.5%) of the drowning casualties were referred to health facilities for further treatment. Conclusions The training of community first responders seems to be an effective way of managing and reducing drowning causalities in countries like Bangladesh, where drowning is a significant public health hazard.

الملخص: أهداف البحث: على الرغم من الانتشار المتزايد للغرق، فإن سلوكيات البحث عن الرعاية الطبية بين ضحايا الغرق لا تزال غير مستكشفة في بنغلاديش. تهدف هذه الدراسة إلى استكشاف سلوكيات البحث عن الرعاية الطبية بين ضحايا الغرق في بنغلاديش. طرق البحث: أجريت هذه الدراسة المقطعية المستندة إلى السكان باستخدام طريقة أخذ العينات الجماعية متعددة المراحل. تم تجميع المعلومات باستخدام استبانة منظمة من ٢٩٩,٢١٦ من سكان القرى والمدن. النتائج: في هذا الاستطلاع، وجدنا ١٩١ من حالات الغرق; ٤٠.٨٤٪ (عدد=٧٨) كانت مميتة و٥٩.١٦٪ (عدد=١١٣) كانت غير مميتة. كان بين حالات الغرق هذه، ٧١.٢٪ (عدد=١٣٦) تم تحويلهم إلى مقدمي الرعاية الصحية، بينما تلقت ٦٢.٨٪ (عدد= ١٢٠) من هذه الحالات الرعاية الطبية من مختلف مقدمي الخدمات الصحية. أظهر المزيد من التحليل أن ٦٦.٦٪ (عدد= ١١٦) كانوا من الأطفال و٢٦.٦٪ (عدد=٤) من البالغين بحثوا عن الرعاية الصحية. سعى أكثر عدد ممكن ٧٨.٩٪ (عدد= ١٢٠ /١٥٢) من سكان القرى للحصول على الرعاية الصحية بالمقارنة ب ٦١.٥٪ (عدد = ٢٤ /٣٩) من سكان المدن. تلقى ٣١.٧٪ (عدد=٣٨) من بين ضحايا الغرق رعاية صحية من مقدمي الرعاية الصحية المؤهلين; بينما تلقى ٦٨.٣٪ (عدد= ٨٢) رعاية صحية من مقدمي الرعاية الصحية غير المؤهلين. تلقى تقريبا ٥٩ (٤٩٪) من الضحايا رعاية من الصيدلية و٣٤ (٢٨٪) من مستشفى معروف. كان معدل الدخول إلى المستشفى بسبب الغرق ١١.٧٪. تم إحضار ١٤ (١١.٧٪) من ضحايا الغرق إلى المستشفى بواسطة المركبات الآلية وغير الآلية. وسعى ما يقارب ٩٧ (٨٠.٨٪) من المرضى للرعاية الصحية وتمكنوا من البقاء على قيد الحياة. الاستنتاجات: سعى عدد كبير من ضحايا الغرق إلى الحصول على رعاية طبية من مقدمي الرعاية الصحية المؤهلين وغير المؤهلين. هناك حاجة لوضع قواعد إرشادية بشأن توفير الرعاية الطبية لضحايا الغرق في بنغلاديش. Abstract: Objective: Despite the high magnitude of drowning, medical care-seeking behaviours among drowning casualties remain unexplored in Bangladesh. This study aimed to explore this behaviour among drowning casualties in Bangladesh. Methods: A population-based cross-sectional study was conducted using a multi-stage cluster sampling method. Data were collected using a structured questionnaire from 299,216 rural and urban residents. Results: From the survey, we found 191 drowning cases: 40.84% (n = 78) were fatal and 59.16% (n = 113) were non-fatal. Among the drowning cases, 71.2% (n = 136) were referred to healthcare providers, while 62.8% (n = 120) received medical care from different health service providers. Further analysis showed that 66.6% (n = 116) of children and 26.6% (n = 4) of adults sought healthcare. As many as 78.9% (n = 120/152) of rural residents sought healthcare, as compared to 61.5% (n = 24/39) of urban residents. Among all drowning casualties, 31.7% (n = 38) received healthcare from a qualified healthcare provider, whereas 68.3% (n = 82) received it from non-qual]ified healthcare providers. About 59 (49%) casualties received care from a pharmacy and 34 (28%) from a recognised hospital. The hospital admission rate for drowning was 11.7%. About 14 (11.7%) drowning casualties were brought to hospitals in motorised or non-motorised vehicles. As many as 97 (80.8%) patients sought healthcare attention and managed to survive. Conclusion: A significant number of drowning casualties sought medical care from qualified and non-qualified healthcare providers. In Bangladesh, it is necessary to develop guidelines for providing medical care for drowning casualties.

PurposeSixteen million adolescents give birth each year, constituting 11% of all births worldwide. Adverse adolescent pregnancy outcomes are well-documented. Available data on adolescent pregnancies have mainly relied on self-reported age and retrospective survey data, which might not capture adolescent births accurately. This paper reports on trends in adolescent pregnancy and associated adverse birth outcomes in Matlab, Bangladesh, using data from the Matlab Heath and Demographic System (HDSS) which precisely documents maternal age.Design/methodology/approachThe study was conducted in the rural subdistrict of Matlab in Bangladesh. HDSS data were used to examine trends in adolescent motherhood (10–19 years) in the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b) service areas (ISA) and government service areas (GSA) between 2007 and 2015. A total of 4,996 adolescent mothers were included in the analysis. Chi-square testing and binary logistic regression were used to document adolescent pregnancy trends and the differences in and causes of perinatal death.FindingsThe fertility rate was 27 per 1000 adolescent mothers in ISA and 20 per 1000 adolescent mothers in GSA, during the 9 years of the study period. The adjusted odd of an adolescent mother having a perinatal death in ISA, relative to GSA was 0.69. Significant determinants of perinatal death among adolescent mothers included maternal education, paternal education, mother’s age at first birth, asset score and distance from the nearest health facility.Originality/valueThis paper documents the real trend of adolescent pregnancy by capturing the accurate age at pregnancy for the first time in Bangladesh.

Background: Carcinoma of the stomach is a major cause of cancer mortality worldwide. Due to social impact of gastric carcinoma (GC), there is a need to stratify patients into appropriate screening, surveillance and treatment programs. Although histopathology remains the most reliable and less expensive method, numerous efforts have been made to identify and validate novel biomarkers to accomplish the goals. In recent years, several molecules have been identified and tested for their clinical relevace in GC management. Among the biomarkers with the exception of HER2, none of the biomarkers is currently used in clinical practice, and some of them were described in single studies. Materials and Methods: This prospective type of observational study was performed in the Department of Surgery, Dhaka Medical College Hospital, Dhaka, 6 months from approval of protocol. Total 45 consecutive patients aged 18 years and above without consideration of gender were selected purposefully. Every patient was evaluated by clinical examination, appropriate investigations and after a confirm diagnosis of the tissue from the cancer. All patients have undergone operative intervention and Gastrectomy specimens were subtotal (including cardiac and pylorus), subtotal (including the pylorus), total radical gastrectomy and oesophago-gastrectomy sample. All specimens obtained were immersed in 10% formalin. Samples of whom were sent to the department of pathology, DMCH for histopathology examination. Portion of representative tissue/block was sent to AFIP (Armed Forces Institute of Pathology, Dhaka) for immunohistochemistry to find out the HER2 expression in gastric cancer and gastro-oesophageal cancer. Data was collected in a pre-designed questionnaire by face to face interview. Result and observation: In this study when 45 cases were categorized according to WHO grading system it was observed that majority (30) patients were found in grade II, among them 3(10%) were HER2 positive. But with grade III tumour the HER2 positivity were found more i,e; 37.5% (3/8). Grade- I tumor show HER2 neu expression 28.57% (2/7) and according to location most of the cases with HER2 positive expression was located in the gastro-esophageal junction which is 27.27% (3/11) than gastric carcinoma which is 14.70% (5/34). Conclusion: Most of the patients of gastric and gastrooesophageal junction adenocarcinoma are diagnosed at a very late stage, so they require special attention in treatment protocol, including chemotherapy and immunotherapy for increasing their survivability. The study showed with poorly differentiated (high grade) tumour, the HER2 positivity were found more. Journal of Surgical Sciences (2018) Vol. 22 (2) : 79-82

Guillain-Barre syndrome (GBS) following typhoid is extremely uncommon and only few case reports are available in literature. The importance of this case report is to highlight upon the fact that a diagnosis of GBS should always be kept in mind whenever a patient of typhoid fever develops weakness. We report a young girl with blood culture proven typhoid fever that developed this very rare neurological complication quite early in the course of the disease. Following treatment with intravenous antibiotics and intravenous immunoglobulin, she was improved. Bangladesh J Medicine July 2021; 32(2) : 142-144

Fever, skin rash, thrombocytopenia and bleeding are common manifestation of dengue fever (DF). Thrombocytopenia usually gets better and platelet count normalizes by day 10 of fever. Chronic thrombocytopenia is not a feature of dengue fever. Proposed mechanisms behind thrombocytopenia are many. Direct platelet destruction by dengue virus, immune-mediated platelet destruction and evenmegakaryocytic immune injury are proposed as underlying mechanisms. We are reporting a case of a 43 year old female who presented in dengue season in 2019 with fever and bleeding and wasdiagnosed as a case of dengue haemorrhagic fever. She had persistent thrombocytopenia which neededto be treated on the lines of immune thrombocytopenia and responded to steroids. Other causes of thrombocytopenia were ruled out. Bangladesh J Medicine January 2021; 32(1) : 62-64

Background Some water bodies of Barishal become the cause of drowning point, which is a major killer where death occurs up to 19,500 each year. Among them, 14,500 are children (0–17 years). Barishal has the highest rate of drowning mortality, which is nine deaths per day. Methods In spite of huge number of fatal drowning was public health threat, it often goes unregistered in government MIS system. Passive drowning surveillance system is to develop a data generation system within government setting to obtain number of fatal drowning in the intervention sites. Results Passive drowning surveillance system has slightly developed based on local government death registration system exist at the union level. The key findings of Union Council register book in Kolapara, Taltoli and Betagi areas, it has found only 17 drowning death case registered partially. The CIPRB staffs have collected 41 drowning death information’s from the local communities during 2017 to 2019. The Union council Secretary & Information officer does not usually record any death case on register book regularly. So unrecorded death notification has hampered on the track of actual drowning status in Barishal regions. Conclusion Due to lack of fulfil effectiveness, drowning death information was received partially from the death register book of the Union councils. However, the community level information showed discrepancy in both number of deaths information. Learning Outcomes The Government should have a mechanism about actual magnitude of the drowning death; there would be strengthen passive surveillance system to reduce drowning situation in Barishal areas.

BackgroundLiving and environmental conditions in rural Bangladesh expose children to drowning. The Anchal programme protects children through crèche-based supervision in an enclosed space run by locally recruited carers. It is unclear under what conditions the programme best operates to maximise protection. We conducted a process evaluation of Anchal to determine enabling factors and challenges to implementation.MethodsQuantitative programme data were analysed to calculate metrics including child participation and fidelity of implementation to defined processes. Qualitative data collection with programme participants and implementers provided insights into barriers and enablers of implementation. Analysis was guided by the UK Medical Research Council’s process evaluation framework.ResultsAnchal operated 400 centres with an average of 22.2 children enrolled, as per target. However, daily attendance averaged lower than the 80% target. Children aged 1–2 years old, who are most at risk of drowning, were least likely to enrol and attend regularly due to low engagement with activities and parental concerns for safety. Greater distances and lower educational attainment in some regions reduced attendance and increased carer attrition.ConclusionsThe Anchal programme met most programme delivery targets. However, programme success could be improved through increasing supervision, providing communication training for implementing staff, designing programmes for children aged 1–2 years old, encouraging community ownership and providing child pick-up services. These contextual solutions can be adapted to similar programmes operating through grassroots-level engagement and recruitment of community health workers, to maximise their effectiveness and sustainability.

Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 240-245

Background: Complete resolution occurs in many other types of infections with the use of antibiotics but not always with chronic pyogenic osteomyelitis.Objective: The aim of the present study was to evaluate the effectiveness of most conventional method of surgical treatment of chronic pyogenic osteomyelitis by sequestrectomy and saucerisation in Children.Methodology: This present study was a prospective study conducted at Bangabandhu Shekh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2015 to December 2016 for a period of two (2) years. Patients aged up to 16 years were included in the study. Purposive sampling was done. Only chronic osteomyelitis of haematogenous origin were included after proper selection of the patients. Sequestrectomy and saucerisation was done. Wound was kept open and allowed to heal from bottom and sides of the wound.Result: A total 36 patients aged up to 16 years were included in the study. Among the cases two third were male 26(72.23%) and rest were female 10(27.77%). The male female ratio was 2.6:1.Therefore the incident was significantly high in males (p

Intimate partner violence (IPV), an actual or threatened physical, sexual, or psychological abuse by a current or former partner or spouse, is a common global public health issue. Understanding both the prevalence of IPV during pregnancy and its potential impact on the health of pregnant women is important for the development and implementation of interventions to prevent maternal morbidity and mortality. The purpose of this study was to explore the association between maternal experiences of IPV during pregnancy and pregnancy complications. A health-facility-based cross-sectional study was conducted from July 2015 to April 2016 among 400 randomly selected women who were admitted to the postnatal wards of Rajshahi Medical College Hospital for delivery. Data were collected through face-to-face interviews using a structured questionnaire. Multivariable logistic regressions were performed to assess relationships between variables of interest after controlling for potential confounders. Results indicated that 39.0% of women reported physical IPV and 26.3% of women reported sexual IPV during pregnancy. Additionally, 69.5% of women experienced medical complications (MCs); of this group, 44.3% experienced obstetric complications (OCs) and 79.3% experienced any pregnancy complication (AC) during their last pregnancy. The experience of physical IPV during pregnancy was significantly associated with the experience of MCs (adjusted odds ratio (AOR): 2.05, 95% confidence interval (CI): 1.15-4.01), OCs (AOR: 4.23, 95% CI: 2.01-7.12) and AC (AOR: 5.26, 95% CI: 2.98-10.52). Women who experienced sexual IPV during pregnancy were also at increased risk of suffering from any MC, any OC, and AC. Maternal experience of IPV during pregnancy is positively associated with pregnancy complications. Preventing IPV directed at pregnant women might reduce maternal morbidity and mortality in Bangladesh.

AIM Inflammatory back pain (IBP) is the earliest symptom of axial and other forms of spondyloarthritis (SpA). However, there are no published data on prevalence of IBP among patients suffering from chronic low back pain (CLBP) in Bangladesh. In this study, we estimated the prevalence of IBP and the subtypes of SpA in a tertiary hospital in Bangladesh. METHODS This 1 year cross-sectional study was conducted among 240 CLBP patients in a rheumatology outpatient clinic. Assessment of Spondyloarthritis International Society classification criteria of IBP and predefined recognized classification criteria were followed to define different subtypes of SpA. Means and standard deviations were reported for continuous variables. Descriptive and bi-variate analyses were accordingly performed. RESULTS Of 240 CLBP patients, 60 (25%) had IBP and 180 (75%) had mechanical back pain (MBP). Among the 60 IBP patients, 52 (86.6%) had predominantly axial SpA (axSpA) and eight (13.4%) had predominantly peripheral spondyloarthritis. In the axSpA group, 49 (94.2%) had radiographic axSpA (rd-axSpA) also known as AS and three (5.8%) had non-radiographic axSpA (nr-axspA). AxSpA patients could be divided into eight (15.35%) with psoriasis, two (3.8%) with reactive arthritis and one patient (1.9%) had arthritis associated with inflammatory bowel disease. Fifty (83.3%) IBP and 73 (40.6%) MBP patients had age at onset of back pain < 40 years. Forty-two (70%) of the IBP and 100 (55.6%) of the MBP patients had normal body mass index. All these differences were statistically significant (P ≤ 0.0001). CONCLUSIONS Inflammatory back pain is common among patients presenting with CLBP. The commonest cause of IBP is AS, followed by PsA and nr-axSpA.

BACKGROUND Glioblastoma (GBM) is an aggressive primary brain tumor with median overall survival (OS) of less than one year in unselected adult patients. There is no standard therapy at recurrence. We aimed to evaluate OS in a consecutive series of GBM patients from Norway’s two largest regional health authorities, compare the effect of physicians’ choice of antineoplastic treatment upon recurrence and identify prognostic and predictive factors. MATERIAL AND METHODS Clinicopathological data from n=467 patients with histologically confirmed GBM diagnosed and treated at Haukeland and Oslo university hospitals from January 2015 to December 2017 was retrospectively collected. Data included tumor location, methylation status of the methylguanine-DNA methyltransferase (MGMT) promoter and mutation of the isocitrate dehydrogenase (IDH) genes, patient age and sex, extent of tumor resection at primary diagnosis, and treatment at first, second and third tumor recurrences. Cox-proportional hazards regression with pairwise analyses adjusted for multiple testing with Scheffé’s post-hoc test were used to adjust effect of multiple risk factors on mortality. RESULTS Median OS was 12.1 months and 21.4 % and 6.8 % of patients were alive at 2 and 5 years, respectively. Treatment at recurrence varied between institutions but did not impact OS (p=0.201). Median time to progression was 8.2 months. Age, MGMT promoter methylation, tumor location and extent of tumor resection were all independent prognostic factors for OS. Patients receiving radiotherapy to 60 Gray with concomitant and adjuvant temozolomide at primary diagnosis had best outcome with median OS of 16.1 months and 9.3% were alive at 5 years. At first recurrence patients eligible for gammaknife/stereotactic radiosurgery (GK/SRS) or surgery, alone or combined with chemotherapy, had superior survival compared to chemotherapy alone (p CONCLUSION Recurrence treatment differed between the two institutions but there was no difference in OS. Our findings underline the lack of standard therapy upon GBM recurrence and the urgent need for novel therapeutic strategies.

Introduction. Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy. Methods. This study was a hospital based descriptive cross sectional study done in BIRDEM general hospital between July, 2015 and June, 2016, for a period of twelve months. The initial clinical diagnosis of DPN was made and was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Results. A total of 354 cases were finally analyzed with 153 (43.2%) patients being symptomatic and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. Majority (38.4%) of patients belonged to the age group of 51-60 years. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). Study subjects with CTS had significantly higher BMI, higher fasting blood sugar and higher HbA1c in comparison to patients without CTS. The mean compound motor action potential was not significantly different between patients with and without CTS. Conclusion. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions should be made carefully after nerve conduction study and proper diagnosis.

In young adults 20%-47% cases of stroke is due to cardiac embolism. Cardiac Myxoma is an infrequent cause of embolic stroke in young. We are reporting a case of a ischemic stroke in a young adult of 34 years with a history of recreational drug use who was eventually diagnosed with Left Ventricular Apical Myxoma, Systemic Lupus Erythematous (SLE), Lupus Nephritis, Secondary Anti phospholipid Syndrome, Hyper homocysteinemia, and Dyslipidemia.Bangladesh Heart Journal 2017; 32(1) : 55-61

Background: Complications of diabetes mellitus (DM) represent the major cause of morbidity and mortality in the modern era, diabetic polyneuropathy (DPN) being one of the most frequents. Nerve conduction study is employed to detect neuropathy. This study is done to see the electrophysiological pattern of diabetic polyneuropathy in a tertiary care setting.Methods: Study was carried out in 100 diagnosed DM patients attending department of neurology, BIRDEM General Hospital from July, 2015 to June, 2016. Diabetic patients with good glycaemic control were grouped in group A and that with poor glycaemic control in group B. Clinical questionnaire and neurological examination were administered, and nerve conduction study (NCS) were performed using standard techniques.Results: Among the 100 patients studied, 54 (54%) patients were Male and 46 (46%) patients were Female. 39% patients who had normal HbA1C was designated as group A and 61% patients having high HbA1c was designated as group B. Mean age of patients in group A was 55.02±10.45 years and group B was 54.94±11.13 years. Mean duration of diabetes in group A was 10.49±4.43 years and group B was 12.44±5.14years. Alterations in NCS included lowered amplitudes and slowed conduction velocities. Most common axonal pattern was found in peroneal nerves and most common demyelinating pattern was found in sural nerves. Sensory conduction velocity in significantly reduced in all sensory nerves in group B in comparison to group A. Compound motor action potential (CMAP) is significantly reduced on peroneal nerve in group B.Conclusion: Risk of neuronal involvement is increased as Diabetes mellitus progresses further which can be accelerated by poor glycaemic control. NCS is used to as an important tool to diagnose the peripheral neuropathy. Early diagnosis of neuropathy can be done by routine NCS and complications of neuropathy can be prevented by controlling Diabetes mellitus more meticulously.Birdem Med J 2017; 7(2): 114-120

We previously reported that the EGFR-targeted inhibitor erlotinib induces G1 arrest of squamous cell carcinoma of the head and neck (SCCHN) cell lines without inducing significant apoptosis. Large-scale genomic studies suggest that >50% of SCCHN cases have activation of PI3K pathways. This study investigated whether cotargeting of EGFR and PI3K has synergistic antitumor effects and apoptosis induction. We examined growth suppression, apoptosis, and signaling pathway modulation resulting from single and combined targeting of EGFR and PI3K with erlotinib and BKM120, respectively, in a panel of SCCHN cell lines and a xenograft model of SCCHN. In a panel of 12 cell lines, single targeting of EGFR with erlotinib or PI3K with BKM120 suppressed cellular growth without inducing significant apoptosis. Cotargeting of EGFR and PI3K synergistically inhibited SCCHN cell line and xenograft tumor growth, but induced variable apoptosis; some lines were highly sensitive, others were resistant. Mechanistic studies revealed that the combination inhibited both axes of the mTORC1 (S6 and 4EBP1) pathway in apoptosis-sensitive cell lines along with translational inhibition of Bcl-2, Bcl-xL, and Mcl-1, but failed to inhibit p-4EBP1, Bcl-2, Bcl-xL, and Mcl-1 in an apoptosis-resistant cell line. siRNA-mediated knockdown of eIF4E inhibited Bcl-2 and Mcl-1 and sensitized this cell line to apoptosis. Our results strongly suggest that cotargeting of EGFR and PI3K is synergistic and induces apoptosis of SCCHN cell lines by inhibiting both axes of the AKT–mTOR pathway and translational regulation of antiapoptotic Bcl-2 proteins. These findings may guide the development of clinical trials using this combination of agents.

Background: Guillain-Barré syndrome (GBS) is the commonest cause of acute flaccid paralysis worldwide, with an incidence of 0.6-4 per 100.000 inhabitants per year. It affects all age groups and carries an incapacity burden of up to 20%. The aims of this study were to evaluate the demographic and clinical presentation, hospital care and outcome with different modalities of treatment in adult patients suffering from GBSadmittedina tertiary care hospital in Dhaka.Methods: This observational study was done in the Neurology department of a tertiary care hospital in Dhaka.The studystarted in July-2011 and the first fiftypatients suffering from GBSwereenrolledconsecutively. Subjects included in this study were>18years of age.All the patients were interviewed and clinically examined. Relevant data were documented in a structured questionnaire. Nerve conduction Study (NCS) and Cerebrospinal fluid (CSF) study results were also documented. All of patients were watched for respiratory insufficiency and those who developed respiratory paralysis were transferred to ICU for respiratory assistance. According to clinical and electrophysiological criteria, the patients were classified into different variants of GBS. Patients were treated with intravenous immunoglobulin (IVIg), plasmapheresis, supportive care and outcome was observed. The patient who recovered and were discharged were later followed up on out –patientbasis for one month Results: The commonest age group affected was 31-50 yrs with male preponderance .The mean age of study subjects was 46years. In most of the patient their weakness progressed for 3-5 days. Clinical evidence of a preceding infection was present inforty-six percent of the patientsbutcausative organism was not identified.Clinical presentations were quadriparesis in 84 % of patients, cranial nerve palsy in 48% of patients. Severe respiratory involvement requiring mechanical ventilation developed in 10% of patientsafter admission. CSF study was done and only10 subjects displayed typical findings of albumino cytological dissociation. NCS wasabnormal in all study subjects and revealed Acute Motor Sensory Axonal Neuropathy (AMSAN) in58%of study population. Among the fifty patients 23received plasmapheresis and another 9 receivedstandard IVIg therapy. Of these patients 20(88%) and 7 (77.6%) patients made significant recovery, respectively. Residual neurodeficit persisted in 6 of the remaining patients who received treatment in the form of only physiotherapy at the end of one month follow-up.Conclusion: Rapidly progressive quadriparesis with cranial nerve involvement was the commonest presentation. In this group of patients NCS proved to be a sensitive study for early diagnosis of patients with GBS in both diabetic and non-diabetic population. The axonal variety of GBS was more common than the demyelinating type. Although not statistically significant, the better response to plasmapheresis seemedencouraging. Again the patients who received IVIg or plasmapheresis early in the course of disease had faster recovery as compared to patients who received only supportive line of treatment.Birdem Med J 2017; 7(1): 38-42

// Zhixiang Zhao 1,2,* , Mohammad Aminur Rahman 1,* , Zhuo G. Chen 1 and Dong M. Shin 1 1 Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States of America 2 Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China * These authors have contributed equally to this study Correspondence to: Dong M. Shin, email: // Keywords : twist1, EMT, stemness, angiogenesis, chemo-resistance Received : June 29, 2016 Accepted : January 01, 2017 Published : January 12, 2017 Abstract Twist1 is a well-known regulator of transcription during embryonic organogenesis in many species. In humans, Twist1 malfunction was first linked to Saethre-Chotzen syndrome and later identified to play an essential role in tumor initiation, stemness, angiogenesis, invasion, metastasis, and chemo-resistance in a variety of carcinomas, sarcomas, and hematological malignances. In this review, we will first focus on systematically elaborating the diverse pathological functions of Twist1 in various cancers, then delineating the intricate underlying network of molecular mechanisms, based on which we will summarize current therapeutic strategies in cancer treatment that target and modulate Twist1-involved signaling pathways. Most importantly, we will put special emphasis on revealing the independence and interdependency of these multiple biological functions of Twist1, piecing together the whole delicate picture of Twist1’s diversified pathological roles in different cancers and providing new perspectives to guide future research.

Objective Our objective was to explore the socio-cultural factors that influence women's early and adequate utilisation of antenatal care (ANC) in rural Bangladesh. Methods A qualitative study was conducted in two rural settings of Bangladesh, including 32 in-depth interviews with pregnant or recently delivered women, husbands whose wives were pregnant or had a recent birth, mothers-in-law whose daughters-in-law were pregnant or had a recent birth; 2 focus group discussions with husbands; and 4 key-informant interviews with community health workers. We used thematic analysis to analyse the data. Findings ANC initiation in the first trimester was not a priority for most women. Women's lack of awareness about the appropriate timing of the first ANC contact, lack of decision-making autonomy and fear of caesarean section were the major barriers to the early and adequate ANC utilisation. There were many superstitions around pregnancy in rural settings which prevented women seeking early and adequate antenatal care and led them to seek care from traditional care providers instead of formal care providers. Conclusion ANC utilisation in rural Bangladesh was associated with several socio-cultural beliefs which are modifiable with interventions that have been used in similar settings. Targeting these socio-cultural barriers with context- and community-specific interventions is important to improve overall ANC utilisation at the community-level which can lead to significant improvements in perinatal outcomes.

Background: The occurrence of maternal anaemia is common in South Asian countries which increase the risk of adverse maternal obstetric and birth outcomes. This may adversely affect the achievement of the Sustainable Development Goals’ (SDG) targets of reducing maternal and under-five deaths by 2030. Objectives: To summarize the evidence on the association of maternal anaemia with adverse birth and maternal obstetric outcomes. Methods: We adopted the PRISMA consensus statement. PubMed, CINAHL and Web of Science databases were searched on February 20, 2020. A total of 38 studies was included, of which 25 articles were included in the quantitative synthesis and meta-analysis. Results: Maternal anaemia was associated with a significantly higher risk of low birth weight (OR, 1.90; 95% CI, 1.06-2.60, p ​

BACKGROUND: The partograph has been endorsed by World Health Organization (WHO) since 1994 which presents an algorithm for assessing maternal and foetal conditions and labor progression. Monitoring labour with a partograph can reduce adverse pregnancy outcomes such as prolonged labor, emergency C-sections, birth asphyxia and stillbirths. However, partograph use is still very low, particularly in low and middle income countries (LMICs). In Bangladesh the reported partograph user rate varies from 1.4% to 33.0%. Recently, an electronic version of the partograph, with the provision of online data entry and user aid for emergency clinical support, has been tested successfully in different settings. With this proven evidence, we conducted and operations research to test the feasibility and effectiveness of implementing an e-partograph, for the first time, in 2 public hospitals in Bangladesh.METHODS: We followed a prospective crossover design. Two secondary level referral hospitals, Jessore and Kushtia District Hospital (DH) were the study sites. All pregnant women who delivered in the study hospitals were the study participants. All nurse-midwives working in the labor ward of study hospitals were trained on appropriate use of both types of partograph along with standard labour management guidelines. Collected quantitative data was analyzed using SPSS 23 statistical software. Discrete variables were expressed as percentages and presented as frequency distribution and cross tabulations. Chi square tests were employed to test the association between exposure and outcome variables. Potential confounding factors were adjusted using multivariate binary logistic regression methods. Ethical approval was obtained from the institutional review board of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b).FINDINGS: In total 2918 deliveries were conducted at Jessore DH and 2312 at Kushtia DH during one-year study period. Of them, 1012 (506 in each facility) deliveries were monitored using partograph (paper or electronic). The trends of facility based C-section rates was downwards in both the hospitals; 43% to 37% in Jessore and from 36% to 25% in Kushtia Hospital. There was a significant reduction of prolonged labour with e-partograph use. In Kushtia DH, the prolonged labour rate was 42% during phase 1 with the paper version which came down to 29% during phase-2 with the e-partograph use. The similar result was observed in Jessore DH where the prolonged labour rate reduced to 7% with paper partograph from the reported 30% prolonged labour with e-partograph. The e-partograph user rate was higher than the paper partograph during both phases (phase 1: 3.31, CI: 2.04-5.38, p < .001 and in phase 2: 15.20 CI: 6.36-36.33, p < .001) after adjusting for maternal age, parity, gestational age, religion, mother's education, husband's education, and fetal sex.CONCLUSION: The partograph user rate has significantly improved with the e- partograph and was associated with an overall reduction in cesarean births. Use of the e-partograph was also associated with reduced rates of prolonged labour. This study has added to the growing body of evidence on the positive impact of e-partograph use. We recommend implementing e-partograph intervention at scale in both public and private hospitals in Bangladesh.TRIAL REGISTRATION: ClinicalTrials.gov NCT03509103.

The microenvironment and architecture of peritumoral tissue have been suggested to affect permissiveness for infiltration of malignant cells. Astrocytes constitute a heterogeneous population of cells and have been linked to proliferation, migration, and drug sensitivity of glioblastoma (GBM) cells. Through double-immunohistochemical staining for platelet-derived growth factor receptor α (PDGFRα) and glial fibrillary acidic protein (GFAP), this study explored the intercase variability among 45 human GBM samples regarding density of GFAP+ peritumoral astrocytes and a subset of GFAP+ peritumoral astrocyte-like cells also expressing PDGFRα. Large intercase variability regarding the total peritumoral astrocyte density and the density of PDGFRα+/GFAP+ peritumoral astrocyte-like cells was detected. DNA fluorescence in situ hybridization analyses for commonly altered genetic tumor markers supported the interpretation that these cells represented a genetically unaffected host cell subset referred to as PDGFRα+/GFAP+ peritumoral astrocytes. The presence of PDGFRα+/GFAP+ peritumoral astrocytes was significantly positively correlated to older patient age and peritumoral astrocyte density, but not to other established prognostic factors. Notably, presence of PDGFRα+/GFAP+ peritumoral astrocytes, but not peritumoral astrocyte density, was associated with significantly shorter patient overall survival. The prognostic association of PDGFRα+/GFAP+ peritumoral astrocytes was confirmed in multivariable analyses. This exploratory study thus demonstrates previously unrecognized intercase variability and prognostic significance of peritumoral abundance of a novel PDGFRα+ subset of GFAP+ astrocytes. Findings suggest clinically relevant roles of the microenvironment of peritumoral GBM tissue and encourage further characterization of the novel astrocyte subset with regard to origin, function, and potential as biomarker and drug target.

Arsenic (As) toxicity and diabetes mellitus (DM) are emerging public health concerns worldwide. Although exposure to high levels of As has been associated with DM, whether there is also an association between low and moderate As exposure and DM remains unclear. We explored the dose-dependent association between As exposure levels and hyperglycemia, with special consideration of the impact of demographic variables, in 641 subjects from rural Bangladesh. The total study participants were divided into three groups depending on their levels of exposure to As in drinking water (low, moderate and high exposure groups). Prevalence of hyperglycemia, including impaired glucose tolerance (IGT) and DM was significantly associated with the subjects' drinking water arsenic levels. Almost all exposure metrics (As levels in the subjects' drinking water, hair and nails) showed dose-dependent associations with the risk of hyperglycemia, IGT and DM. Among the variables considered, sex, age, and BMI were found to be associated with higher risk of hyperglycemia, IGT and DM. In sex-stratified analyses, As exposure showed a clearer pattern of dose-dependent risk for hyperglycemia in females than males. Finally, drinking water containing low-to-moderate levels of As (50.01–150 μg/L) was found to confer a greater risk of hyperglycemia than safe drinking water (As ≤10 μg/L). Thus the results suggested that As exposure was dose-dependently associated with hyperglycemia, especially in females.

Bangladesh has historically been cholera endemic, with seasonal cholera outbreaks occurring each year. In collaboration with the government of Bangladesh, the Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) initiated operational research to test strategies to reach the high-risk urban population with an affordable oral cholera vaccine (OCV) “ShancholTM” and examine its effectiveness in reducing diarrhea due to cholera. Here we report a sub-analysis focusing on the organization, implementation and effectiveness of different oral cholera vaccine delivery strategies in the endemic urban setting in Bangladesh. We described how the vaccination program was planned, prepared and implemented using different strategies to deliver oral cholera vaccine to a high-risk urban population in Dhaka, Bangladesh based on administrative data and observations made during the program. The objective of this study is to evaluate the organization, implementation and effectiveness of different oral cholera vaccine delivery strategies in the endemic urban setting in Bangladesh. OCV administration by trained local volunteers through outreach sites and mop-up activities yielded high coverage of 82% and 72% of 172,754 targeted individuals for the first and second dose respectively, using national Expanded Program on Immunization (EPI) campaign mechanisms without disrupting routine immunization activities. The cost of delivery was low. Safety and cold chain requirements were adequately managed. The adopted strategies were technically and programmatically feasible. Current evidence on implementation strategies in different settings together with available OCV stockpiles should encourage at-risk countries to use OCV along with other preventive and control measures.

Background The investigation of the potential impact of unintended pregnancy on maternal and child health is important to design effective interventions. This study explored the associations between unintended pregnancy and low birthweight (LBW) and pregnancy complications. Methods A cross-sectional survey was conducted among 400 randomly selected women in the postnatal wards of Rajshahi Medical College Hospital, Bangladesh. Multivariate logistic regression analyses were used to identify associations. Results Results of this study indicate that 30.5% of all pregnancies were unintended and 29.3% of babies were born with LBW. Additionally, 79.3% of women experienced any pregnancy complication (AC), 69.5% experienced medical complications and 44.3% experienced obstetric complications (OCs) during their last pregnancy. Unintended pregnancy was significantly associated with LBW (adjusted odds ratio [AOR]: 3.18, 95% CI: 1.79 to 5.54), maternal experience of OCs (AOR: 1.83, 95% CI: 1.03 to 3.28) and AC (AOR: 2.93, 95%: 1.14 to 7.58). Women with unintended pregnancies were at higher risk of developing high blood pressure and anemia during pregnancy. Conclusions Women with unintended pregnancies are at increased risk of producing LBW babies and experiencing complications during pregnancy. Therefore, maternal pregnancy intention should be addressed in interventions aimed to reduce maternal and child morbidity and mortality.

BackgroundThe prevalence of overweightness in Bangladesh is increasing, while underweightness also continues to persist. A better understanding of the patterns and socioeconomic risk factors of both conditions, particularly among women, is critical in order to promote the development of interventions to improve maternal health in Bangladesh. This study therefore sought to assess the patterns of under- and overweightness between 2004 and 2014 and to examine the predictors of individual and community-level inequalities of under- and overnutrition in Bangladesh.MethodsCross-sectional data of 10, 431, and 16,478 ever-married nonpregnant women aged between 15 and 49 years who did not give birth in the two months preceding the survey were extracted from the 2004 and 2014 Bangladesh Demographic and Health Surveys, respectively. Body mass index was used to measure weight status, and underweightness, at-risk for overweightness, overweightness, and obesity were the main outcome variables. Patterns of nutritional change over time was examined by considering the annual average rate of change. Multilevel multinomial logistic regression and quantile regression were used to identify the inequalities.ResultsIn 2014, the age-adjusted prevalence values of underweightness, at-risk for overweightness, overweightness, and obesity were 19.7%, 14.9%, 18.1% and 4.0%, respectively. A higher average annual rate of reduction of underweightness was found among wealthier, highly educated, and wealthier community-living women, while a rate of increase of overweightness was found among poorer, uneducated, and poor community-living women. Individual and community-level inequalities of malnutrition were observed among these populations. In comparison with women living in low wealth communities, women from wealthier communities were at an increased risk of being at-risk for overweightness [adjusted odds ratio (AOR): 1.53, 95% confidence interval (CI): 1.23-1.91], overweight (AOR: 1.60, 95% CI: 1.27-2.00), and obese (AOR: 2.12, 95% CI: 1.42-3.18).ConclusionsThis study suggests the coexistence of a double burden of under- and overnutrition in Bangladesh and that the prevalence of overweightness surpasses that of underweightness. The burdens of under- and overnutrition are strongly associated with women's individual socioeconomic positions and the nature of the community in which they live.

Background Diabetic retinopathy can cause blindness even in the absence of symptoms. Although routine eye screening remains the mainstay of diabetic retinopathy treatment and it can prevent 95% of blindness, this screening is not available in many low- and middle-income countries even though these countries contribute to 75% of the global diabetic retinopathy burden. Objective The aim of this study was to assess the diagnostic accuracy of diabetic retinopathy screening done by non-ophthalmologists using 2 different digital fundus cameras and to assess the risk factors for the occurrence of diabetic retinopathy. Methods This validation study was conducted in 6 peripheral health facilities in Bangladesh from July 2017 to June 2018. A double-blinded diagnostic approach was used to test the accuracy of the diabetic retinopathy screening done by non-ophthalmologists against the gold standard diagnosis by ophthalmology-trained eye consultants. Retinal images were taken by using either a desk-based camera or a hand-held camera following pupil dilatation. Test accuracy was assessed using measures of sensitivity, specificity, and positive and negative predictive values. Overall agreement with the gold standard test was reported using the Cohen kappa statistic (κ) and area under the receiver operating curve (AUROC). Risk factors for diabetic retinopathy occurrence were assessed using binary logistic regression. Results In 1455 patients with diabetes, the overall sensitivity to detect any form of diabetic retinopathy by non-ophthalmologists was 86.6% (483/558, 95% CI 83.5%-89.3%) and the specificity was 78.6% (705/897, 95% CI 75.8%-81.2%). The accuracy of the correct classification was excellent with a desk-based camera (AUROC 0.901, 95% CI 0.88-0.92) and fair with a hand-held camera (AUROC 0.710, 95% CI 0.67-0.74). Out of the 3 non-ophthalmologist categories, registered nurses and paramedics had strong agreement with kappa values of 0.70 and 0.85 in the diabetic retinopathy assessment, respectively, whereas the nonclinical trained staff had weak agreement (κ=0.35). The odds of having retinopathy increased with the duration of diabetes measured in 5-year intervals (P Conclusions Digital fundus photography is an effective screening tool with acceptable diagnostic accuracy. Our findings suggest that diabetic retinopathy screening can be accurately performed by health care personnel other than eye consultants. People with more than 5 years of diabetes should receive priority in any community-level retinopathy screening program. In a country like Bangladesh where no diabetic retinopathy screening services exist, the use of hand-held cameras can be considered as a cost-effective option for potential system-wide implementation.

Background and Objectives: Diabetes in the young patients, less than 30 years of age, usually has sudden onset and severe hyperglycemia who are resistant to ketosis. Taking the advantage of this uniqueness of this group of patients the present study was aimed to evaluate their peripheral nerve functional status, explore its relationship with glycemic status and find out utility of nerve conduction study for detection of neuropathy at diagnosis to introduce timely intervention in the necessary cases.Materials and Methods: A total number of 32 newly diagnosed untreated diabetic patients, age 30 years or less, consecutively attending the BIRDEM Out-patient department were recruited. Age-matched healthy subjects (n=30) with no family history of diabetes served as controls. Motor and sensory conduction velocities (NCV), distal latencies (DL), compound muscle and sensory nerve action potentials (CAMP, SNAP) of ulnar, peroneal and sural nerves were studied following standard protocol. Glucose was determined by glucose-oxidase, Fructosamine by enzymatic colorimetric method.Results: Ulnar motor NCV (m/sec, mean±SD) was significantly slower in diabetic group compared to the controls [58.29±6.88 vs 66.56±6.13; p

Glioblastomas (GBMs) are aggressive brain tumours with a dismal prognosis, despite combined surgery, radio- and chemotherapy. Close to 90 % of all GBMs harbour a deregulated PI3K pathway, which is essential in regulating central cellular functions such as proliferation, cell growth, motility and survival. Thus, PI3K represents a potential target for molecular therapy in GBM. We investigated the anti-tumour efficacy of the PI3K inhibitor buparlisib (NVP-BKM120) in GBM cell lines in vitro and in vivo, when treatment was initiated after MRI-confirmed tumour engraftment. We found that buparlisib inhibited glioma cell proliferation in a dose dependent manner, demonstrated by MTS assay, manual cell count and BrdU incorporation. A dose dependent increase in apoptosis was observed through flow cytometric analysis. Furthermore, by immunocytochemistry and western blot, we found a dose dependent inhibition of Akt phosphorylation. Moreover, buparlisib prolonged survival of nude rats harboring human GBM xenografts in three independent studies and reduced the tumours’ volumetric increase, as determined by MRI. In addition, histological analyses of xenograft rat brains showed necrotic areas and change in tumour cell nuclei in buparlisib-treated animals. The rats receiving buparlisib maintained their weight, activity level and food- and water intake. In conclusion, buparlisib effectively inhibits glioma cell proliferation in vitro and growth of human GBM xenografts in nude rats. Moreover, the compound is well tolerated when administered at doses providing anti-tumour efficacy. Thus, buparlisib may have a future role in glioma therapy, and further studies are warranted to validate this compound for human use. Electronic supplementary material The online version of this article (doi:10.1007/s11060-016-2158-1) contains supplementary material, which is available to authorized users.

Sexually transmitted oral cancer/head and neck cancer is increasing rapidly. Human papilloma virus (HPV) is playing a role in the pathogenesis of a subset of squamous cell carcinoma of head and neck (SCCHN). Paclitaxel is a widely used anticancer drug for breast, ovarian, testicular, cervical, non-small cell lung, head and neck cancer. However, it is water insoluble and orally inactive. We report the synthesis of water soluble nanosize conjugates of paclitaxel, branched PEG, and EGFR-targeting peptide by employing native chemical ligation. We performed a native chemical ligation between the N-hydroxy succinimide (NHS) ester of paclitaxel succinate and cysteine at pH 6.5 to give the cysteine-conjugated paclitaxel derivative. The thiol functionality of cysteine was activated and subsequently conjugated to multiarm thiol-PEG to obtain the paclitaxel branched PEG conjugate. Finally, we conjugated an EGFR-targeting peptide to obtain conjugates of paclitaxel, branched PEG, and EGFR-targeting peptide. These conjugates show anticancer activity against squamous cell carcinoma of head and neck cells (SCCHN, Tu212).

Tuberous sclerosis is a disorder affecting multiple organs leading to morbidity and mortality. It is important to make an early diagnosis of tuberous sclerosis so that lifelong monitoring, early recognition of complications and proactive treatment can lower the morbidity and mortality rates. Here we report a case of a 50-year-old male who presented with seizure. This case report emphasizes the importance of complete evaluation of a case presenting with seizures. Tuberous sclerosis must be included in the differentials if patient presents with seizures, skin manifestations and mental retardation.Birdem Med J 2016; 6(2): 127-129

Background: Epidemiologic studies have identified hyper-homocysteinemia as a possible risk factor for atherosclerosis.The aim of my study was based on evaluation of relationship between homocysteinemia with ischemic stroke patients. Methods and materials: It was a prospective observational study conducted in the Department of Neurology, Sir Salimullah Medical College & Mitford hospital, Dhaka. Thirty six consecutive patients with ischemic stroke were analyzed by serum total homocysteine, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride and Equal number of controls same ages were compared with the case group. Result: Mean Fasting blood sugar, serum fasting total cholesterol (TC), serum fasting Low density lipoprotein (LDL) were significantly higher in case group (p=0.001). Serum TC and LDL had a positive correlation with serum homocystine a (p=0.001). Serum High density lipoprotein (HDL) had a negative correlation (p=0.718) and serum triglyceride (TG) had a negative correlation (p = 0.182). Total plasma fasting homocysteine level in case group was 21.89 ± 9.38 ìmol/l and control group was 12.31 ± 3.27 ìmol/l, (p=0.001). Elevated fasting homocystein level was found in 75.0% of ischemic stroke patient and in 16.67% of healthy controls (p=0.001). The incidence of hyperhomocysteinemia is higher in ischaemic stroke cases than that in age-sex matched healthy controls. Conclusion: Hyperhomocysteinemia in ischaemic stroke patients has as been determined as vascular risk factor in our study. Significant correlation has been found between homocysteine concentration and ischaemic stroke.DOI: http://dx.doi.org/10.3329/jom.v14i1.14536 J MEDICINE 2013; 14 : 47-51

Unlike chemotherapy drugs, the safety of natural compounds such as curcumin has been well established. However, the potential use of curcumin in cancer has been compromised by its low bioavailability, limited tissue distribution and rapid biotransformation leading to low in vivo efficacy. To circumvent these problems, more potent and bioavailable analogs have been synthesized. In the current study, we investigated the mechanism of anti-tumor effect of one such analog, FLLL12, in lung cancers. IC50 values measured by sulforhodamine B (SRB) assay at 72 h and apoptosis assays (annexin V staining, cleavage of PARP and caspase-3) suggest that FLLL12 is 5–10-fold more potent than curcumin against a panel of premalignant and malignant lung cancer cell lines, depending on the cell line. Moreover, FLLL12 induced the expression of death receptor-5 (DR5). Ablation of the expression of the components of the extrinsic apoptotic pathway (DR5, caspase-8 and Bid) by siRNA significantly protected cells from FLLL12-induced apoptosis (p < 0.05). Analysis of mRNA expression revealed that FLLL-12 had no significant effect on the expression of DR5 mRNA expression. Interestingly, inhibition of global phosphatase activity as well as protein tyrosine phosphatases (PTPs), but not of alkaline phosphatases, strongly inhibited DR5 expression and significantly inhibited apoptosis (p < 0.05), suggesting the involvement of PTPs in the regulation of DR5 expression and apoptosis. We further showed that the apoptosis is independent of p53 and p73. Taken together, our results strongly suggest that FLLL12 induces apoptosis of lung cancer cell lines by post-transcriptional regulation of DR5 through activation of protein tyrosine phosphatase(s).

Central nervous system (CNS) tuberculous meningitis is a progressive disease that presents in many ways. CNS TB is encountered frequently in areas of high prevalence of tuberculosis and dissemination is common. An 18 year old female presented with complaints of headache, low grade fever & double vision. We found cranial nerve palsy & focal neurological signs during examination. Work up revealed cerebral spinal fluid (CSF) study consistent with acute lymphocytic meningitis. Magnetic resonance imaging (MRI) revealed multiple tuberculomas with gadolinium enhancement & cerebral infarction on basal ganglia. Given the characteristic CSF and MRI finding for Tuberculosis (TB), positive MT & choroidal tubercle on fundoscopy, ischemic stroke due to tubercular meningitis is made. The patient showed significant improvement after anti tuberculosis therapy was begun. CNS TB is a treatable disease but can be fatal if not detected or treated. Clinicians should be aware of key clinical features of TB meningitis, and maintain a high level of suspicion when patients present with focal neurological signs.Bangladesh Crit Care J September 2016; 4 (2): 128-130

Intramedullary spinal cord metastasis is one of the rare manifestations of systemic neoplasm causing diagnostic dilemma. Here we report a case of metastatic renal cell carcinoma presented initially as spinal cord lesion. A 62 years old Bangladeshi gentleman presented with spastic paraparesis, bone pain with unexplained weight loss. After thorough examination & detailed investigations we found intramedullary spinal cord metastasis with infiltrative lesion on bone scan. We confirmed renal cell carcinoma after doing CT Abdomen and histopathology as primary site of lesion. He was treated by radical nephrectomy & radiotherapy. It is imperative that clinicians should be cautious of occult carcinoma as the cause of suspicious intramedullary spinal cord lesion.Bangladesh Crit Care J March 2016; 4 (1): 51-53

Non-fatal injuries have a significant impact on disability, productivity, and economic cost, and first-aid can play an important role in improving non-fatal injury outcomes. Data collected from a census conducted as part of a drowning prevention project in Bangladesh was used to quantify the impact of first-aid provided by trained and untrained providers on non-fatal injuries. The census covered approximately 1.2 million people from 7 sub-districts of Bangladesh. Around 10% individuals reported an injury event in the six-month recall period. The most common injuries were falls (39%) and cuts injuries (23.4%). Overall, 81.7% of those with non-fatal injuries received first aid from a provider of whom 79.9% were non-medically trained. Individuals who received first-aid from a medically trained provider had more severe injuries and were 1.28 times more likely to show improvement or recover compared to those who received first-aid from an untrained provider. In Bangladesh, first-aid for non-fatal injuries are primarily provided by untrained providers. Given the large number of untrained providers and the known benefits of first aid to overcome morbidities associated with non-fatal injuries, public health interventions should be designed and implemented to train and improve skills of untrained providers.

// Jun Zhang 1, 2, 3 , Sreenivas Nannapaneni 2 , Dongsheng Wang 2 , Fakeng Liu 2 , Xu Wang 2 , Rui Jin 2 , Xiuju Liu 2 , Mohammad Aminur Rahman 2 , Xianghong Peng 2 , Guoqing Qian 2 , Zhuo G. Chen 2 , Kwok-Kin Wong 4 , Fadlo R. Khuri 1, 2 , Wei Zhou 1, 2 and Dong M. Shin 1, 2 1 Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA 2 Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA 3 Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Internal Medicine, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA 4 Dana-Farber Cancer Institute, Harvard Medical School, Dana Building 810B, HIM243, Boston, MA 02115, USA Correspondence to: Dong M. Shin, email: dmshin@emory.edu Wei Zhou, email: wzhou2@emory.edu Keywords: NSCLC, KRAS, LKB1, phenformin, selumetinib Received: February 28, 2017 Accepted: July 18, 2017 Published: August 01, 2017 ABSTRACT MEK inhibition is potentially valuable in targeting KRAS-mutant non-small cell lung cancer (NSCLC). Here, we analyzed whether concomitant LKB1 mutation alters sensitivity to the MEK inhibitor selumetinib, and whether the metabolism drug phenformin can enhance the therapeutic effect of selumetinib in isogenic cell lines with different LKB1 status. Isogenic pairs of KRAS-mutant NSCLC cell lines A549, H460 and H157, each with wild-type and null LKB1, as well as genetically engineered mouse-derived cell lines 634 ( kras G12D/wt /p53 -/- /lkb1 wt/wt ) and t2 ( kras G12D/wt /p53 -/- / lkb1 -/- ) were used in vitro to analyze the activities of selumetinib, phenformin and their combination. Synergy was measured and potential mechanisms investigated. The in vitro findings were then confirmed in vivo using xenograft models. The re-expression of wild type LKB1 increased phospho-ERK level, suggesting that restored dependency on MEK->ERK->MAPK signaling might have contributed to the enhanced sensitivity to selumetinib. In contrast, the loss of LKB1 sensitized cells to phenformin. At certain combination ratios, phenformin and selumetinib showed synergistic activity regardless of LKB1 status. Their combination reduced phospho-ERK and S6 levels and induced potent apoptosis, but was likely through different mechanisms in cells with different LKB1 status. Finally, in xenograft models bearing isogenic A549 cells, we confirmed that loss of LKB1 confers resistance to selumetinib, and phenformin significantly enhances the therapeutic effect of selumetinib. Irrespective of LKB1 status, phenformin may enhance the anti-tumor effect of selumetinib in KRAS-mutant NSCLC. The dual targeting of MEK and cancer metabolism may provide a useful strategy to treat this subset of lung cancer.

Over one-quarter of deaths among 1–4 year-olds in Bangladesh were due to drowning in 2003, and the proportion increased to 42% in 2011. This study describes the current burden and risk factors for drowning across all demographics in rural Bangladesh. A household survey was carried out in 51 union parishads of rural Bangladesh between June and November 2013, covering 1.17 million individuals. Information on fatal and nonfatal drowning events was collected by face-to-face interviews using a structured questionnaire. Fatal and non-fatal drowning rates were 15.8/100,000/year and 318.4/100,000/6 months, respectively, for all age groups. The highest rates of fatal (121.5/100,000/year) and non-fatal (3057.7/100,000/6 months) drowning were observed among children 1 to 4 years of age. These children had higher rates of fatal (13 times) and non-fatal drowning (16 times) compared with infants. Males had slightly higher rates of both fatal and non-fatal drowning. Individuals with no education had 3 times higher rates of non-fatal drowning compared with those with high school or higher education. Non-fatal drowning rates increased significantly with decrease in socio-economic status (SES) quintiles, from the highest to the lowest. Drowning is a major public health issue in Bangladesh, and is now a major threat to child survival.

Background Little is known about the role of glial host cells in brain tumours. However, supporting stromal cells have been shown to foster tumour growth in other cancers. Methods We isolated stromal cells from patient-derived glioblastoma (GBM) xenografts established in GFP-NOD/scid mice. With simultaneous removal of CD11b+ immune and CD31+ endothelial cells by fluorescence activated cell sorting (FACS), we obtained a population of tumour-associated glial cells, TAGs, expressing markers of terminally differentiaed glial cell types or glial progenitors. This cell population was subsequently characterised using gene expression analyses and immunocytochemistry. Furthermore, sphere formation was assessed in vitro and their glioma growth-promoting ability was examined in vivo. Finally, the expression of TAG related markers was validated in human GBMs. Results TAGs were highly enriched for the expression of glial cell proteins including GFAP and myelin basic protein (MBP), and immature markers such as Nestin and O4. A fraction of TAGs displayed sphere formation in stem cell medium. Moreover, TAGs promoted brain tumour growth in vivo when co-implanted with glioma cells, compared to implanting only glioma cells, or glioma cells and unconditioned glial cells from mice without tumours. Genome-wide microarray analysis of TAGs showed an expression profile distinct from glial cells from healthy mice brains. Notably, TAGs upregulated genes associated with immature cell types and self-renewal, including Pou3f2 and Sox2. In addition, TAGs from highly angiogenic tumours showed upregulation of angiogenic factors, including Vegf and Angiopoietin 2. Immunohistochemistry of three GBMs, two patient biopsies and one GBM xenograft, confirmed that the expression of these genes was mainly confined to TAGs in the tumour bed. Furthermore, their expression profiles displayed a significant overlap with gene clusters defining prognostic subclasses of human GBMs. Conclusions Our data demonstrate that glial host cells in brain tumours are functionally distinct from glial cells of healthy mice brains. Furthermore, TAGs display a gene expression profile with enrichment for genes related to stem cells, immature cell types and developmental processes. Future studies are needed to delineate the biological mechanisms regulating the brain tumour-host interplay. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3109-8) contains supplementary material, which is available to authorized users.

Background Overweight and obesity are increasing in low- and middle-income countries, while underweight remains a significant health problems. However, the association between double burden of nutrition and risk of adverse birth and health outcomes is still unclear in Bangladesh. The aim of this study was to determine the effect of maternal undernutrition and excessive body weight on a range of maternal and child health outcomes. Methods In this study, we used Bangladesh Demographic and Health Survey (BDHS) 2011 and 2014 data sets to cover the maternal, child and non-communicable diseases related health outcomes. The study considered a range of outcome variables including pregnancy complication, cesarean delivery, diabetes, hypertension, stunting, and wasting, low birth weight, genital discharge, genital sore/ulcer, stillbirth, early neonatal mortality, perinatal mortality, preterm birth and prolonged labor. The key exposure variable was maternal body mass index. Multilevel regression analysis was performed to examine the association between outcomes and exposure variables. Results Maternal overweight and obesity has increased from 10% in 2004 to 24% in 2014, a 240% increase in 10 years. Between 2004 and 2014, maternal undernutrition declined from 33% to 18%, a reduction rate of only 54% in 10 years. Compared to normal-weight women, overweight and obese women were more likely to have experienced pregnancy complication, cesarean delivery, diabetes, and hypertension. Underweight women were 1.3 times more likely to have children with stunting and 1.6 times more likely to experience wasting compared to normal weight women. Maternal BMI was not significantly associated with increased risk of genital sore or ulcer, genital discharge, menstrual irregularities, or low birth weight though in certain cases risk was higher. Conclusions High maternal overweight and obesity were observed to have significant adverse effects on health outcomes, while underweight was a risk factor for newborn health. The findings show that weight management is necessary to prevent adverse birth and health outcomes in Bangladesh. Trial registration Data related to health was collected by following the guidelines of ICF international and Bangladesh Medical Research Council. The registration number of data collection is 132989.0.000 and the data-request was registered on March 11, 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13690-017-0181-0) contains supplementary material, which is available to authorized users.

Malignant gliomas are infiltrative tumors arising in the brain, characterized by degradation of the extracellular matrix and tumor cell migration along white matter tracts. The most aggressive form displays florid angiogenesis and recruitment of host vessels. In a reciprocal fashion, host-derived factors exert modulatory effects on the glioma cell compartment. Thus, tumor-stroma interactions regulate critical aspects of brain tumor progression. These interactions are shaped by the structural organization of the central nervous system (CNS) and involve multiple cell types, extracellular matrix (ECM) components, and host cell-derived soluble factors that are unique to the CNS. Here, we will first provide an overview of the CNS microenvironment, followed by a review of how these elements contribute to the brain tumor-host interplay.

Background and methods Caesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression. Findings During 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section. Conclusions C-section rate in this area was much higher than national average as well as global recommendations. Very few of C-sections were undertaken for AMIs. Routine monitoring of clinical indication of C-section in public and private facilities is needed to ensure rational use of the procedure.