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Thymoquinone is a pharmacologically active component of Nigella sativa Linn. seeds. Despite the diverse neuropharmacological attributes of TQ, limited reports related to adult neurogenesis and memory research are available. In this study, we investigated the effects of TQ on the proliferation and neural differentiation of cultured neural stem/progenitor cells (NSCs/NPCs). We also investigated the effect of TQ chronic administration on neurogenesis and memory in adult rats. Under proliferation conditions, TQ (0.05-0.3 μM) significantly increased NSCs/NPCs viability, neurosphere diameter, and cell count. TQ treatment under differentiation conditions increased the proportion of cells positive for Tuj1 (a neuronal marker). Furthermore, chronic oral administration of TQ (25 mg/kg/day for 12 weeks) to adult rats increased the number of bromodeoxyuridine (BrdU)-immunopositive cells double-stained with a mature neuronal marker, neuronal nuclei (NeuN), and a proliferation marker, doublecortin (Dcx), in the dentate gyrus of the hippocampus. TQ-administered rats showed a profound beneficial effect on avoidance-related learning ability, associated with an increase in the hippocampal mRNA and protein levels of brain-derived neurotrophic factor (BDNF), as measured by both real-time PCR and ELISA. Western blot analysis revealed that TQ stimulates the phosphorylation of cAMP-response element-binding protein (CREB), the upstream signaling molecule in the BDNF pathway. Furthermore, chronic administration of TQ decreased lipid peroxide and reactive oxygen species levels in the hippocampus. Taken together, our results suggest that TQ plays a role in memory improvement in adult rats and that the CREB/BDNF signaling pathways are involved in mediating the actions of TQ in hippocampal neurogenesis.

Background: Hemorrhagic stroke accounts for 10-15% of all strokes with higher mortality rates than cerebral infarction. Intracerebral hemorrhage has a reported 30-day mortality of 44% to 51%, with almost half of the death occurs within the first 48 hours. Advanced age, low level of consciousness, large volume of hemorrhage has been linked with poor outcome. Objectives: To predict early outcome of hemorrhagic stroke patient in relation with age, Glasgow Coma Scale, volume of hemorrhage and ventricular extension. Materials and Methods: Hospital based prospective study carried out in hundred hemorrhagic stroke patients. The formula of ABC/2 was used to calculate hemorrhage volume in bedside by using CT scan. Results: 1st month mortality rates of hemorrhagic stroke was 44% with 45.45% of patients died within the first 48 hours of onset. Mean age of patients of hemorrhagic stroke was 61.2 ± 13.88 years. Mortality rate of intracerebral hemorrhage after age of 60 was 51.06% in 1st month. Volume of intracerebral hemorrhage was the strongest predictor of both 48 hours and 30 days mortality. Using three categories of intracerebral hemorrhage (X for < 30 ml, Y for 30 - 50 ml and Z for > 50 ml group) calculated by ABC/2 formula showed 100% mortality rate in Z group, 50% in Y group and only 12% mortality rate in X group in 1st month. Among all death, 61.5% of Z group 25% of Y group and 16.67% of patients of X group died within 48 hours. Two categories of Glasgow Coma Scale (≤ 8 and ≥ 9) were used and shown death rates 80.77% in GCS ≤ 8 and 4.55% in GCS ≥ 9 in 1st month. Conclusion: Volume of intracerebral hemorrhage in combination with advanced age, initial Glasgow Coma Scale is a powerful and easy to use in both 48 hours and 1st month mortality in patients with spontaneous intracerebral hemorrhage. KYAMC Journal. 2021;12(3): 127-132

Introduction: Chronic obstructive pulmonary disease (COPD) has considerable effects on cardiac functions, including those of the right ventricle, left ventricle, and pulmonary blood vessels. Most of the increased mortality associated with COPD is due to cardiac involvement. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate the cardiac changes. Aims: We aimed to prospectively study the patients with diagnosed COPD with echocardiogram for evaluating the right heart. Materials & Methods: Our study was an observational, cross sectional study was done on 50 patients with COPD who were admitted at Department of Cardiology, CMCH and underwent echocardiographic evaluation from November 2017 –October 2018. All echocardiogaphic parameters focused on right heart and its function were assessed. Results: Out of total 50 COPD patients studied, majority of them were male (46 patients ,92%). The mean age group of the studied patients was 58.4 ±7.7 years. Pulmonary hypertension defined as sPAP>30 mmHg was evident in all of the patients; with 30 patients (60%), 14 (28 %) and 6(12 %) patients having severe, moderate and mild pulmonary hypertension respectively. RV dysfunction was evident with reduced average TAPSE values (1.59± 0.38 cm) and elevated RIMP values (0.58±0.16). Conclusion: Majority of COPD patients had evidence of pulmonary hypertension. Echocardiogram can be a helpful tool to assess early changes on the right heart size and function in patients with COPD and also monitor these patients for rapid progression of the illness. Medicine Today 2021 Vol.33(2): 123-128

Graphical abstract, Introduction Nephrotic syndrome is a common pediatric kidney disease. Investigations on several genetic polymorphisms revealed an inconsistent influence on the resistance of patients to steroids. Objectives This study aimed to identify the association of ABCB1 (1236C > T, 2677G > T, 3435C > T), NR3C1 (rs10482634, rs6877893), and CYP3A5 (CYP3A5*3) gene polymorphism as well as sociodemographic and clinicopathological parameters with the risk of developing prednisolone resistance in pediatric patients with nephrotic syndrome. Methods A case-control analysis was performed on 180 nephrotic syndrome patients. Among them, 30 patients were classified as prednisolone resistant group, and 150 were classified as prednisolone sensitive group. Genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results No significant association of 1236C > T polymorphism with the risk of prednisolone resistance (p > 0.05) was found. The GT heterozygous of 2677G > T was found to be significantly associated with the development of prednisolone resistance (OR = 3.9, p = 0.034). In the case of 3435C > T, a statistically significant association was observed in TC heterozygous and TT mutant homozygous genotypes (OR = 0.38, p = 0.047; OR = 3.06, p = 0.038, respectively) with prednisolone resistance. For rs10482634 polymorphism, the AG heterozygous and AG+GG genotypes were significantly linked with prednisolone resistance (OR = 2.40, p = 0.033; OR = 2.36, p = 0.034, respectively). We found no association with the risk of prednisolone resistance with rs6877893 and CYP3A5*3 polymorphism (p > 0.05). CTC and TGT haplotypes of ABCB1 and GA haplotype of NR3C1 were also associated with the increased risk of pediatric prednisolone resistance (OR = 4.47, p = 0.0003; OR = 2.71, p = 0.03; and OR = 4.22, p = 0.022, consecutively). We also observed the correlation of different sociodemographic and clinicopathological factors with prednisolone resistance in pediatric nephrotic syndrome. Conclusion Our findings showed a significant association of ABCB1 and NR3C1 gene polymorphisms with prednisolone resistant pediatric nephrotic syndrome.

Background: The Coronavirus Disease 2019 (COVID-19) pandemic is a significant challenge particularly for low and middle-income countries like Bangladesh. Interventions such as home isolation, frequent hand washing, wearing face mask, maintaining social distancing are difficult to implement in densely populated areas. The aim of the study was to delineate demographics, clinical manifestations, treatment modalities and outcomes of COVID-19 affected patients of our hospital. Methods: This prospective observational study was carried out at National Heart Foundation Hospital & Research Institute of Bangladesh between 08 March 2020 to 07 March 2021. During this period all admitted patients who subsequently were diagnosed as COVID positive and health care personnel of this hospital, who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace & become COVID positive were included. Results: During this one-year period a total of 769 COVID positive patients were detected in our hospital. Mean age of the patients was 48.16 ±15.63 years (range 1-92 years). Two third were male (64.9% vs 35.1%) and had multiple co-morbidities. One fifth of the patients were (19%) asymptomatic. The mean duration of onset of symptoms to test was 3.72±3.7 days. Most common symptoms were fever (65.3%), cough (37.1%), shortness of breath (33.6%) and fatigue (27.8%). Other symptoms were bodyache (18.6%), headache (16.6%), anosmia 16%), sore throat (12.1%), diarrhoea (6.8%), dizziness (5.3%), generalized itching (3.8%). Nearly two third of the COVID positive patients (63.2%) had a diagnosed cardiovascular disease at onset and remaining 36.8% patients presented with only COVID-19 disease. About 75% patients received ivermectin, 5.1% patients received favipiravir and 4.4% patients received remdesivir. Three fourth (74.38%) of patients were hospitalized and remaining one fourth (25.62%) patients were treated either in home isolation or in institutional isolation. Most of the patients recovered, with a case fatality rate of 3.5%. Diabetes, hypertension and age ≥50 years were the independent predictors of mortality. Conclusion: Although most of the patients had good outcome the study revealed 3.5% case fatality. Male with multiple co-morbidities were predominantly affected by COVID 19. Fever, cough, shortness of breath and fatigue were common presenting symptoms. Bangladesh Heart Journal 2021; 36(2): 89-97

Background: Catheter ablation can be curative in patients with drug-refractory tachyarrhythmias. 3D electro anatomical mapping (EAM) is an established tool facilitating catheter ablation. This system is particularly valuable for mapping complex arrhythmias, which provide excellent assistance to catheter navigation, reduces fluoroscopy exposure, and also allow for the accurate placement of catheters. The Rhythmia Mapping System (RMS, Boston Scientific) is a novel system that allows for ultra-fast, high-density 3D mapping. Aim of this Study: The aim of this study was to find out the result of a high-density 3D mapping for the ablation of complex Cardiac Arrhythmias and to share our experiences. Methods: A total number of 44 patients of different tachyarrhythmias were scheduled for catheter ablation by Rhythmia Mapping System in National Institute of Cardiovascular Diseases, Bangladesh from 3rd February’2018 to 18th July’2019. During and after, the procedure all the cases were evaluated for different procedure parameters, acute success and in-hospital success. Results: Among the patients (28/44 male) 13 (25.55%) cases were atrial fibrillation, 6 (16.64%) cases were atrial flutter, 6 (16.64%) cases were atrial tachycardia, 2 (4.55%) cases were ventricular tachycardia, 11 (25%) cases were PVC and 6 (16.64%) cases were accessory pathway. The mean age was 38±4.5 years. In 25 (56.82%) of tachyarrhythmia patients, the mechanism was macro reentry/micro reentry, while in 19 (43.18%) cases the mechanism was increased automaticity. In all cases, the tachycardias were adequately mapped & proper identification of focus was done during the index procedure with the ultra-high density 3-D Rhythmia Mapping System (RMS). These all were successfully terminated by radiofrequency ablation, except one, which was one of the two cases of Ventricular tachycardia. With this system our study samples had a success rate of 98% with arrhythmia elimination. In patients of atrial fibrillation, all 4 pulmonary veins isolation were done. The mean mapping time was 28.6 ± 17 minutes, and the mean radiofrequency ablation time to arrhythmia termination was 3.2± 2.6 minutes. During our study only two out of 44 patients developed complications. One of the patients with atrial fibrillation developed cardiac tamponade and the other patient with PVC originating from Aortic cusp developed ischemic stroke. Fortunately, they were both managed accordingly. During hospital discharge, all the patients were free of tachyarrhythmia and were in sinus rhythm. Conclusions: This new automated ultrahigh-resolution mapping system allows accurate diagnosis of tachyarrhythmia circuits. Ablation of the focus resulted in high acute success. Bangladesh Heart Journal 2021; 36(2): 98-104

Background: Corona Virus Disease (COVID -19) patients present mainly with respiratory manifestations and viral pneumonia. The cardiovascular presentation includes early signs of acute myocardial injury. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or nonspecific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities and mortality. Methods and materials: It was a prospective observational study, conducted in four tertiary care Private Hospitals of Chattogram City of Bangladesh. The study enrolled 181 consecutive patients admitted to hospital from June 01, 2020 to December 31, 2020 due to Covid-19 disease on the basis of presentation of signs and symptoms severity. Upon admission, routine investigations cTnI and ECG were carried out. Results: Mean age of the patients was 54.3±7.3 years with 63.5% male. Hypertension was the most common comorbidity followed by diabetes and obesity. 57.1% of the patients had abnormal ECG. Abnormal axis deviation [26 % (left axis deviation 23.9% vs right axis deviation 2.0%)], Poor R wave progression (22.9%), T inversion (14.5%), left ventricular hypertrophy (LVH) (11.4%) followed by ST segment depression (8.3%) were major findings observed in the study population. Presence of LVH (p=0.008), ST segment elevation (p≤0.001), ST segment depression (p≤0.001) and T inversion (p=0.003) showed statistically significant association with Severe COVID-19 disease. 48.2% had raised cTnI level. Thirteen (7.2%) patients expired in hospital. The mortality rate increased with incrementally higher troponin group: 12/18 than mildly elevated troponin 1/63 (p < 0.01). The presence of an abnormal ECG finding resulted in significant in the intermediate Troponin elevation group (0.05-1 ng/ml) but not in the low ( 1 ng/ml) Troponin elevation groups. There were statistically significant association between between cTnI level and death; and between ECG findings and death. Conclusion: Study conclude that Troponin-I level and ECG are a prognostic factor for mortality in hospitalized COVID-19 patients. Bangladesh Heart Journal 2021; 36(2): 105-112

Pharmacological therapy is mostly employed in the management of supraventricular tachyarrhythmias in different part of the world including Bangladesh. However, Radiofrequency catheter ablation has been found to be highly effective and safe in the treatment of such tachyarrhythmias. Objective: The current study is aimed at sharing our experiences of 842 patients who presented with Supraventricular tachycardias and were diagnosed by EPS and treated with Radiofrequency catheter ablation. Methods: This descriptive study has been carried out in the cardiac electro physiology Department of NICVD, Dhaka, Bangladesh from 2nd January 2015 to 31st December, 2020. Electrophysiology study(EPS) was carried out to identity and diagnose the mechanism of different SVTs in 842 consecutive patients. RF catheter ablation was used to interrupt the tachycardia circuit. Results: Out of a total 842 patients who underwent Electrophysiology study, 435 were found to have atrioventricular nodal re-entry tachycardia (AVNRT) as underlying mechanism and 391 were having accessory pathway responsible for the reentry mechanism; of these accessory mediated tachycardia, 250 patients were manifested accessory pathway (WPWS); 141 were concealed accessory pathway (out of them 365 were presented with orthodromic and 26 as antidromic reciprocating tachycardia); moreover among the accessory pathway 231 patients were found having left sided accessory pathway whereas 155 having right sided pathway; 12 patients were having focal atrial tachycardia and 4 were found atrial flutter as the underlying cause for SVT. Radiofrequency catheter ablation was used with an overall success rate of 95%, recurrence rate of 2% without any significant complication. Complication: One patient developed pulmonary thrombo-embolism, 6 patients developed DVT of right lower limb, 4 patients developed complete heart block. Conclusion: RF catheter ablation is safe and highly effective mode of treatment of different types of supraventricular tachyarrhythmias which is emerging and becoming popular in our country. Bangladesh Heart Journal 2021; 36(2): 68-73

Skin diseases are frequent and quite perennial in the world, and in some cases, these lead to cancer. These are curable if detected earlier and treated appropriately. An automated image-based detection system consisting of four main modules: image enhancement, region of interest segmentation, feature extraction, and detection can facilitate early identification of these diseases. Diverse image-based methods incorporating machine learning techniques are developed to diagnose different types of skin diseases. This article focuses on the review of the tools and techniques used in the diagnosis of 28 common skin diseases. Furthermore, it has discussed the available image databases and the evaluation metrics for the performance analysis of various diagnosis systems. This is vital for figuring out the implementation framework as well as the efficacy of the diagnosis methods for the neophyte. Based on the performance accuracy, the state-of-the-art method for the diagnosis of a particular disease is figured out. It also highlights challenges and shows future research directions.

The COVID-19 pandemic has generated fear, panic, distress, anxiety, and depression among many people in Bangladesh. In this cross-sectional study, we examined factors associated with different levels of psychological impact as a result of COVID-19 in Bangladesh. From April 1 to 30, 2020, we used a self-administered online questionnaire to collect data from 10,609 respondents. Using the Impact of Event Scale-Revised to assess the psychological impact of the COVID-19 pandemic on respondents, we categorized the levels of impact as normal, mild, moderate, or severe. Ordinal logistic regression was used to examine the associated factors. The prevalence of mild, moderate, and severe psychological impact was 10.2%, 4.8%, and 45.5%, respectively. Multivariate analysis revealed that the odds of reporting normal vs mild, moderate, or severe psychological impact were 5.9 times higher for people living in the Chittagong Division, 1.7 times higher for women with lower education levels, 3.0 times higher among those who were divorced or separated, 1.8 times higher for those working full time, and 2.4 times higher for those living in shared apartments. The odds of reporting a psychological impact were also higher among people who did not enforce protective measures inside the home, those in self-quarantine, those who did not wear face masks, and those who did not comply with World Health Organization precautionary measures. Increased psychological health risks due to COVID-19 were significantly higher among people who experienced chills, headache, cough, breathing difficulties, dizziness, and sore throat before data collection. Our results showed that 1 in 2 respondents experienced a significant psychological impact as a result of the COVID-19 pandemic. Public health researchers should consider these factors when targeting interventions that would have a protective effect on the individual's psychological health during a pandemic or future disease outbreak.

Background: Lung disease is viewed as perhaps the most far reaching and deadly malignancies all throughout the planet. The most seasoned and most crucial technique is based on sputum cytology. The last outskirts for getting sufficient material are fine needle yearning cytology (FNAC) of bronchial development. Aims and Objective: To relate the meaning of sputum cytology and fine needle goal cytology of bronchial tissue under CT rules for diagnosing cellular breakdown in the lungs. Materials and Methods: This potential observational investigation was completed by the division of medication in Chattogram Medical College Hospital, Chattogram, Bangladesh. Where data was collected from January 2019 to June 2020. A total of 50 patients with a suspected history, symptoms, and risk profile of having primary lung cancer, as demonstrated by chest radiography and CT scan, were chosen for the research population. Fifty patients with clinical and biochemical verification of suspected. All collected data were coding and input in SPSS-25 for further analysis. Both descriptive and inferential statistics were tested. Results: Among the 50 patients the vast majority of the patients were 51-60 years of age and the biggest number of the (94 %) patients were male. Sputum cytology is 8% touchy which isn’t steady with different examinations and CT guided FNAC is 94% sensitive. Conclusion: A definitive point of picture guided histological or cytological examination is to stay away from unnecessary thoracotomy and accomplish a particular determination with sensible exactness and least results. So, in this examination we found that sputum cytology is 8% delicate which isn’t steady with different investigations and CT guided FNAC is 94% touchy to last histological analysis of lung cancer. The discoveries recommended that CT guided FNAC discovered to be protected, feasible and viable.

Background: Posterior urethral valve (PUV) is the most common obstructive anomaly of the urethra. Urethral valves have a wide range of clinical and anatomical presentations and today most patients are diagnosed in the prenatal or early neonatal period. Cold knife and diathermy fulguration are two of the technique of PUV ablation. Objective: To find out early outcome of posterior urethral valve ablation between cold knife and diathermy fulguration. Methodology: This prospective comparative interventional study was conducted in the Department of Pediatric surgery in Dhaka Shishu Hospital (DSH), Dhaka. 54 patients with PUV, admitted for valve ablation during study period were included in this study. Patients were divided in to two group. Among them, 27 were in Group-A, whose PUV ablation were done by cold knife and 27 were in Group-B whose PUV ablation were done by diathermy fulguration. Successful ablation was confirmed under endoscopic vision as well as with the demonstration of good stream following supra pubic compression, at the end of the procedure. All patients were kept with 72 hours of urethral catheterization (All silicon self retaining Foley’s catheter according to body texture ) .Post PUV ablation pt. were given discharged with prophylactic antibiotics on 4th POD. Results: The mean age was found 18.37±16.13 months in cold knife ablation group and 12.70±11.03 months in diathermy fulguration group. Significant number (06/22.2%) of cases were associated with residual valve in diathermy fulguration group and non signicant number (301/3.7%) cases in cold knife ablation group . Significant number (04/14.8%) of cases were associated with post PUV ablation stricture urethra also in diathermy fulguration group and no stricture was found in cold knife ablation group . Significant hematuria. was present in 2(7.4%) in cold knife ablation group and 1(3.7%) in diathermy fulguration group. Conclusion: This study concludes that use of cold knife in case of ablation of PUV causes less post ablation obstruction (residual valve and stricture urethra) than using diathermy fulguration and can be regarded a safe and better option for PUV treatment.

Aim: Drug-drug interactions (DDI) can cause unexpected side effects, changes in drug efficacy, metabolism or overall action of any particular drug and DDI is one of the major prescription errors. DDI can be caused by using concomitant administration of a second drug. This study aims to find DDI in prescriptions of 10 different medical specializations of Bangladesh. Study Design and Methodology: This study is based on the evaluation of prescription, type, and clinical significance of drug-drug interaction. For this study, 21088 prescriptions were evaluated from 45 different medical institutions and 10 different specializations including general practitioners, cardiologists, medicine specialists, general surgeons, gynecologists, ENT specialists, neurologists, urologists, pediatricians, and ophthalmologists. After the collection of prescriptions, all prescribed medications were checked by using several sources to point out the probable interactions. Results: Among all the prescriptions most DDI was found from cardiologists (6.17%) and the least DDI was found from pediatricians (3.29%). Clopidogrel and warfarin were the most common medications causing drug interaction while drug interaction with cardiovascular drugs and antibiotics generic were most common among all. Polypharmacy, absence or shortage of pharmacists, workload, miscommunications and lack of knowledge were found as the leading causes of DDI. Conclusion: Active participation of the pharmacist in crosschecking the prescribed medication, proper communication of the physician and patients, relevant workshops regarding DDI and distribution of the workload of the physicians in different levels can play a role in minimizing DDI.

Skin biopsy for histopathology is the most reliable investigation for diagnosis of skin diseases. The main purpose of skin biopsy is to confirm clinical diagnosis but dermatologists usually looking for the concordance with histopathological report. The aim of the study was to observe the consistency of clinical and histopathological diagnosis of skin diseases. An observational study was conducted on 630 patients that undertaken skin biopsy and that was performed at the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University from January 2018 to January 2019. Patients who were advised for biopsy by outpatient and inpatient department and the biopsy was done accordingly was included in the study. Finally the inclusion was confirmed when the histopathological report was available. Demographic information, clinical diagnosis, type of biopsy procedure, types of specimen taken and send for histopathological procedure and the histopathological diagnosis was noted in data collection sheet. Histopathological diagnosis and its correlation with clinical diagnosis was assessed for consistency and it was the main outcome measure of the study. The mean age of patients on whom biopsy was performed was 35.14 ±16.57 years and the age range was 5-82 years. Male patients outnumbered female and the male to female ratio was 1.15: 1. Three types of biopsy were performed among them incisional biopsy was the commonest type (93.5%). In most of the cases collected specimen was skin 94.76%, others type of specimens were mucous membrane 2.6%, nail matrix 1.9% and 0.6% specimen was hair follicle. Among the cases 71.43% was diagnosed clinically. The common clinical diagnosis in which biopsy was done was psoriasis and its types 17.77%, lichen planus and its variants 14.12%, the connective tissue diseases 6.19% and infectious diseases 5.39%. In 79.52% cases histopathological diagnosis was done and 68.22% diagnosis was consistent with the clinical diagnosis. The maximum clinico-pathological concordance was found in vesiculo-bullous disease 93.33%. Then connective tissue diseases 79.48%, vasculitides 75% and lichenoid diseases 73.56%. Skin biopsy is a conclusive tool to overcome diagnostic dilemmas in dermatological diseases. The clinico-pathological concordance is assumed lower than the expectation of dermatologists but the collective efforts of dermatologists and pathologists can improve the capacity of diagnosis of biopsy samples. Bangladesh Med J. 2020 Sept; 49(3) : 29-34

Background: The increasing trend in multisystem inflammatory syndrome in children (MIS-C) during Covid-19 pandemic is alarming. Understanding the clinical course and outcome will give the clinical and public health implications of this syndrome. Objectives: This study was conducted to find out the clinical presentation, course of the disease and outcome of the children and adolescents of MIS-C. Methods: This observational study was conducted in the department of Pediatric Nephrology, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh, from August 2020 to October 2020. Total 12 children of MIS-C diagnosed according to WHO diagnostic criteria of MIS-C were included after taking written informed consent from the parents. Mean, median and standard deviation were calculated for the continuous variables. Results: The age ranged from 17 days to 13 years, 56% were male, 17% were positive for SARS-CoV-2 by RT-PCR and 4(33%) had history of the COVID-19 exposure. Organsystem involvement included bilateral pneumonia in 92%, myocarditis in 78%, swollen hands and feet in 67%, mucocutaneous involvement in 50%, diarrhea in 50%, musculoskeletal involvement in 50%, acute kidney injury (AKI) in 33% patients and acute pancreatitis in 25% patients. The median duration of hospitalization was 11 days and ICU stay was 5 days. Mean duration of fever was 8.66 days. Kawasaki’s diseaselike features were documented in 50% patients and 4 of them had elevated level of procalcitonin and troponin I. Markedly elevated C reactive protein (CRP), Ferritin and D dimer in all patients were present. All patients with cardiac involvement had left ventricular dysfunction and ejection fraction was as low as 38.5%. Coronary-artery dilatation was documented in 33%. About 67% received intensive care with oxygen support by low flow nasal cannula or face mask, 33% received vasoactive support and systemic glucocorticoid, 50% received intravenous immunoglobulin (IVIG) plus methyl prednisolone. Antiplatelet and anticoagulant therapy was given in 75% and 33% patients respectively. Out of 12 patients 2 died, the contributing cause of death included complications like hypotension, shock, myocarditis, coagulopathy and AKI. Conclusion: MIS-C led to serious and life-threatening complications especially when there are cardiac involvement, hypotension and acute kidney injury. DS (Child) H J 2020; 36(2): 87-94

While the global coronavirus crisis worsens, a surprising feature of the disease appears that children might be immune from the worst form of it. Studies suggest that COVID- 19 is more likely to infect older adult men, particularly those with comorbidities. There is only limited data detailing the effects of COVID-19 on the pediatric population. Patients with underlying cardiovascular comorbidities are at increased risk of morbidity and mortality from SARS-CoV-2 infection. Certain adult patients with congenital heart disease (ACHD) and with complex congenital heart disease can be considered as high risk for complications related to COVID-19 infection on the basis of decreased functional reserve. While no study on COVID-19 has been included paediatric patients with congenital heart disease, it stands to reason that patients with congenital heart disease can be considered at higher risk for complications from COVID-19. Given the increased risk for severe COVID-19 in adults with underlying cardiac disease, there is concern that patients with congenital heart disease (CHD) may likewise be at increased risk for severe infection, as they are known to have higher risk for complications with viral illnesses including respiratory syncytial virus and influenza. DS (Child) H J 2020; 36(2): 138-145

Objective: Maternal active smoking is significantly associated with an increased risk of congenital heart defects (CHDs), but the association between maternal passive smoking and risk of CHDs is inconclusive. This study was conducted to evaluate the effect of passive smoking and the risk of development of CHD among Bangladeshi population. Methodology: It was a case control study, conducted from July 2018 to July 2019 in Paediatric Cardiology department of Dhaka Shishu (Children) Hospital. Parents of the children with CHD visiting the out-patient department of Dhaka Shishu Hospital was considered as cases. Controls were taken from parents of the children who don’t have congenital heart disease. Face-to-face interviews were conducted to collect information on maternal active and passive smoking. Data was collected by using a structured questionnaire containing all the variables of interest and analyzed by using SPSS version 21. Chi square test (ꭓ2), Odds ratio (OR) and 95% confidence intervals (CIs) were calculated to estimate the associations between maternal passive smoking and all CHDs. Risk factors on bivariate analysis were introduced into a logistic regression model as independent factors and dependent variable was CHDs to find out the association between CHDs and maternal passive smoking. Results: Among case group no mother was active smoker, 51.9% were passive smoker and most of the cases source was husband, 19.6% took smokeless tobacco or green tobacco, 55.8% took tea and 5.8% took coffee during pregnancy period. On logistic regression analysis passive smoking (p=0.019) was independently associated with CHDs. Mother with passive smoking exposure had 1.5 times risk of developing CHDs compared to those who were not exposed. Conclusions: Passive smoking is significantly associated with CHDs.

Previous studies suggested that COVID-19 is more likely to infect older adults, particularly those with chronic comorbidities. However in Bangladesh, paediatric patients are on the rise. Three percent of children less than 10 years were identified as having COVID-19 infection. Though over 90% of the cases were mild or moderate in nature but many of them required hospital admission. So it appeared that local situation in Bangladesh seems to be different. This study was carried out to find out hospital experiences and impact of COVID-19 in child health in Bangladesh. Data were collected from three tertiary care hospitals of Bangladesh dealing majority of COVID-19 infected children. The hospitals were Dhaka Shishu (Children) Hospital, Dhaka Medical College Hospital and Mugda Medical College Hospital. As COVID-19 outbreak also adversely affecting different services among the children of Bangladesh, review was done to evaluate essential health delivery services especially routine immunization. Total 422 children were included from three tertiary care hospitals. They were predominantly male. Children of all age groups were infected. Significant numbers of children were admitted with moderate to severe illness (moderate 42.89%, severe 35.78% and critical 16.11%) with some casualties (mortality 4.27%). Routine immunization has already been hampered and threatened a significant increase in child mortality due to Vaccine Preventable Disease (VPD) in coming days. Paediatric patients were on the rise and unfortunately we noticed large number of hospital admission and some casualties already. Essential health care services should be preserved to prevent avoidable losses of child lives during the COVID-19 pandemic and to protect progress in reducing child mortality achieved over recent years.

Varicose vein is one type of venous insufficiency that presents with any dilated, elongated, or tortuous veins caused by permanent loss of its valvular efficiency. Destruction of venous valves in the axial veins results in venous hypertension, reflux, and total dilatation, causing varicosities and transudation of fluid into subcutaneous tissue. The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens. Evidence of surgical intervention was found in the 1860s. However dramatic advances of varicose vein management occurred in the latter half of twentieth century. Varicose veins affect from 40 to 60% of women and 15 to 30% men. Multiple intrinsic and extrinsic factors including age, gender, pregnancy, weight, height, race, diet, bowel habits, occupation, posture, previous DVT, genetics, and climate are considered to be the predisposing factors for formation of varicose vein. Other reported factors are hereditary, standing occupation, chair sitting, tight underclothes, raised toilet seats, lack of exercise, smoking, and oral contraceptives. Common symptoms are unsightly visible veins, pain, aching, swelling, itching, skin changes, ulceration, thrombophlebitis, and bleeding. The signs of varicose vein disease are edema, varicose eczema or thrombophlebitis, ulcers (typically found over the medial malleolus), hemosiderin skin staining, lipodermatosclerosis (tapering of legs above ankles, an “inverted champagne bottle” appearance), and atrophie blanche. Varicose vein is classified according to CEAP classification, the components of which are clinical, etiological, anatomy, and pathophysiology. The revised CEAP classification was published on 2020 based on four principles which were preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based medicine, and practicality.

Background The unprecedented COVID-19 pandemic has become a global burden disrupting peoples' quality of life. Students being an important cohort of a country, their mental health during this pandemic has been recognized as a concerning issue. Therefore, the prevalence and associated risk factors of Bangladeshi students' mental health sufferings (ie, depression, anxiety, and stress) are systematically reviewed herein for the first time. Methods Adhering to the PRISMA guideline, a systematic search was performed from 1 to 5 April, 2021 in several databases including PubMed; and finally, a total of 7 articles were included to this review. Results The prevalence rates of mild to severe symptoms of depression, anxiety, and stress ranged from 46.92% to 82.4%, 26.6% to 96.82%, and 28.5% to 70.1%, respectively. The risk factors concerning mental health problems included the factors related to (i) socio-demographic (younger age, gender, lower educational grade, urban residence, family size, currently living with family/parents, and having children in the family), (ii) behavior and health (smoking status, lack of physical exercise, more internet browsing time, and dissatisfaction with sleep), (iii) COVID-19 pandemic- (COVID-19 related symptoms, COVID-19 related perceptions, and fear of COVID-19 infection), (iv) miscellaneous (losing part-time teaching job, lack of study concentration, agitation, fear of getting assaulted or humiliated on the way to the hospital or home, financial problems, academic dissatisfaction, inadequate food supply, higher exposure to COVID-19 social and mass media, engaging with more recreational activities, and performing more household chores). Conclusion The overall assumption of mental disorders' prevalence rates can be regarded as problematic to this cohort. Thus, the authorities should consider setting up possible strategies to diminish the pandemic effect on students' mental health.

Background: Non-ST elevation myocardial infarction (NSTEMI) patients like other patients with acute coronary syndrome (ACS) need assessment of severity of coronary artery disease (CAD) for prognostication and management. The available scoring systems are complex and include invasive parameters. On the other hand, potassium is a key element and its blood level has been shown to reflect health and disease of vasculature including in some ACS. Objective: The study was conducted to find out the relationship between serum potassium level and angiographic severity of CAD in NSTEMI. Method: A total of 200 cases of NSTEMI patients undergoing coronary angiography (CAG) were included. Patients getting medications that alter potassium homeostasis (e.g., diuretics, glucocorticoids, intravenous insulin), having renal impairment, haematological or liver disease, congenital or valvular heart disease, cardiomyopathy, prior percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were excluded. Serum potassium was measured soon after admission with NSTEMI, and the patients were divided: mid to high normal (4 to 5.5 mmol/L) constituted the group I and low normal (3.5-3.9 mmol/L) constituted the group II. CAG was done during index admission, SYNTAX score calculated and compared between 2 groups. Results: High SYNTAX score was significantly more commonly found in group I than in group II (62.1% vs. 14.7%, p

Background Stroke is a sexually dimorphic disease. Previous studies have found that young females are protected against ischemia compared to males, partially due to the protective effect of ovarian hormones, particularly estrogen (E2). However, there are also genetic and epigenetic effects of X chromosome dosage that contribute to stroke sensitivity and neuroinflammation after injury, especially in the aged. Genes that escape from X chromosome inactivation (XCI) contribute to sex-specific phenotypes in many disorders. Kdm5c and kdm6a are X escapee genes that demethylate H3K4me3 and H3K27me3, respectively. We hypothesized that the two demethylases play critical roles in mediating the stroke sensitivity. Methods To identify the X escapee genes involved in stroke, we performed RNA-seq in flow-sorted microglia from aged male and female wild type (WT) mice subjected to middle cerebral artery occlusion (MCAO). The expression of these genes (kdm5c/kdm6a) were confirmed in four core genotypes (FCG) mice and in post-mortem human stroke brains by immunohistochemistry (IHC), Western blot, and RT-PCR. Chromatin immunoprecipitation (ChIP) assays were conducted to detect DNA levels of inflammatory interferon regulatory factor (IRF) 4/5 precipitated by histone H3K4 and H3K27 antibodies. Manipulation of kdm5c/kdm6a expression with siRNA or lentivirus was performed in microglial culture, to determine downstream pathways and examine the regulatory roles in inflammatory cytokine production. Results Kdm5c and kdm6a mRNA levels were significantly higher in aged WT female vs. male microglia, and the sex difference also existed in ischemic brains from FCG mice and human stroke patients. The ChIP assay showed the IRF 4/5 had higher binding levels to demethylated H3K4 or H3K27, respectively, in female vs. male ischemic microglia. Knockdown or over expression of kdm5c/kdm6a with siRNA or lentivirus altered the methylation of H3K4 or H3K27 at the IRF4/5 genes, which in turn, impacted the production of inflammatory cytokines. Conclusions The KDM-Histone-IRF pathways are suggested to mediate sex differences in cerebral ischemia. Epigenetic modification of stroke-related genes constitutes an important mechanism underlying the ischemic sexual dimorphism.

Background: The feeling of hopelessness begins immediately after the diagnosis & continues through the treatment. Caring and treatment of a child with cancer brings an enormous physical, psychological, social & economical burden upon the family. Objective: The objective of the study was to assess the level of hopelessness of the parents with a child suffering from cancer. Materials and Methods: The study was conducted among 217 parents with childhood cancer among which 129 were mothers and 88 were fathers, recruited from the Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital, Dhaka from January 2018 to November 2018. The research participants were selected following the convenient method of sampling on the basis of defined selection criteria. The data were collected by face to face interview of the respondents respectively maintaining privacy and confidentiality using a questionnaire called Beck Hopelessness Scale. The research instruments were interviewer's questionnaire and hopeless measuring standard scales. Results: A total 19.4 %( n=42) had severe hopelessness and 4.6%(n=10) had minimal hopelessness status. That, mothers were more severely affected by hopelessness than fathers. Among the 19.4% of the parents with severe hopelessness 2 28.7%,(n =37) were mothers and only 5.7%,(n=5) were fathers. That parents who were less educated were more severely affected by hopelessness than higher educated parents. Conclusion: Efficiently designed investigations are important to assess and treat psychological distress of the parents with childhood cancer patient. KYAMC Journal Vol. 11, No.-4, January 2021, Page 184-188

Back ground: Abdominal lipoblastomas which are benign but uncommon soft tissue tumors in children rarely arise from the mesentery.However, benign, these may attain in large size and cause compression symptoms. Complete resection and close post-operative monitoring are necessary for avoidance of recurrence. Histopathology with immunohistochemistry in conjunction with the morphology is the gold standard for diagnosis. Herein such a rare a case of mesenteric lipoblastoma with huge abdominal distention is reported. Case presentation: A 2-year-old girl presented with an enormous abdominal swelling occupying almost all quadrants of the abdomen with repeated dull abdominal pain. The swelling was a non-tender and tensely cystic. USG and CT Scan could not distinguish the proper origin or location of the mass but demonstrated as a large encapsulated and lobulated fatty mass measuring about (16.4x10.0x18.6cm) involving right hypochondriac, epigastric, bilateral ilio-lumber, umbilical & hypogastric regions, pushing the bowel loops upward & laterally with mild mesenteric thickening of perilesional mesentery and separated from the liver & both kidneys and other intraabdominal organs. After exploratory laparotomy there revealed a well capsuled large (about 15x11x14cm)soft yellow mass displacing the entire intra-abdominal contents, connected by a single vascular pedicle with the mesentery and loosely enclosing the mesentery as a whole. Histology and immunohistochemistry of completely resected mass conûrmed the presence of mature adipocytes and immuno-morphology was compatible with Lipoblastoma. Conclusion: This case represents one of the largest mesenteric lipoblastomas in accordance to the patient’s age that histologically, mostly composed of mature adipocytes with few lipoblasts. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 54-57

Background: Malnutrition is widely recognized as a major health problem in children in developing country. Malnutrition is a serious public health problem that has been linked to increase risk of morbidity and mortality .Many factors can cause malnutrition, most of which relate to poor diet, family size, family income, repeated ARI and diarrhea that may or may not causes electrolytes changes, particularly in underprivileged populations. Objective: To determine the serum electrolyte disturbances in malnourished under 5 children with or without diarrhea. Methodology: This is a descriptive study and conducted among 100 under 5 malnourished children of randomly selected in admitted patient of Dhaka Shishu Hospital. It was carried out during January-2015 to December-2017. They were suffering from different grades of malnutrition with or without diarrhea. On the basis of history, physical examination and anthropometrics measurement they were divided into Group A patients (n=56) who were malnourished but had diarrhoea and Group B patients (n=44) who were also malnourished and had no diarrhoea. Serum electrolytes were done in patients of both groups and the results were analyzed statistically by using SPSS windows programs 21. Results: Analysis of serum electrolytes in both groups that hyponatremia and hypokalemia were seen more frequently in patients of group A as compared to group B. In group A hyponatremia was seen in 41 patients (71.92%) while it was observed in 16 patients (28.07%) in group B (p

Different mechanisms of lung injury in COVID-19 have been described, like viral to immune-mediated mechanisms. Lung injury can be either subsequent to chronic inflammation or an idiopathic and genetically influenced process. Pulmonary fibrosis can occur with acute lung injury & a known sequela to ARDS. However, persistent radiological abnormalities after ARDS are of little clinical significance and have dwindled with protective lung ventilation. Pulmonary fibrosis is associated with permanent pulmonary architectural distortion and irreversible lung dysfunction. Available clinical, radiographic, and autopsy data has indicated that pulmonary fibrosis is central to severe acute respiratory distress syndrome (SARS) and MERS pathology, and current evidence suggests that pulmonary fibrosis could also complicate infection by SARS-CoV-2 The aim of this review is to explore the current literature on the pathogenesis of lung injury in COVID-19 infection, its risk factors & to find out the possible effective therapy within the existing medication. After literature review, we conclude that, currently there are no approved therapies for SARS COV2. Trials are based on drugs that are already approved for other diseases, have acceptable safety profiles or have been effective in animal studies against the other two highly pathogenic coronaviruses. Apart from the potent use of antivirals to reduce the viral effects, the use of antifibrotic therapies could also be under consideration based on the pulmonary fibrotic disease observed after COVID-19 recovery. Pirfenidone and Nintedanib are the two approved anti fibrotic drugs for Idiopathic Pulmonary Fibrosis (IPF). Despite having different modes of action, both are effective in attenuating the rate of lung function decline and are widely considered to improve life expectancy. J MEDICINE JAN 2021; 22 (1) : 46-50

Introduction: Peritonitis secondary to gastrointestinal perforation is one of the commonest surgical emergencies encountered all over the world. This study was done to highlight the spectrum of perforation peritonitis encountered in surgery unit of Dhaka Medical College Hospital. Method: It was observational prospective of 100 cases of perforation peritonitis treated in our hospital. All cases of perforative peritonitis whether spontaneous, infective or neoplastic pathology were included in this study. Results: The maximum numbers of patients were in age group between 31 to 40 years (39 %) with mean age 35 years. Male female ratio was 9:1. The most common aetiology of perforation peritonitis was peptic ulcer disease (73%) followed by enteric fever (12%), appendicitis (10%), tuberculosis (3%) and malignancy (2%). The most common sites of perforation were in descending order of frequency - first part of the duodenum (65%), terminal ileum (12%), appendix (10%), gastric antrum (9%), jejunum (3%) and rectum (1%). Abdominal pain (100%) and vomiting (81%) were the most common symptoms while tachycardia (96%), muscle guard and rigidity (100%) were the common signs. Approximately 15-20% presented late with features of shock. Mortality rate was 2% and was significantly high in patients coming hospital late. Conclusion: Gastrointestinal perforations are one of the most common surgical emergencies. Duodenal perforations are most common. Ileal perforations secondary to enteric fever have highest morbidity. Early recognition and timely appropriate intervention is very important in reducing morbidity and mortality. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 106-109

Background: The platelet transfusions help in prevention of bleeding related complications and thus prevents morbidity and mortality in thrombocytopenic patients. Platelet transfusion plays an important role in the treatment of haematological, oncological, surgical, and transplant patients. Platelets are transfused by two methods i) by fractionation of whole blood and ii) by platelet apheresis. Over the last decade there has been a trend towards the use of SDPs rather than pooled random donor platelets in thrombocytopenic patients. Optimization of platelet yield is an emerging issue to identify factors which may help in selecting donors to obtain higher platelet yields in shorter time and consequently better clinical outcome. Objective: The quality of single donor platelets (SDP) in terms of yield influences the platelet recovery in the recipient. The aim was to identify the SDP donor factors that influence platelet yield. Methods: The study was undertaken at transfusion medicine department, DMCH from 1st January 2017 to 31st December 2017. The study included 350 plateletpheresis procedures. All procedures were performed according to manufacturer’s manual and standard operating procedure. Results: During the period of study, 350 platelet pheresis donors were studied. All of the donors were male. Platelet yield showed high statistical significance with pre donation platelet count and its indices. (p=0.000). Statistical significant negative correlation was seen between pre donation Hb concentration and the platelet yield. (p =0.005). No statistical significance was seen height (p=0.933), weight (p=0.760) of donor on platelet yield. Conclusion: Platelet recovery in the patient is influenced by the transfused dose of platelets, which in turn is dependent on the quality of the platelet product in terms of yield. Various donor factors such as pre donation platelet count and haemoglobin concentration may affect platelet yield. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 179-183

COVID-19 caused by SARS COV-2 is a major threat to man kinds. Rapid identification of cases and isolation are vital for containments of rapidly spreading disease.Clinical data on COVID 19 in Bangladesh is lessThe objectives of the study were to evaluate the Demographic profile of Corvid 19 positive Bangladeshi patients and also to see their clinical outcome within defined period. We conducted a retrospective descriptive study on epidemiological & clinical profile along with short term treatment outcomes of 729 COVID 19 patients from COVID dedicated unit including Ward/Cabin, HDU & ICU of Evercare Hospitals Dhaka during the period of 1st May June to 31st October 2020 (6 months) Total 729 COVID-19 cases were enrolled after getting the result positive for RT-PCR. After collection, data were analyzed to show demographic profile of patients and their outcome after treatment.Among 729 cases, 453 (62%) were male and 276 (38%) were female. The most prevalent affected age groups were 50-64 (32%) . Patients in 15-29 years age group, 52 (10%) in 30- 49 years, 218 (29%). in 50- 64 years of age 247(32%) and in 65 above of age 212(29% Mean age is 52.2±2. Among the total admitted cases in different facilities only 79 patient expired .among them 48 patients was male and 31 was female of different age group. Bangladesh J Medicine January 2021; 32(1) : 25-30

Background: Acute kidney injury can occur among the younger children due to different reasons. Objective: The purpose of the present study was to find out the risk factors and primary disease responsible for acute kidney injury among younger children. Methodology: This cross-sectional study was conducted in the Department of Paediatric Nephrology with the collaboration of Paediatric Gastroenterology, Paediatric Neurology, Paediatric Neonatology and Microbiology and Immunology at Bangabandhu Sheikh Mujib University, Dhaka, Bangladesh from May 2018 to July 2019 for a period of one year. Patients with the age group of 1 month to 17 years who were at risk of AKI, and admitted in the inpatient department of Pediatrics and allied at Bangabandhu Sheikh Mujib University, Dhaka, Bangladesh in both sexes were selected as study population. To detect AKI, serum creatinine was measured at 0 h (baseline), 48 h and 5th day respectively. Result: A total number of 42 patients, who fulfilled the inclusion criteria were enrolled in this study. The risk factors of AKI was mainly pre renal in 60% (n=9) cases, mostly due to nephrotoxic drugs followed by hypovolemia. Renal causes were in 40% (n=6) cases. Among these 50% cases due to amikacin and 50% cases due to use of radiocontrast agent. Most patients were with renal disease which was 30(58%) cases. Among them 28(93.0%) cases were nephrotic syndrome and 2(7.0%) cases were hydronephrosis. However, 7(13%) cases were cardiac disease presented with congenital heart disease who used radiocontrast agent. Conclusion: In conclusion most common risk factors of acute kidney injury among younger children is pre-renal causes which are due to nephrotoxic drugs. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 42-46

Gastrointestinal (GI) parasitic infection is considered a common problem in sheep and goat production in Bangladesh. The current investigation was undertaken to determine the prevalence of GI parasitic infection and its associated risk factors (e.g., age, sex, nutritional & deworming status etc.) in sheep and goats of the Sandwip Island, Chattogram, Bangladesh. A total of 330 faecal samples of which 220 sheep and 110 goats were taken using a random sampling method. All the samples were subjected to routine coproscopy (e.g., direct smear, flotation and sedimentation) to detect the eggs/oocysts of helminths and protozoan parasites. Results demonstrated that the overall prevalence of GI parasitic infections was 68.64% in sheep and 61.82% in goats. The frequency of nematodes and trematodes was higher in comparison to cestodes and protozoan infections in both sheep and goats of all the three study areas. Age-specific prevalence demonstrated that adult goats had significantly higher GI parasitic infections in comparison to the young population. Female sheep were more prone to GI parasitic infections whereas the opposite trend was noticed for goats. The sheep and goats having the ‘poor’ body condition score/nutritional status were more susceptible to parasitic infections compared to moderate and good health conditions. Rarely or non-dewormed sheep and goats also harboured more GI parasites compared ‘dewormed animals’. The current investigation was fresh of its types in the study areas, therefore, we recommended extensive studies including epidemiological and molecular approaches to identify GI parasitic diseases and their associated risk factors., Gastrointestinal (GI) parazit enfeksiyonu, Bangladeş'te koyun ve keçi yetiştiriciliğinde yaygın bir sorun olarak kabul edilmektedir. Mevcut araştırma, Bangladeş'in Chattogram yöresindeki Sandwip Adası koyun ve keçilerinde GI parazit enfeksiyon prevalansını ve ilişkili risk faktörlerini (örneğin, yaş, cinsiyet, beslenme ve parazitlerden arındırma durumu vb.) belirlemek için yapıldı. Rastgele örnekleme yöntemiyle 220 koyun ve 110 keçi olmak üzere toplam 330 dışkı örneği alınmıştır. Helmintlerin ve protozoan parazitlerin yumurtalarını / ookistlerini tespit etmek için tüm numuneler rutin dışkı muayenesine (örn., Doğrudan yayma, yüzdürme ve sedimantasyon) tabi tutulmuştur. Sonuçlar, GI paraziter enfeksiyonların genel prevalansının koyunlarda %68.64 ve keçilerde %61.82 olduğunu göstermiştir. Nematod ve trematod prevalansı, üç çalışma alanının her ikisinde de hem koyun hem de keçilerde sestod ve protozoan enfeksiyonlarına kıyasla daha yüksek bulunmuştur. Yetişkin keçiler, genç popülasyona kıyasla önemli ölçüde daha yüksek GI parazit enfeksiyonları göstermiştir. Dişi koyunlar GI parazit enfeksiyonlarına daha yatkın olmasına rağmen, keçilerde bunun tersi bir eğilim tespit edildi. Vücut kondisyon puanı / beslenme durumu kötü olan koyun ve keçiler, orta ve iyi sağlık koşullarına göre paraziter enfeksiyonlara daha duyarlı olduğu belirlendi. Nadiren arındırılmış ya da parazitlerden arındırılmamış koyun ve keçiler, "parazitlerden arındırılmış hayvanlara" kıyasla daha fazla GI paraziti barındırdığı ortaya konmuştur. Mevcut araştırma, çalışma alanlarında tespit edilen türler bakımından ilkdir, bu nedenle, GI paraziter hastalıkları ve bunlarla ilişkili risk faktörlerini tanımlamak için epidemiyolojik ve moleküler yaklaşımları içeren kapsamlı çalışmaların yapılması önerilmektedir.

not available DS (Child) H J 2019; 35(2) : 94-99

Background: Recently it has been apprehended that sildenafil, a drug which has been successfully using in the treatment of PPHN and erectile dysfunction in adult, is going to be withdrawn from the market of Bangladesh due to threat of its misuses. Objective: The aim of this study was to see the extent of uses of sildenafil in the treatment of PPHN and importance of availability of this drugs in the market inspite of its probable misuses. Methods: This cross sectional study was conducted in neonatal intensive care unit (NICU), special baby care unit (SCABU) and cardiac intensive care unit (CICU) of Dhaka Shishu (Children) Hospital from June, 2017 to May 2018. Neonates with PPHN were enrolled in the study. All cases were treated with oral sildenefil for PPHN along with others management according to hospital protocol. Data along with other parameters were collected and analyzed. Results: Total 320 patients with suspected PPHN were admitted during the study period. Among them 92 (29%) cases had PPHN. Male were 49(53 %) cases and female were 43(47%) cases. Mean age at hospital admission was 29.7±13.4 hours. Based on echocardiography,13(14%) cases had mild, 38 (41%) cases moderate and 41(45%) cases severe PPHN. Mean duration of sildenafil therapy was 11.9±7.1 days. Improved from PPHN were 83 (90%) cases. Mortality was 10% (9). Conclusion: In this study it was found that the incidence of PPHN is 29% among the suspected newborns. Sildenafil is successfull in improving the oxygenation of PPHN and to decrease the mortality of neonates. DS (Child) H J 2019; 35(2) : 100-104

Peripheral spondyloarthritis is a variant of spondyloarthritis which usually has a chronic course. There is an increased risk of cardiovascular diseases among patients with chronic inflammatory diseases in general. Coexisting diabetes mellitus can potentially add to the risk. The objective of this study was to determine the frequency of glucose intolerance in patients with spondyloarthritis The study was conducted among 35 participants with peripheral spondyloarthritis who visited the Department of Rheumatology, Enam Medical College & Hospital, Savar, Dhaka, Bangladesh from September, 2018 to January, 2020. The participants underwent either oral glucose tolerance test or estimation of HbA1C. The mean age of participants was 43.96 years. The majority (80%) of them were young to muddle-aged (≤40 years). 22.9% of the participants were prediabetic. Diabetes mellitus was found to be present in 37.1% of the participants. There was no significant difference between the study population and the general population in terms of frequency of prediabetes. But the frequency of diabetes in the study population was higher than that in the general population. There was no significant difference between males and females with regard to the frequencies of prediabetes and DM. Moreover, there was no significant difference in the frequencies of prediabetes and DM between young and middle-aged to elderly population. Considering the greater burden of DM among patients with peripheral spondyloarthritis across all age groups, routine screening for DM may be indicated in these individuals.

Introduction: Intussusception is very common in childhood between the ages of 5 months to 1 year. In adults it is a rarity, in whom it commonly presents with a nonspecific, repeated, chronic or subacute intestinal obstruction. Ninety percent of them have a variable number of secondary pathological ‘lead point’- from benign lesion to malignant.5 Objective: This study aims to find out the variations & the commonest ‘Lead points’ in rare adult intussusceptions. Methodology: Study period was from January 2015 to June 2019. All patients of adult intussusceptions, admitted in Shaheed Suhrawardy Medical college Hospital, were examined, investigated, & analysed peri-operative findings with post-operative histopathological results, in this prospective observational study. Result: In this study, among 15 patients, GIST found to be the commonest (46%) Lead point in adult intussusceptions. Others include Adenocarcinoma, Leiomyomatous polyp, Meckel’s Diverticulum, intestinal TB, etc. Male was mostly sufferer (67%). Ileoileal (II) variety was found more in male & Ileocecal (IC) variety in female. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 138-141

Laparoscopic inguinal hernia repair has become popular as an alternative to open surgery. The classical TEP technique is the laparoscopic technique of hernia repair which is considered closest to ideal for inguinal hernia repair, but this technique has several drawbacks such as limited space for dissection and mesh placement, restricted port placement, a low tolerance of accidental pneumoperitoneum, and difficulty in teaching and learning the technique. Extendedview modification, the eTEP technique, which overcomes several of these drawbacks. The eTEP approach can quickly and easily create an extraperitoneal space, enlarge the surgical field, provide a flexible port setup adaptable to many situations, allow unencumbered parietalization of the cord structures , ease the management of the distal sac in cases of large inguinoscrotal hernias, and improve tolerance of pneumoperitoneum, which is a common complication. The purpose of this study was to evaluate the safety and effectiveness of eTEP procedure with placement of polypropylene mesh and fixation by tackers. Method : It was a observational study of 25 cases. The study was conducted in Shaheed Suhrawardy Medical College Hospital, Dhaka from July 2018 to June 2019. Sociodemographic status, operation time, peroperative blood loss, unwanted events like peritoneal tear, vessel injury, nerve injury, duration of hospital stay, postoperative pain and urinary retention were recorded. All the patients were followed up for at least 3 times at the end of 1st week, 1st month and 3rd month. Any surgical site infection, mesh infection, seroma, scrotal swelling, severity of pain according to visual analogue scale, haematoma and recurrence within this time was recorded. All the data were analyzed on SPSS. Result : Among the 25 patients average time of operation was 1 hour and 35 minutes, peroperative blood loss was below 20 ml in all patients, peritoneal tear occurred in 2 patients, 1 vessel injury but no nerve injury was observed during the procedure. One patient had mild chronic pain even after the end of 3rd month. One patient developed scrotal swelling which subsided by the end of 1st week. No SSI, mesh infection, seroma, wound hematoma, and recurrence found within this period. Conclusion : This study showed that, eTEP procedure is cost effective, has minimum complication with easier learning. In the hands of an experienced surgeon, eTEP repair can be safe and effective. New study can be done to find out it’s effectiveness in incisional hernia in lower abdomen and bilateral inguinal hernia. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 96-100

Inter-individual genetic makeup can trigger variability in platinum-based chemotherapeutic responses and corresponding adverse drug reactions and toxicities. Exploring the genetic causes behind these inter-individual variabilities in platinum-based chemotherapeutic responses by investigating the effects of GSTP1 (rs1695), XRCC1 (rs25487), XPC (rs2228001) and ERCC1 (rs11615) genetic polymorphisms on toxicity and therapeutic response of this treatment among Bangladeshi advanced non-small cell lung cancer (NSCLC) patients was the aim of this study. 285 Clinically proven either stage IIIB or IV (advanced) NSCLC patients aging not less than 18 years old and receiving platinum-based chemotherapy were recruited to assess the influence of these four single nucleotide polymorphisms (SNPs) on peripheral leukocytes. Toxicity and response were evaluated by multivariate regression analyses using SPSS statistical software (version 17.0). XRCC1 (rs25487) polymorphism was found to act as a predictive factor for not only grade 3 and 4 anemia (p = 0.008), neutropenia (p = 0.010), thrombocytopenia (p = 0.025) and gastrointestinal toxicity (p = 0.002) but also for therapeutic response (p = 0.012) in platinum-based chemotherapy. Although GSTP1 (rs1695) polymorphism might serve as prognostic factor regarding grade 3 or 4 neutropenia, a significant (p = 0.044) improvement in response to platinum-based chemotherapy was observed. However, XPC (rs2228001) and ERCC1 (rs11615) polymorphisms could not establish any significant relation with toxicity or therapeutic response. XRCC1 (rs2228001) and GSTP1 (rs1695) polymorphisms might explain platinum-induced clinical outcomes in terms of both toxicity and therapeutic response variations among Bangladeshi advanced NSCLC patients.

The customised birthweight model can be used to improve detection of babies that may be at risk of adverse outcomes associated with abnormal growth, however it is currently used in conjunction with either an intrauterine growth standard or the individualised birthweight ratio (IBR), both of which have significant methodological flaws. Our aim was to investigate the statistical validity of the IBR and attempt to develop a new measurement to represent the appropriateness of an infant's size at birth that will support clinicians in identifying infants requiring further attention.Routinely collected hospital maternity and neonatal data on singleton, term births from a tertiary Australian hospital were extracted for the time period 1998-2009. The relationships between birthweight, customised birthweight and IBR are investigated using correlation, regression analysis and division of births into groups of 2500 g, 2500-4000 g and 4000 g. A new measure, the Birthweight Appropriateness Quotient (BAQ), is developed. The utility of the BAQ is compared with IBR and birthweight to identify infants with a composite neonatal morbidity outcome.Statistical flaws with the IBR due to significant correlation between birthweight and customised birthweight and a heterogenous relationship between these two measurements across the range of birthweight are present. BAQ is uncorrelated with birthweight. Comparison of BAQ and IBR as indicators of adverse neonatal outcome demonstrates that BAQ identifies babies at risk due to their small size and those babies at risk due to inappropriate size.BAQ is a customised measurement of an infant's size free of the statistical flaws experienced by the IBR with the ability to identify at-risk infants.

Background: Obstructive sleep apnea is currently the most common sleep breathing disorder worldwide. In recent years, social media has emerged as a major contributor to the spread of health informa...

Coronavirus disease‐19 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), is one of the most contagious diseases in human history that has already affected millions of lives worldwide. To date, no vaccines or effective therapeutics have been discovered yet that may successfully treat COVID‐19 patients or contain the transmission of the virus. Scientific communities across the globe responded rapidly and have been working relentlessly to develop drugs and vaccines, which may require considerable time. In this uncertainty, repurposing the existing antiviral drugs could be the best strategy to speed up the discovery of effective therapeutics against SARS‐CoV‐2. Moreover, drug repurposing may leave some vital information on druggable targets that could be capitalized in target‐based drug discovery. Information on possible drug targets and the progress on therapeutic and vaccine development also needs to be updated. In this review, we revisited the druggable targets that may hold promise in the development of the anti‐SARS‐CoV‐2 agent. Progresses on the development of potential therapeutics and vaccines that are under the preclinical studies and clinical trials have been highlighted. We anticipate that this review will provide valuable information that would help to accelerate the development of therapeutics and vaccines against SARS‐CoV‐2 infection.

Background Self-medication practice (SMP) is widely adopted among residents of such countries as Bangladesh. However, the major determinants of SMP have only scarcely been evaluated. Therefore, this cross-sectional study aimed to fill this knowledge gap by assessing the prevalence and determining factors of SMP. Methods A convenience sample of individuals residing in Savar (Dhaka, Bangladesh) >16 years of age and suffering from an illness >2 months underwent face-to-face interviews during January-February, 2019. Results Among 520 interviewees fulfilling entry criteria, the prevalence of SMP was reported as 60.2%. Drug shops, previous knowledge or prescription, and consulting with peers (friends or relatives) were the most sought sources of SMP, whereas simple illness, higher consulting fees, unsatisfactory health-care services, and delayed access were reported as the motives. From the regression analysis, the sociodemographic risk factors of SMP were reported as being older (compared to

Introduction: The COVID-19 has overwhelmed health systems across the countries globally. This pandemic has also impacted health related rehabilitation services worldwide which is particularly profound in low and middle-income countries including Bangladesh. Methods: Information used in the study gathered from World Health Organization (WHO) Bangladesh Director General of Health Services (DGHS), Institute of Epidemiology Disease Control and Research (IEDCR), online literature search using PubMed and PubMed Central research engines. Information also collected over personal telephone and email correspondence from the selected government, public, corporate, non-government institutes, and rehabilitation personals during the period of March-May 2020. Gathered data were analyzed; a set of challenges identified, and recommendations were made for a safe and standard working rehabilitation environment in the altered COVID-19 situation. Results: Rehabilitation doctors and therapists at most of the public and private institutes are dedicated to COVID-19 services as per the local administrative directives keeping routine rehabilitation services apart. Few rehabilitation workforces to continue team works, environmental hygiene maintenance and space crisis at service outlets were the major challenges. Specially arranged virtual OPD and telerehabilitation services opened to minimize the rehabilitation burden and sufferings of the patient during the COVID-19 pandemic lock down restriction period. Conclusion: COVID-19 seriously impacted the overall schedule of rehabilitation services. Rehabilitation must be recognized as an un-omissible part of COVID-19 management which requires a planned accommodative working environment in the altered situation within the health care system. Recommendations are provided to keep this pandemic contained while providing adequate and standard rehabilitation services to the disabled in the safe environment in line with WHO rehabilitation 2030. J Bangladesh Coll Phys Surg 2020; 38(0): 76-81

Now days, obesity is a major risk factor for intervertebral disc degeneration (IDD). However, adipokine, such as chemerin is a novel cytokine, which is secreted by adipose tissue, and are thought to be played major roles in various degenerative diseases. Obese individuals are known to have high concentration of serum chemerin. Our purpose was to study whether chemerin acts as a biochemical relationship between obesity, and IDD. In this study, we found that the expression level of chemerin was significantly increased in the human degenerated nucleus pulposus (NP) tissues, and had higher level in the obese people than the normal people. Chemerin significantly increased the inflammatory mediator level, contributing to ECM degradation in nucleus pulposus cells (NPCs). Furthermore, chemerin overexpression aggravates the puncture-induced IVDD progression in rats, while knockdown CMKLR1 reverses IVDD progression. Chemerin activates the NF-kB signaling pathway via its receptors CMKLR1, and TLR4 to release inflammatory mediators, which cause matrix degradation, and cell aging. These findings generally provide novel evidence supporting the causative role of obesity in IDD, which is essentially important to literally develop novel preventative or generally therapeutic treatment in the disc degenerative disorders.

Introduction: The outbreak of COVID-19 is taking an unprecedented mental toll on health workers worldwide. So it comes as no surprise that the mental well-being of health care workers of Bangladesh too is in serious jeopardy. This survey was aimed to assess the immediate psychological impact on doctors working in largest Covid-19 dedicated facility in Bangladesh, Dhaka Medical College Hospital. Methods: This cross sectional study was conducted in a single-centre with response received from participating doctors between 31st May to 3rd June, 2020. Mental health variables were assessed via the Athens Insomnia Scale (AIS) and Hospital Anxiety Depression Score (HADS). Results: We received 192 completed questionnaires (response rate, 64.43%) among whom around 50% of the participating doctors reportedly have depression and anxiety symptoms respectively. Among them 104 doctors (54.17%) responded to have insomnia. Around 56% of the responding subjects perceived the highly contagious nature of the SARS-CoV-2 as the most striking threat of COVID-19. Conclusion: Agonizing disease process, high death toll, highly contagious nature of the responsible virus is taking a serious mental toll on physicians in the background of their heightened concern about personal health and family health, scarcity in PPE and adequate hospital facility. Psychological protective measures implemented by the hospital could be helpful. J Bangladesh Coll Phys Surg 2020; 38(0): 50-55

Thiopurine methyltransferase (TPMT) enzymes play a crucial role in azathioprine metabolism. Mutations in the enzyme initiate generation of excess thioguanine, which causes suppression of various cell lineages. The objectives of this study were to investigate the prevalence of TPMT mutation in Bangladeshi patients with systemic lupus erythematosus (SLE) requiring azathioprine therapy and its relation to the development of myelosuppression. 250 patients with SLE were enrolled, then monitored for myelosuppression adverse events for 4 months. TPMT*3C (rs1142345), TPMT*3B (rs1800460), and TPMT*2 (rs1800462) polymorphisms were analyzed using polymerase chain reaction–restriction fragment length polymorphism. The risk of myelosuppression (i.e., leukopenia, thrombocytopenia, and anemia) was estimated as the odds ratio (OR) with 95% confidence intervals (CIs) and p values. Of the 250 patients, 17 (6.8%) were heterozygous for the TPMT*3 mutation and 233 (93.2%) were homozygous for the wild type; no patients carried a homozygous mutation. Grade III/IV leukopenia, thrombocytopenia, and anemia occurred in 12.0%, 12.0%, and 27.9% of wild-type TPMT patients respectively; corresponding rates in heterozygous TPMT*3C patients were 70.6%, 64.7%, and 5.9%. Patients with Grade III/IV azathioprine-induced leukopenia were significantly more likely to have the heterozygous TPMT*3C genotype than the wild-type variant (OR 17.6; 95% CI 5.8–53.6; p