Public Health

Zimbabwe antenatal HIV prevalence rate is 16.1%. HIV-positive pregnant adolescent girls and young women (AYW) are at high risk to experience perinatal mental health challenges, attributed to a combination of factors including HIV status, stigma and perinatal depression. Perinatal depression and stigma among AYW is understudied in Zimbabwe and may affect short- and long-term health of HIV positive mothers and their children, and can impact treatment adherence.

This article examines the epidemiology of the US juvenile legal system, which disproportionately impacts youth with multiple marginalized identities and exacerbates health inequities. Policy changes that can improve the treatment of children who display disruptive behavior are highlighted, so as to lay out a path forward for supporting children and enhancing health equity while bolstering public safety. Finally, this article concludes that the systemic racism pervasive in the juvenile legal system signals an important role for pediatrics to advance racial equity and transform our approach to childhood.

A primer for pediatric providers on understanding stigma in health care, the terminology and types of stigma, the conditions commonly faced with stigma in pediatrics, the components of evidence-based anti-stigma initiatives, and guidance to effect change within a pediatric practice. The authors outline the negative effects of stigma in pediatrics and how to combat the problem at the source, and explore self-stigma, public stigma, and structural stigma and how it applies to weight, diabetes, disability, HIV, mental health, and substance use in pediatrics.

Respiratory syncytial virus (RSV) is a common viral pathogen that accounts about 33 million cases of acute lower respiratory tract infection (LRTI) worldwide in children under the age of 5 years each year. High-risk populations, particularly preterm infants, those with underlying chronic lung disease, congenital heart disease, or compromised immune systems, are afflicted most significantly. RSV infection is characterized by significant amount of mucus and submucosal edema in the respiratory tract, leading to congestion and, oftentimes, significant respiratory distress. Antigen- and PCR-based testing are used to diagnose RSV infection.

Medical imaging, particularly fetal MR imaging, has undergone a transformative shift with the introduction of 3 Tesla (3T) clinical MR imaging systems. The utilization of higher static magnetic fields in these systems has resulted in remarkable advancements, including superior soft tissue contrast, improved spatial and temporal resolution, and reduced image acquisition time. Despite these notable benefits, safety concerns have emerged, stemming from the elevated static magnetic field strength, amplified acoustic noise, and increased radiofrequency power deposition. This article provides an overview of fetal MR imaging at 3T, its benefits and drawbacks, and the potential safety issues.

Families with infants admitted to the neonatal intensive care unit (NICU) are at a markedly increased risk of developing postpartum depression (PPD) because of the stressors they experience by having an infant in this intensive setting. Routine screening for PPD is not regularly performed for these families because many NICUs do not offer it and well-child visits are missed while the infant is hospitalized. Because the identification and treatment of PPD is often missed in these families, screening needs to be administered in the NICU to ensure improved outcomes.

Parieto-occipital sulcus is one of the major sulcus of the cerebral hemisphere which separates the occipital lobe from the parietal lobe. Morphology of this sulcus varies with age, sex, manual skill, handedness and in many diseases. For various clinical investigations and surgery, detailed morphological knowledge of this sulcus is very much essential for the surgeons and radiologists. This study is carried out to establish a normal standard in length of the parieto-occipital sulcus in different age and sex groups of Bangladeshi people. A cross-sectional, descriptive type of study was conducted in the department of Anatomy, Mymensingh Medical College, Bangladesh from July 2016 to July 2017. About 60 specimens were collected from medico-legal cases and divided into four age groups including, Group A (20-29 years), Group B (30-39 years), Group C (40-49 years) and Group D (50 years and above). The mean length of parieto-occipital sulcus was 3.92±0.559cm to 3.29±0.434 cm in male and 3.81±0.715cm to 3.03±0.551cm in female. The difference in mean length of the parieto-occipital sulcus for both left and right hemisphere between male and female was statistically non-significant in all age groups. For statistical analysis, differences between age and sex groups were analyzed by using students unpaired 't' test. In this study, the length of the parieto-occipital sulcus showed gradual decreasing values with advancing age.

The bicipital groove is a groove on the anterior aspect of the proximal end of the humerus. It lies between the greater and lesser tubercles. The variations of this groove may lead to various pathologies of the biceps brachii tendon, one of the most common causes of shoulder pain. Hence, this study examines the various osteometric parameters of bicipital groove in the Bangladeshi population. This cross-sectional descriptive study was done on 100 dry adult human cadaveric humeri (43 right sides and 57 left sides) in the Department of Anatomy, Mymensingh Medical College, Bangladesh from July 2021 to June 2022. The length, maximum width and depth of the bicipital groove and the length of this groove's medial and lateral walls were measured using a digital Vernier slide caliper. Data were recorded in a predesigned data sheet separately and analyzed statistically using Microsoft Excel and SPSS. According to the present study, the mean±SD length of the bicipital groove of the right humeri was 66.646±11.563mm and the left humeri were 66.002±13.025mm. The mean±SD maximum width of the bicipital groove of the right humeri was 10.870±1.799mm and the left humeri were 11.480±1.402mm. The mean±SD depth of the bicipital groove of the right humeri was 4.242±0.655mm and the left humeri were 4.452±0.854mm. The mean±SD medial wall length of the bicipital groove of the right humeri was 60.671±12.360mm and the left humeri were 59.161±13.660mm. The mean±SD lateral wall length of the bicipital groove of the right-sided humeri was 64.996±11.611mm and the left humeri were 64.074±13.115mm. It is expected that this osteometric study of bicipital groove among the Bangladeshi population will be very helpful for clinical anatomists, orthopaedic surgeons, anthropologists and radiologists.

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease of airflow limitation that is not fully reversible. COPD affects the lungs and produces significant systemic consequences. In Bangladesh, the prevalence of COPD after 40 years of age is 21.24% and the general population is 4.3%. COPD leads to a sedentary life, which reduces the functional status of the individual. Functional status assessment is vital for appropriate therapy and rehabilitation programs in COPD patients. A Sit-to-stand test (STST) has been proposed as a better alternative to 6MWT, but a Squat-to-stand test (SqTST) to test their ability to stand from the squatting position will be more appropriate in rural patients. This study was conducted using a cross-sectional observational design from July 2020 and September 2021 in the Department of Respiratory Medicine at the National Institute of Diseases of the Chest and Hospital, Bangladesh. Sixty (60) diagnosed cases of COPD patients were enrolled in this study. Severities of airflow obstruction according to GOLD were categorized on the basis of post-bronchodilator FEV₁ by spirometry. SqTST was performed on all patients, and functional status was recorded. All data were collected using a preformed questionnaire. Statistical analyses of the findings were carried out using SPSS version 23.0. In this study, the majority of 21(35.0%) patients had very severe COPD, and almost half (48.3%) of the patients had abnormal SqTST. A significant relation was found between the severity of COPD with SqTST (p=0.001). Based on the receiver-operator characteristic (ROC) curve, SqTST had an area under curve 0.901. SqTST had 82.1% sensitivity, 85.7% specificity, 83.3% accuracy, 91.4% positive predictive value, and 72.0% negative predictive value to find severe COPD cases in stable COPD patients. ROC was constructed using SqTST, which gave a cut-off value <7.0, with 82.1% sensitivity and 85.7% specificity for predicting severe COPD. From this study, it may be concluded that SqTST is a clinically useful tool to assess the functional status of stable COPD patients.

Parkinson's disease (PD) is a chronic, progressive neurodegenerative disease with unknown etiology. Some previous studies suggest that elevated serum homocysteine level is a risk factor for stroke, ischemic heart disease; atherosclerosis and neurodegenerative diseases like Parkinson's disease. Serum homocysteine level relates with Parkinson's disease through various mechanisms including gene defect, apoptosis, oxidative stress and DNA damage. Some recent studies reveal that serum homocysteine level is elevated in Parkinson's disease patient compared to healthy individuals. This study was aimed to compare the serum homocysteine level in Parkinson's disease patients and age and sex matched apparently healthy individuals. This was a case control study which was conducted in Department of Neurology and Medicine, Mymensingh Medical College Hospital, Mymensingh during November 2019 to April 2021. Total 55 cases of Parkinson's disease patients and age and sex matched 55 apparently healthy controls were enrolled in this study. Demographics and clinical data were collected using structured case record form and adopting purposive type of sampling method. Serum homocysteine level was measured in both case and control groups. The study reveals that, average age of the patients and control group was in sixth decade. Male predominance was found with male to female ratio was 1.5:1 in case group. Both groups showed almost similar demographic profiles. Twenty-nine (52.72%) patients of Parkinson's disease observed higher serum homocysteine level in contrast to only 8(14.54%) in control group. The mean serum homocysteine ±SD was 15.43±6.04μmol/L in case group and 10.04±5.31μmol/L in control group; the difference was statistically significant (p=0.001). Mean serum homocysteine levels were measured progressively higher with increased duration and advanced stages of disease. It was concluded that, serum homocysteine level is higher in Parkinson's disease patients than normal healthy individuals. In addition, there was significant positive correlation of elevated serum homocysteine with increased duration of Parkinson's disease and advanced stages of the disease.

Extracellular vesicles (EVs) play a crucial role in triggering tumour-aggressive behaviours. However, the energetic process by which tumour cells produce EVs remains poorly understood. Here, we demonstrate the involvement of β-hexosaminidase B (HEXB) in mediating EV release in response to oxidative stress, thereby promoting the development of hepatocellular carcinoma (HCC). Mechanistically, reactive oxygen species (ROS) stimulate the nuclear translocation of transcription factor EB (TFEB), leading to the upregulation of both HEXB and its antisense lncRNA HEXB-AS. HEXB-AS can bind HEXB to form a protein/RNA complex, which elevates the protein stability of HEXB. The stabilized HEXB interacts with lysosome-associated membrane glycoprotein 1 (LAMP1), disrupting lysosome-multivesicular body (MVB) fusion, which protects EVs from degradation. Knockdown of HEXB efficiently inhibits EV release and curbs HCC growth both in vitro and in vivo. Moreover, targeting HEXB by M-31850 significantly inhibits HCC growth, especially when combined with GW4869, an inhibitor of exosome release. Our results underscore the critical role of HEXB as a modulator that promotes EV release during HCC development.

In Intensive Care Units (ICUs) infection represents the most frequent complication leading to high mortality. Particularly the incidence of fungal infections, especially due to Candida spp., has been increasing during the last years. Over last two decades there is predominance of Non albicans Candida (NAC) infection with increased isolation of novel species and decreased susceptibility. Early identification of Candida species and determination of antifungal susceptibility pattern is essential for effective management. Therefore, the study was conducted to isolate and identify Candida species from the blood samples of the patients suspected of candidemia and assess their antifungal susceptibility pattern. This cross-sectional, descriptive type of observational study was conducted in the Department of Microbiology, Mymensingh Medical College, Bangladesh from March 2021 to February 2022. Venous blood was collected from clinically suspected patients admitted at ICU, Neonatal Intensive Care Unit (NICU), Mymensingh Medical College Hospital, Bangladesh. Primary blood culture was performed by automated method followed by sub-culture in Saboraud's Dextrose Agar (SDA) and blood agar media. Candida species were recognized by phenotypic and genotypic methods. Antifungal susceptibility testing was done by disk diffusion and broth microdilution method (BMD). Out of 125 blood specimens collected, Candida species were isolated from 39(31.0%) blood samples of which NAC species were 35(89.0%) whereas C. albicans was only 4(10.2%). Eight (8) different Candida species were identified of which C. parapsilosis was predominant 16(41.0%). Rare and emerging drug resistant species of C. ciferrii 23.0%, C. auris 7.7%, C. rugosa 10.3%, C. lusitaniae 2.6% were also isolated. Candidemia was highest in neonate 33(84.61%) with male predominance 24(61.54%). Use of broad-spectrum antibiotics, prolonged hospital stay, pre-maturity and low birth weight (LBW) were found to be important risk factors. In candidemia the highest resistance was to Fluconazole-33% and lowest to Voriconazole-5%. The study showed that NAC species were more common with emergence of rare and multidrug resistant species.

Both of neurological emergencies and hyperglycemia are independently associated risk factors of mortality in the ICU patients. In critically ills, hyperglycemia is secondary to already existing DM or stress-induced hyperglycemia (SIH). Admission glycemic gap (AGG) is considered as a reliable indicator of SIH. This study aimed to explore the association of AGG on diabetic neuro-critical patients' short-term mortality, and understand the potential of AGG as the predictor of outcome. Sixty adult diabetic neuro-critical patients admitted in ICU and stayed at least for 24 hours, were prospectively observed for 30 days, or until discharge or death, whichever came first. The patients' initial clinical assessment and HbA1c, CBC, ABG, and blood glucose level were done within 24 hours of admission. A1c derived admission glucose (ADAG) was calculated as, ADAG = (1.59 × HbA1c) - 2.59 (mmol/L). The AGG was calculated by subtracting ADAG from admission blood glucose level (ABGL). Death or survival of 30 days was our primary outcome and participants were divided between survivor or non-survivor groups according to primary outcome. Statistical comparisons of the study variables between the groups were performed and the relationship between parameters derived from blood glucose and mortality was prospected. Among the 60 patients enrolled, 35(58.3%) were non-survivors and 25(41.7%) were survivors. Age, sex, residence, primary diagnosis, co-morbidity, or drug history had no association with survival/non-survival. Among the initial clinical assessment parameters, lower GCS had significant association with non-survival. AGG, HbA1c, ADAG and ABGL were significantly different between the groups, with higher values in the non-survivors. Lower GCS, and higher AGG, HbA1c, ADAG and ABGL showed significant odds of non-survival. The highest odds of non- survival was for AGG (OR 2.95, 95% CI: 1.83-4.75; p<0.001). For ABGL and HbA1c the OR were 2.03 (95% CI: 1.44-2.86; p<0.001) and 1.93 (95% CI: 1.04-3.58; p<0.04) respectively. The final adjusted odds (aOR) of non-survival for higher AGG was 3.25 (95% CI: 1.71-6.16; p<0.001), signifying that AGG is independently associated with non-survival. AGG, GCS level, ABGL, HbA1c level, and ADAG can predict short-term outcome (mortality). However, AGG has the greatest potential to predict short-term outcome in diabetic neuro-critical patients.

Burns are very common and important injuries associated with epilepsy. Epileptics are afflicted with burns when they come in contact with fire or other burning agents while seizing, due to loss of consciousness. The aim of the study was to identify the causes of burn, pattern and characteristics of burn in patients with epilepsy, duration of hospital stay and pattern of treatment in these patients. This prospective observational study was conducted in the Department of Burn and Plastic Surgery, Mymensingh Medical College Hospital, Bangladesh from January 2022 to December 2023. Epileptics were found in 0.84% (n=19) of the total admission (2274) in Burn unit. Majority of the patients were females (84.2%) and the mean age was (31.42±1.32) years. Maximum patients were housewives (78.9%). Among 19 cases, 11 cases (57.89%) had history of irregularly taking antiepileptic drugs and 8 cases (42.11%) had no history of treatment for epilepsy. Two cases (10.53%) had history of previous burn injury. Flame burn was the major etiology (89.5%). Mean total burn surface area (TBSA) was (6.94±4.12%). Most patients had full thickness burns (63.2%). Regarding distribution of burn, maximum involvement was in upper limb i.e. 68.21% cases. Surgical treatment was needed in the majority of the patients (68.5%). Mean hospital stay of these patients was (5.36±2.26) weeks. Epilepsy patients whose seizures are inadequately controlled are at increased risks of injury, especially burn. For prevention of burn, epilepsy should be treated properly.

Multiple myeloma (MM), mature B-cell lineage neoplasm, is characterized by abnormal clonal proliferation of plasma cells and presence of monoclonal protein (M protein). The study was conducted to reveal presenting features, laboratory findings, Eastern Cooperative Oncology Group (ECOG) performance status and skeletal survey on patients with multiple myeloma. This descriptive, cross-sectional study was carried out in the Department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2019 to July 2020 with a sample size of 81. Data were collected in a case record form after obtaining informed verbal consent from patients and /or their legal guardians. Relevant ethical issues and data quality assurance were taken into consideration. Data were analyzed with SPSS, Version 25.0 with presentation in figures and tables with frequency, percentage, mean and standard deviation based on data nature. Statistical tests were carried out as appropriate with 5.0% level of significance for assessing statistical association. Mean age of the patients was 58.9±12.0 years. Male female ratio was 2:1. 35(43.2%) patients were smokers with only 2(2.5%) had family history of haematological malignancies. Bone pain (72.8%) was the most common presenting feature, while hypertension (59.1%), diabetes mellitus (29.5%), respiratory illness (11.3%) and cardiac disease (11.4%) were the common co-morbidities. Most common ECOG performance status was ECOG-1(48.1%). Mean haemoglobin (Hb) was 9.4±2.3gm/dl and mean erythrocyte sedimentation rate (ESR) was 89.5±42.1 mm in 1st hour. Mean serum creatinine level was 2.0±1.85 mg/dl and ≥2.0mg/dl in 42(34.2%). Among 50 documentation serum lactate dehydrogenase (LDH) was raised in 18(36.0%). Mean serum calcium level was 9.6±1.8mg/dl >11.0mg/dL in 10(14.5%) cases. Serum albumin <3.5gm/dl in 37(49.3%), β2-microglobulin >5.5mg/dl in 37(57.8%) cases, International staging system (ISS) stage III was in 59.4% and Bence Jones Protein (BJP) was present in 46.7% cases. Lytic lesions were present in 75.0%, In 38(74.5%) patients vertebrae were involved, while in 18(35.2%) ribs were involved, in 14(27.5%) patients skull was involved and in 3(5.9%) patients involved bones were femur, humerus, sternum and scapula. Mean plasma cells percentage was 62.1±24.9%. Immuno-Fixation Electrophoresis (IFE) revealed IgG (72.7%), IgA (18.2%), Free light chain (FLC) (9.1%). FLC ratio was ≥100 in 29.0% cases. Significant statistical association was observed between serum creatinine with Hb concentration (p<0.05), serum creatinine level with ISS staging (p<0.05) and serum calcium level (p<0/05), while insignificant association was revealed between BJP present status and serum creatinine level (p>0.05). Bone pain, fatigue, fever and neurological impairment were the common presenting features. Anaemia, renal impairment and skeletal lytic events were the prominent physical findings. ISS staging was statistically associated with serum creatinine level, while serum calcium level was associated with serum creatinine and lytic lesions.

The cross sectional, analytic and descriptive type study was conducted among 5-10 years aged Bangladeshi children at different areas of Mymensingh District (Fulbaria, Trisal, Haluaghat, Fulpur and Muktagacha), Bangladesh on 109 Bangladeshi children from January 2016 to December 2016. Nonrandom purposive sampling technique was taken for sample collection. Any kind of foot deformity resulting either from physical injury or congenital anomaly was excluded to construct standard data. The present anthropometric study was designed to construct data of 5 to 10 years aged Bangladeshi children regarding great toe length, to measure correlation of stature with great toe length and comparison of great toe length between male and female children. This study has been made out to grow interest among the researchers for future study of different country. Stature of the subject was measured with the stadiometer and great toe length was measured using slide caliper. The children were requested to stand with weight distributed equally on both feet. The legs were perpendicular to the feet. The mean great toe length of both sides of 5, 6, 7, 8, 9 and 10 years aged male were 2.90±0.51 cm, 3.00±0.38 cm, 3.18±0.42 cm, 3.41±0.26 cm, 3.34±0.32cm and 3.57±0.45 cm respectively and those of female were 2.93±0.70 cm, 2.70±0.43 cm, 3.05±0.37 cm, 3.02±0.25 cm, 3.42±0.55 cm and 3.62±0.44 cm respectively. Great toe length showed non-significant positive correlation with stature in 5 years old female, 7 years old male and female, 8 years old male, 9 and 10 years old male and female children. In 5 years old male, 6 years old male and female and 8 years old female children, great toe length showed non-significant negative correlation with stature. Comparison of great toe length between male and female children was done by Unpaired Students 't' test which was statistically non-significant.

Abnormal uterine bleeding (AUB) is the most common and frequent presenting complaint in Gynaecology in all age group especially in perimenopausal and postmenopausal women. The spectrum of AUB in women of our country includes a wide varieties of organic pathology. The objective of this study was to assess the role of endometrial thickness as a predictor of endometrial malignancy among the women presenting with AUB. This cross-sectional descriptive type of observational study was conducted among 122 women of perimenopausal (40-50 years) and 87 women of postmenopausal (>50 years) age group presenting with AUB in the Obstetrics and Gynaecology department of Mymensingh Medical College Hospital, Bangladesh from February 2020 to August 2021. These patients were subjected to a detailed history and meticulous general, systemic and local examination. The relevant investigations like Transvaginal Sonography (TVS) followed by endometrial biopsy by dilatation and curettage were done in all study participants. Most of the women were in the age group 41-45 years in perimenopause and 51-55 years in postmenopause. Mean±SD was 45.8±4.1 years in perimenopause and 56.3±6.4 years in postmenopause. There was statistical significance in developing endometrial malignancy regarding risk factors of nulliparity, Hypertention (HTN), Diabetes mellitus (DM) and hormone intake between perimenopause and postmenopause. Endometrial thickness was measured in perimenopause and postmenopause. Mean±SD of Endometrial thickness (ET) in perimenopause and postmenopause was 11.3±4.4mm and 7.2±6.3mm with statistical significance (p<0.001). Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV) and accuracy of TVS were 85.5%, 67.4%, 81.2%, 73.8% and 78.7% in perimenopause and 85.9%, 20%, 89%, 75% & 83.9% in postmenopause. Cut off limit of ET in detection of endometrial malignancy was 18.5mm with sensitivity 74.8% and specificity 63.6% in perimenopause and 12.2mm with sensitivity 81.0% and specificity 65.8% in postmenopausal women. Women with AUB, endometrial malignancy should be suspected when endometrial thickness on TVS >18.5mm and >12.2mm in perimenopause and postmenopausal age group respectively. TVS has high sensitivity in detection of endometrial malignancy both in perimenopausal and postmenopausal women with AUB and TVS is a reliable, noninvasive method.

Recent advancement in surgical treatment of haemorrhoidal disease is not accessible by low socio-economic group of patient in a peripheral hospital of an underdeveloped country, where we aimed to evaluate the outcome of conventional surgeries. This descriptive, prospective, observational study was performed from diagnosis of haemorrhoidal disease to surgical intervention and followed up 12 months post operatively. Clinico-pathological data and outcome in the form of complications and recurrence within follow-up period was studied. Total 64 adult patients with mean age 38.6 years and male female ratio 1.7:1 were included in this study. Mean duration of symptoms was 13 months, reflects late presentation. Two (2) piles mass was seen most frequent in 36(56.3%) cases and most of the patients i.e. 44(68.8%) had haemorrhoids only on primary sites (3, 7 and 11 o'clock) of anal canal, but 18(28.1%) had mixed primary and secondary position of haemorrhoids. Similarly among those who had more than one haemorrhoid, grade 4 was commonest 35(53.1%) followed by only grade 3 in 15(23.4%) cases but mixed grade 3 and 4 was seen in 10(15.6%) patient. Complication less recovery was seen in 56(87.5%) cases, where delayed wound healing and pain was reported in 2(3.6%) patient each, followed by 1(1.6%) each reported urinary retention, anal sepsis, primary bleeding and reactionary bleeding. Mean hospital stay was 4 days. Conventional surgeries are equally efficacious and cost effective option for management of operable haemorrhoidal disease at any setup.

Oral contraceptives pills (OCPs) are one of the most commonly used methods of birth control by women worldwide. Presently, worldwide about 100 million women are current users of combined hormonal contraceptives (COC) most frequently used in the western world. The most frequently used agents are a combination of drugs containing both an estrogen and a progesteron. This combination is considered to be highly efficacious, generally considered 99.9% and a use effectiveness of 97.0% to 98.0%. This study was done to find out the association of serum total cholesterol and blood pressure in combined oral contraceptive pill users. This cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh between the periods from July 2021 to June 2022. A total number of 120 reproductive aged women, age ranged from 15-55 years were included in this study. They were divided into two group, sixty (60) combined oral contraceptive pill users were taken as study group (Group II) and sixty (60) age matched oral pill non users subjects were taken as control group (Group I). Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test and pearson's correlation coefficient test. Pearson 'r' value of systolic blood pressure and diastolic blood pressure are 0.582 and 0.416 respectively indicates positive correlation with serum total cholesterol. Correlation is statistically highly significant (p<0.001). Blood pressure and serum total cholesterol were positively connected in study group in comparison to control group respectively. So from this study, it can be concluded that there is a significant association between serum total cholesterol and blood pressure with oral contraceptives.

An anal fissure is a small cut or tears in the skin or mucosal lining of anal passage or at the opening of anus. It affects the quality of life due to severe pain and sometimes causes bleeding also while passing the stool. It can affect people of any age. In recent time, laser treatment creates a new era for management of anal fissure. It is easier, safer, faster for the treatment of chronic anal fissure. The aim of the study was to evaluate short term and long term clinical and surgical outcome of laser treatment. In this prospective study total 82 patients with chronic anal fissure underwent laser treatment from July 2019 to June 2020 at Anower Khan Modern Medical College Hospital and Care Medical College Hospital, Bangladesh. All the patients who completed their 1.5 months and 6 months follow up were included for the study and their data was analyzed. Out of 82 patients, 71 were females and 11 were male. The mean age 40.31±9.23, mean operative time was 15.0±10.0 minutes. Mean hospital stay 24.35±1.23 hours (1 day). Mean healing time was 14.03±12.04 days. All patients were followed upto at outpatient clinic 1.5 and 6.0 months postoperatively. This study shows that laser treatment is a simple, safe, and effective procedure to treat the anal fissure with a low rate of complications. It can be treated as an effective treatment for patients with chronic anal fissure. However, this procedure has some limitations.

The spectrum of indications for primary caesarean section changes with advancing parity. As parity advances more cesarean section are done for maternal rather than fetal indications. The objective of this study was to determine the indications and complications of caesarean section in multiparous women with history of previous vaginal delivery. This cross-sectional descriptive observational study was conducted in Mymensingh Medical College Hospital from January 2019 to June 2019 among 100 purposively selected multiparous women who underwent primary caesarean section. A well-designed, semi-structured questionnaire was used to collect data by face-to-face interview, clinical examinations and laboratory investigations. Data analysis was conducted in SPSS 20.0 version. Majority (74.0%) of the women in this study were in the age group 21-30 years with mean age of 26.3±5.76 years. Majority of the patients were of second gravida (42.0%) followed by third gravida (33.0%). The highest gravida in this study was 6th. Most of the patients were of para 1(44.0%). Highest para in this study was para 5. The most common indication of caesarean section in this study was foetal distress (26.0%). The next common indications were cephalo-pelvic disproportion (22.0%), antepartum haemorrhage (13.0%), mal-presentaion or mal-position (16.0%). Other causes were PROM (8.0%), prolonged labour (6.0%), cord prolapse (2.0%), post-dated pregnancy (4.0%), severe pre-eclampsia (2.0%) and secondary subfertility (1.0%). There was no case of maternal mortality in this study but 15 mothers suffered from various post-operative complications like wound infection (4.0%), UTI (4.0%), puerperal pyrexia (3.0%), postpartum haemorrhage (3.0%) and paralytic ileus (1.0%). Among the babies delivered 97 were live births. Among the 97 live births 11(11.34%) were preterm babies. Among the babies delivered majority (85.0%) was with good APGAR score (7-10). In conclusion it can say that a multiparous women in labour requires the same attention as that of primigravida. A parous women needs good obstetric care to improve maternal and neonatal outcome and still keeping caesarean section to a lower rate.

Coronavirus disease 2019 (Covid-19) disease have been associated with significant mortality amongst doctors globally including Bangladesh. To delineate the clinico-epidemiological characteristics of the physician affected with Covid-19 was the objective of the study. This cross-sectional 'Facebook' based survey was conducted in the period of August 2020 to September 2020. Snowball sampling methods was followed. A total of 151 physicians affected with Covid-19 participated in this survey. Self-reported perceived severity scale (zero meaning not severe at all and ten denoting the most severe) was used. Collected data were analyzed by SPSS 25.0. Among the participants, the majority were male, 98(64.9%). The most prevalent affected age groups were 24-35 years 131(86.8%). Approximately 45.0% worked in COVID dedicated hospital. Entry-level physicians (Medical Officer or Assistant Surgeon) were the most affected 117(94.4%). One-third of the physicians had at least the one co-morbidity. Bronchial asthma, obesity and diabetes were the most frequent. Predominate symptoms of the infection were fever 94(62.3%), cough 94(62.3%) and myalgia 92(60.9%). Half of the participants had sore throat, anosmia, gastro-intestinal symptoms and one-third of the patients developed dyspnea. Perceived severity of the symptoms ranged between 2 and 6. The pattern of drug use to prevent the Covid-19 showed no uniformity. However, intake of Zinc, Vitamin C, Vitamin D, antihistamine and Ivermectin was found in 74.8%, 67.5%, 41.7%, 49.0% and 37.7% respectively. As the current pandemic continues to evolve, physicians must be equipped with appropriate knowledge, skills and must be cautious on the prevention measures against Covid-19.

Metabolic Syndrome (METS) plays a pivotal role in the development of diabetes mellitus, coronary artery diseases and stroke. Due to the scarcity of data in this issue, this study aims to assess the frequency and risk factors association of METS among the hypertensive patients. This cross-sectional study recruited 667 eligible hypertensive patients aged between 20 and 70 years using non-probability purposive sampling method conducted from 1st January 2019 to 30th June 2019. Hypertensive patients with the known history of diabetes, thyroid, renal, cardiac, or hepatic disease, Cushing syndrome or malignancy and secondary causes of obesity, confirmed pregnancy, bed ridden, taking lipid lowering drugs or drugs that affect lipid and glucose metabolism were excluded from the study. METS among the hypertensive patients (DE novo or established hypertensive patients) of this study was demonstrated by NCEP-ATPIII (National Cholesterol Education Program-Adult Treatment Panel III) criteria having two or more of the following points [a) increased waist circumference ≥102cm in men and ≥88cm in women, b) hypertriglyceridemia: ≥150mg/dl, c) reduced High density lipoprotein cholesterol (HDL-C) <40mg/dL (1.04mmol/L) in men and <50mg/dL (1.29mmol/L) in women, d) high fasting blood glucose: 110mg/dl]. Significantly high frequency (69.9%, p<0.001) of METS was found with a significant female preponderance (52.5%, p<0.001) where the mean age of the study population was 48±11 years. Sex (p<0.001), education (p=0.041), occupation (p<0.001), Body mass index (BMI) (p<0.001) and hypertensive status (p=0.002) showed a highly significant role in the development of METS. Following binary logistic regression analysis after adjusting for confounders, the female sex was 17 times higher than the male [Adjusted odd ratio (AOR) =16.96, 95% CI=4.91-58.66, p<0.001)], obesity 4 times higher than non-obese [BMI (obese AOR=4.24, 95% CI=2.55-7.98, p<0.001)], hypertensive status [established hypertension two times higher than de novo (de-novo AOR=0.60, 95% CI=0.037-0.97, p=0.037)] were significant and independent predictors of METS. Significantly high BMI (27.7±4.2 and p<0.001), high waist circumference (60.4%, p<0.001) and hyper tri-glyceridaemia and reduced HDL (46.0%, p<0.001 and 51.3%, p<0.001) were found in the subjects with METS. In conclusion, high frequency of METS among the hypertensive patients was found in Jashore, Bangladesh with significant risk factors related to female sex, education, occupation, BMI and hypertensive status. So, a holistic evaluation of metabolic components among the hypertensive patients may reduce premature cardiovascular morbidity and mortality.

The presence of bright resonance of more than 1 mm or more cusps of the aortic valve, mitral valve or mitral annulus is termed as cardiac valve calcification. If an intense echo producing structure located at the junction of the atrioventricular groove and posterior mitral valve leaflet on Echocardiography that is Mitral annular calcification (MAC). This study was conducted to observe the association of MAC with clinical and echocardiographic findings of ischemic heart disease (IHD) and the role of trans-thoracic echocardiography to detect MAC which is a marker IHD. In this prospective, observational, case-control study, total of 100 IHD patients, 50 patients with MAC were assigned as case group and 50 patients without MAC were control group after fulfilling inclusion criteria. All the detailed history, clinical examination and relevant investigation reports of each patient were recorded in pre designed data collection sheet. MAC was detected with transthorasic echocardiography. Analysis was done to observe the association and correlation of MAC with clinical findings of IHD. Mean age of the case control was 55.16±10.73 years and control was 49.80±8.84 years. MAC was noted highest about 56.0% in between age 45 to 60 years. Eighty two percent (82.0%) of cases and 84.0% of controls were male, 18.0% of cases and 16.0% of controls were female. BMI among the MAC group 2.0% were underweight, 72.0% normal, 24.0% over weight and 2.0% were obese and among non MAC controls group 10.0% were underweight, 68.0% normal, 20.0% over weight and 2.0% were obese. Clinically among cases 14(28.0%) had Stable angina, 8(16.0%) had UA, 3(6.0%) had Non STEMI, 2(4.0%) had AMI, 2(4.0%) had Recent myocardial infarction and 21(42.0%) had OMI. Diabetes mellitus was significantly higher in the case groups (p=0.006). Significant p-value was noted in hyper-triyglyceridemia and low HDL in case group than control. Echocardiographic studies showed 52.0% of cases and 32.0% of controls had regional wall motion abnormality (RWMA). Transthorasic echocardiographically detected MAC is an independent predictor of Ischemic heart disease. The low cost, portable and radiation free nature of the ultrasound approach make MAC an attractive parameter in the ongoing search for IHD.

Very early onset inflammatory bowel disease (VEO-IBD) is called when age of onset of IBD occurs below 6 years. Though it is rare, it has been increasing over last decade with decreasing age of onset. VEO-IBD is different compared with pediatric and adult-onset IBD in many aspects, including the disease type, location of the lesion, disease behavior and genetic susceptibility. These children with VEO-IBD are usually present with more severe disease than older children and adults. VEO-IBD is associated with monogenic defect. The thought of a monogenic cause of VEO-IBD was first confirmed by the detection of mutations of interleukin 10 (IL-10) receptor genes that cause impaired IL-10 signaling. Monogenic IBD possesses significant concern because it usually presents with refractory to conventional IBD treatment or fistulous Crohn's disease, so early treatment with biologics or an alternative approach such as hematopoietic stem cell transplantation (HSCT) might be looked-for. Before establishing IBD, we must think of more common diseases of this age group. Infection and Cow's milk protein allergy (CMPA) are two common conditions and it can cause severe colitis. Confirmation of chronic intestinal inflammation by endoscopies is of greatest significance for the diagnosis of IBD. There should be no age limit for performing endoscopies. Severe disease should be treated with biologic agents and surgery. Identification of genes associated with IBD leads to better understanding of its pathogenesis, which could help to provide more targeted interventions. We discuss the topic here to create awareness among Pediatricians so that the patients can be benefited.

A baby's weight at birth is an important predictor of infant growth and survival. Low birth weight leads to an impaired growth of the infant and its attendant risks of a higher mortality and morbidity. Various studies found higher maternal plasma homocysteine level was associated with lower offspring birth weight. Therefore, this study was carried out to find out association between maternal serum homocysteine and birth weight. A cross sectional study was conducted in the Department of Obstetrics and Gynaecology, BSMMU from September 2018 to August 2019. Pregnant women at their third trimester between 37-40 weeks admitted to in patient Department of Obstetrics and Gynaecology, BSMMU were included in this study. Ethical committee clearance was obtained from the institution. After matching eligibility criteria informed written consent were taken from the patients. Data was collected from the patients using the structured design by interview, observation, clinical examination and haematological investigations. The serum homocysteine level of these patients and birth weight of their babies was measured immediately after delivery. Negative correlation was found between maternal serum homocysteine level and neonatal birth weight, (r = -0.419, p<0.05). During regression analysis maternal homocysteine and gestational age was found significant when adjusted with maternal age, parity, maternal BMI and sex of the baby. So, increased maternal serum homocysteine is negatively associated with low birth weight babies.

Exudative pleural effusion appears as manifestation of underlying specific disease process and pleural biopsy is usually enough to find out the underlying causative disease. The aim of the study was to find out the efficacy of needle biopsy of pleura in the aetiological diagnosis of pleural effusion. This cross-sectional study was conducted for a period of one year from January 2008 to December 2008 in the Department of Medicine, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh enrolling 50 subjects with exudative pleural effusion. The cases with transudative pleural effusion were not included. Needle biopsy was done in all the cases. Histopathological reports of pleural biopsy specimen were correlated with other data and analyzed to detect the causes of effusion. Major incidence of malignant effusion occurred between 41 to 70 years of age. No malignant effusion was found before 30 years of age. Incidence of tuberculous and malignant pleural effusion was much more common in males than in females. Sensitivity and specificity of combined pleural biopsy and pleural fluid analysis in the diagnosis of pleural effusion was 97.06% and 100.% for tuberculosis and 81.82% and 100.0% for malignancy. The present study reveals that pleural biopsy was very effective method in the diagnosis of cause of pleural effusion.

Stroke is one of the most common neurological disorder and third most common cause of death in the world. Low vitamin D concentrations have been shown to predict risk of cardiovascular disease and all-cause of mortality. The aim of this study was to estimate serum vitamin D level in acute ischemic stroke patients. This comparative cross-sectional type of study was conducted in the Department of Neurology and Department of Medicine at Mymensingh Medical College and Hospital, Bangladesh from November 2017 to June 2019 with a total number of 100 study subjects. Total fifty patients with acute ischemic stroke were enrolled in Group A and another fifty age and sex matched volunteer subjects were enrolled in Group B with no prior history of stroke or transient ischemic attacks. Serum vitamin D levels, fasting plasma glucose and lipid profile were assessed in both groups and compared with each other. P value <0.05 was considered as significant in the study. Mean fasting blood sugar, serum fasting total cholesterol (TC), serum fasting triglycerides, serum fasting Low density lipoprotein (LDL) were significantly higher in Group A than Group B (p<0.05). Serum vitamin D level in Group A was 25.28±8.47ng/ml and in Group B was 30.90±5.80, (p=0.001). Insufficient vitamin D level was found in 52.0% of ischemic stroke patients and in 30% of healthy controls (p=0.0002). Vitamin D deficiency was found in 20.0% ischemic stroke patients and 10.0% in healthy controls. This study demonstrates a positive association between low serum vitamin D level and acute ischemic stroke. Further studies are required to determine whether vitamin D supplementation could improve functional outcome in patients with ischemic stroke.

Rectal malignancies that require abdominoperineal resection (APR) and Anterior resection (AR) is very common. Laparoscopic APR or AR can be a better option. This study observed the feasibility of this newer technique for alternative to conventional open method. This prospective type of observational study was comprised of patients with diagnosis of rectal cancer, who admitted to BIRDEM General Hospital for Laparoscopic APR or AR from November 2015 to April 2016. Among 19 patients, age range was from 20-78 years, mean age was 49.84±17.04 years. Male: female ratio was 12:7 (63.2%:36.8%). Twelve (12) patients underwent Laparoscopic APR, 6 Laparoscopic AR, one conversion (conversion rate - 5.3%). Less analgesics were required, a mean of 5.61±1.57 dose/ample/mg opioid injections needed for 4.05 days. An early postoperative ambulation (2.16±0.76 days) was noted. Mean post-operative hospital stay was 11.53±1.98 days. Laparoscopic APR or AR is a safe, effective and technically feasible procedure. It can be a better operative procedure in terms of early postoperative outcome such as less analgesics requirement, early ambulation and shorter hospital stay.

Vertebral and Hip fractures are the commonly encountered in low bone mass condition termed as osteoporosis. Bone mass and structure also affected by hypertension leading to increased susceptibility to fractures. This comparative cross-sectional study was conducted at two tertiary care centers in Dhaka metropolis from 1st January 2017 to 31st December 2017 under the department of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM) to assess whether HTN is linked with higher OP fracture risk. In this study 54 hypertensive and 34 non-hypertensive osteoporotic female patients were involved. After face to face interview data were collected by using semi-structured questionnaire and checklist. Online assessment of fracture risk probability was done among the two groups by Fracture Risk Assessment Tool (FRAX) and statistical analysis was performed by Statistical Packages for Social Sciences (SPSS-23.0). In this study it is found that the mean ages were 61.94±9.362 years and 59.18±11.269 years for hypertensive and non-hypertensive patients respectively. Most of the patients with hypertensive (96.3%) and non-hypertensive (82.4%) were housewives. Mean duration of hypertension in osteoporotic women was 6.41±4.049 years while mean duration of osteoporosis was 8.80±5.022 years and 7.53±5.920 years in hypertensive and non-hypertensive patients respectively. The difference in risk of major osteoporotic fractures (MOF) by age was significantly (Χ², p<0.05) higher among patients aged 60-79 years and remarkably higher in hypertensive patients. In hypertensive patients though the risk of MOF by hypertension was relatively higher but it was not significant statistically (Χ², p>0.05). However the risk of hip fracture (HF) by hypertension was relatively higher among hypertensive patients and it was significant statistically (Χ², p<0.05). This reflects that the risk of hip fracture is higher significantly in hypertensive patients.

Obesity is associated with metabolic disorders such as dyslipidaemia, diabetes mellitus (DM), hypertension (HTN) and cardiovascular disease (CVD). There has been rising burden of childhood and adolescent obesity in most developing countries in recent years. Changes in dietary habits, junk and fast food, physical inactivity and smoking habits increases among adolescent students, which causes obesity and simultaneously increases risk of metabolic diseases. The objective of the study is to determine the correlation between Body Mass Index (BMI) and lipid profile among adolescent students of Bangladesh. This cross-sectional observational study was conducted among 79 undergraduate healthy adolescent students, aged 10-18 years who were selected through purposive sampling. The study was conducted from July 2022 to June 2023 in urban and rural areas of Dhaka, Narayanganj and Rangpur. Data was collected using a semi-structured questionnaire. Correlation of dyslipidemia and BMI was analyzed by Pearson Coefficient. Data was analyzed using SPSS version 22.0 with level of statistical significance at p<0.05. Mean age of the respondents was 14.9±4.5 years. Male and female ratio was 2.16:1. Among respondents, 46.8% had BMI 18.5-23.0 (normal), 31.6% had BMI 23.1-25.0 (overweight) and 21.5% had BMI >25.0 (obese). Prevalence of dyslipidaemia was 34.1%. Overweight and obese respondents had raised total cholesterol (TC) level 209.51±48.6 mg/dl and 218.36±80.0 mg/dl respectively. Mean high density lipoprotein (HDL) cholesterol level was 38.91±10.51 mg/dl in overweight and 36.54±10.04 mg/dl in obese. Mean low density lipoprotein (LDL) cholesterol level was 135.23±44.5 mg/dl in overweight and 143.61±56.0 mg/dl in obese. Among obese cases, 94.1% respondents had borderline triglyceride (TG) with mean 164.46±111.0 mg/dl. Among the study respondents, overweight and obesity (higher BMI) tend to have abnormal lipid profile. It is recommended that assessment of BMI should be incorporated into school health programme and those with overweight and obesity should be subjected to routine lipogram in order to apply timely preventive as well as therapeutic measures to save lives.

Physical activity and mindfulness techniques, such as exercise and Kapalbhati Pranayama, are known to have positive effects on health and well-being. However, limited research has directly compared their impact on physiological and psychological parameters. This study aimed to investigate and compare the effects of exercise and Kapalbhati Pranayama on Heart Rate Variability (HRV) and Electroencephalogram (EEG) activity, shedding light on their contributions to overall health and mental well-being. The study was conducted at All India Institute of Medical Sciences (AIIMS) in Bhopal, India, from 2018 to 2022. A prospective interventional design was employed over two months, involving 20 participants with normal BMI and no respiratory or cardiac conditions. Exclusion criteria included lung or cardiac diseases, smoking history, dyspnoea during physical activity, pedal edema, and high blood pressure. The Kapalbhati Pranayama intervention was supervised and limited to 5 minutes. HRV was assessed using the HRV Brain Tap Neuralchek Machine before, during, and after Kapalbhati. For exercise, a mild-intensity cycling protocol was performed on healthy volunteers aged 20 to 50. HRV was recorded before, during, and after exercise. The EEG analysis revealed notable changes in brain wave patterns. At baseline, participants exhibited higher levels of delta, theta, and alpha waves, indicating a state of relaxation and calmness. During exercise, there was a significant increase in beta waves and a decrease in delta, theta, and alpha waves, reflecting heightened brain activity and alertness. After Kapalbhati, beta wave levels remained elevated, while delta and theta wave suppression was more pronounced, suggesting a stimulating effect on the brain similar to exercise. The changes in beta and gamma EEG waves could be attributed to factors such as exercise intensity, duration, frequency, and the release of endorphins during both exercise and Kapalbhati. The HRV analysis demonstrated distinct responses to exercise and Kapalbhati. Exercise led to a significant reduction in HRV parameters, characterized by increased heart rate and decreased time-domain HRV measures, aligning with the typical sympathetic nervous system dominance during physical activity. In contrast, Kapalbhati's impact on HRV parameters was milder, with minor changes in heart rate and subtle alterations in time-domain HRV measures. The high LF/HF ratio during Kapalbhati suggested a potential stimulation of the sympathetic nervous system. More comprehensive research is required to confirm these findings and understand the long-term effects of Kapalbhati on HRV and cardiovascular health. This study contributes to the understanding of how exercise and Kapalbhati Pranayama affect both cognitive and cardiovascular aspects of health. It highlights that both interventions increase brain activity and alertness, but Kapalbhati may have a more potent effect. Exercise significantly reduces HRV parameters, indicating sympathetic nervous system dominance, while Kapalbhati has milder HRV effects. Further research with larger and more diverse populations is essential to confirm and expand on these findings, providing insights into optimizing cognitive function and cardiovascular health through tailored approaches of exercise and Kapalbhati Pranayama.

Chronic non-healing ulcers present significant challenges in diabetic, dermatological and surgical patients. Platelet-Rich Plasma (PRP), enriched with bioactive factors, offers promise for wound healing enhancement. The prospective observational study was done in the Department of Transfusion Medicine at AIIMS Bhopal for a period of two years, from April 2020 to 2022. This study evaluates PRP's efficacy, prepared via the single spin method, in non healing chronic ulcers. Aseptically, 100 ml of blood was drawn into CPDA (citrate-phosphate-dextrose-adenine) bags. PRP was prepared by centrifuging blood at 3400 rpm for 10 minutes, yielding PRP and buffy coat. Patient serum and 10.0% calcium gluconate were added to fibrin gel. PRP was injected around the ulcer and then dressed. Dressings were changed on the 5th, 15th and 20th days with PRP. The evaluation was done on day 30 using surface area and volume assessments. Thirteen patients aged 18-65 participated. The patients treated with single spin PRP (four females, nine males) had mean hemoglobin of 10.79±2.22gm/dL. Initial lesions (14.72cm²) significantly reduced to (8.78cm²) after application of single Spin PRP sessions (p=0.005). The PRP showed a mean platelet count of 1,527.00±192.26 × 10⁹/L. Ulcer surface area decreased from 9.87cm² to 7.56cm²; lesion volume reduced from 14.72cm³ to 8.78cm³. Platelet count differences between whole blood and PRP were significant (p<0.05). The single-spin PRP method exhibited considerable improvements in healing parameters, showcasing its potential for chronic ulcer management.

Construction work is common all over the world. Construction workers are exposed to various physical, chemical, biological and ergonomic hazards that may directly affect respiratory health. Aim of the study was to assess construction workers' pulmonary function and compare pulmonary function with healthy volunteers. This cross-sectional study was carried out in the Department of Physiology ARMCH & RC, Solapur, India from March 2022 to March 2023 on construction workers (n=25) and healthy subjects (n=25). Pulmonary function assessment in both groups was done using a Spiro Excel machine spirometer. The comparison was made between both groups for frequency of respiratory symptoms, spirometry pattern, and spirometry values. Statistical software used unpaired t-test and chi-square test. A normal pattern was observed in 40.0% of healthy subjects compared to 72.0% of construction workers (p<0.05). Restrictive and mixed patterns were evident in 4.0% and 1.0%, respectively, in healthy volunteers compared to 11.0% and 3.0% in construction workers (p<0.05). Statistical difference was seen in all lung function parameters, i.e. FVC, FEV₁, FEV₁/FVC%, FEF 25.0-75.0%, PEFR except MVV between both groups. In conclusion the construction workers are at risk of respiratory function derangement. This derangement is in the form of increased frequency of respiratory symptoms, restrictive & mixed patterns and decreased spirometry values of various parameters.

Autoimmune thyroiditis gradually destroys the thyroid gland leading to hypothyroidism and may even lead to papillary thyroid carcinoma. Deficiency of Vitamin D has been linked to development of autoimmunity. Single nucleotide polymorphisms of the Vitamin D receptor gene have associated with autoimmune diseases in several studies. In this hospital based non interventional cross-sectional study Vitamin D receptor gene was studied for FokI (rs2228570) polymorphism from purified DNA in forty-eight adult cases and fifty age and sex matched healthy controls. This study was conducted in the department of Biochemistry, Calcutta National Medical College, Kolkata, West Bengal, India from January 2021 to July 2022. Their DNA was isolated using phenol chloroform method and were analysed for the related single nucleotide polymorphism by restriction digestion using appropriate restriction enzymes after amplification by PCR. Differences in allele frequencies between two groups were estimated by chi square and odds ratio test. Any potential association between the vitamin D anti TPO antibody and thyroid hormone status with polymorphic variations were assessed by post hoc ANOVA among the three genotypes. The distribution of FF genotype was significantly higher among the case group (Χ²=10.2788, p=0.006). The odds ratio for the allele F was significantly higher in case group for a range of 1.97 to 5.94 for 95 percent confidence interval (Χ²=13.9678, p=<0.001). The genotype FF group had significantly lowest Vitamin D (p=0.008) and highest Anti TPO ab (p=0.031) compared to Ff and ff genotypes. Thus, significant association was revealed between the VDR gene Fok1(rs2228570) polymorphism and autoimmune thyroiditis with the predominance of FF genotype being a strong susceptibility factor for autoimmune thyroiditis and Vitamin D deficiency in the studied population of Eastern India.

Congenital heart disease is a leading cause of non-communicable childhood death. This is especially true in nations with limited resources where shortages of skilled workforce, healthcare facilities, and essential equipment limit the ability to provide care. This retrospective study was designed to determine the volume and distribution of surgical care being provided to patients with congenital heart disease in Bangladesh, as well as to characterize the facilities providing such care. Pre-existing survey data of hospitals performing congenital heart surgery in the year 2022 in Bangladesh was obtained. Additional information was gathered on these facilities, including hospital location and type. The distribution of care by geographic location, type of facility, and volume of cases was reported. Overall, a total of 2333 surgeries were performed in 2022 at 28 facilities. The majority of hospitals were performing <50 cases per year, while a small number (5) provided greater than 50.0% of all surgeries. In addition, while the majority of hospitals were private in nature, the majority of surgeries occurred at not-for-profit hospitals. There was a large geographic skew of surgeries and hospitals being located within the city of Dhaka (79.0% of centers and 94.0% of surgeries). The data suggests that, though there has been great progress in increasing the number of surgeries performed in Bangladesh, the vast majority of patients still do not have access to care. In addition, nearly all care is being provided in Dhaka, which presents challenges for patients who come from across the nation seeking care. Finally, there is a great need for further research to fully understand the challenges faced and find workable solutions.

Obesity and hypothyroidism are interlinked. In this prospective study, 142 children and adolescents (mean age 140±34 months, girls 54.2%) either with obesity or overweight were included from the patients attending at the Endocrine out-patient clinic of Dhaka Shishu (Children) Hospital during a period from March, 2017 to February, 2020 and were assessed for thyroid function. Among them, 85 were obese (Body mass index, BMI >95th percentile), 29 were overweight (BMI between 85th to 95th percentile) and 28 had normal weight (BMI <85th percentile). Girls were more frequent in obese (57.6%) and overweight (51.7%) groups than boys. Mean TSH was not significantly different among the three groups (3.39 vs. 4.01 vs. 4.06mIU/L; p=0.248). Subclinical hypothyroidism was present in 22 cases (15.5%); the frequencies were 3.6% in Group 1, 17.2% in Group 2 and 18.8% in Group 3. Both overweight and obese groups had significantly (p<0.005) higher prevalence of SCH than the normal-weight group. Girls were more frequently affected than boys (72.7% vs. 27.3%, p=0.047). Among the 22 children who had SCH, 2(9.1%) had a mild goiter and higher serum levels of anti-TPO and anti-TG. Serum TSH had no correlations with age, body weight, height, BMI and serum FT₄. The findings indicate that a substantial portion of over weight and obese children and adolescents have SCH and the causes other than thyroid autoimmunity are more prevalent in them.

Now a days, chronic obstructive pulmonary disease (COPD) is a global health problem. This study was done to evaluate the changes of body mass index (BMI) and blood pressure (BP) in COPD patients in comparison to healthy person. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh between the periods from July 2018 to June 2019. Total 160 male subjects, age ranged from 30-70 years was included in this study. Among them, in study group (Group II) eighty (80) male COPD subjects and eighty (80) age matched male healthy subjects were taken as control group (Group I). BMI was calculated as weight in kilogram divided by the height in meter square. Blood pressure was measured with an aneroid sphygmomanometer. Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean±SD of BMI of Group I and Group II were 24.52±1.35kg/m² and 21.22±1.30kg/m² respectively. The mean±SD of systolic blood pressure of Group I and Group II were 118.75±7.73 mm of Hg and 134.56±15.24 mm of Hg respectively. The mean±SD diastolic blood pressure of Group I and Group II were 77.63±6.70 mm of Hg and 84.69±8.05 mm of Hg respectively. The mean±SD of BMI was significantly lower in study group and the mean±SD of systolic and diastolic blood pressure was significantly higher in study group than control group. Low BMI and hypertension in subjects with COPD are associated with a high risk of exacerbations and mortality. So assessment of this parameter is important for prevention of complication related to COPD for leading a healthy life.

Objective of the study was the effect of Covid-19 infection on pregnancy and neonatal outcomes. This prospective cohort study was conducted in Combined Military Hospital (CMH) Bogura, Obstetrics and Gynaecology department from June 2020 to October 2020. We have collected and analyzed data of 29 pregnant ladies positive for Covid-19. Control group was Covid-19 negative pregnant patients. Nasopharyngeal swab was taken for real time polymerase chain reaction for detection of Covid-19. We observed symptoms, compared any complication in mother and fetus, mode of termination, and duration of hospital stay. Only six patients were asymptomatic (10.3%). Fifteen (25.9%) had fever, six (6) had weakness (10.3%), 5(8.6%) had sore throat, 3(5.2%) had nausea and 5(8.6%) presented with loss of smell. Among twenty-nine patients, 5(8.6%) delivered normally, 24(41.4%) were delivered through caesarean section which was significantly higher than control group (p value <0.001). No mother became critical or expired, neonatal death was also absent. Mean duration of hospital stay was 14.13±6.192 days in case and 5.18±4.99 in control which was significantly (p value <0.001) higher. Breast feeding was significantly higher in control group (p value <0.001). This study shows feto-maternal outcome of Covid-19 pregnancy is almost same as those of normal pregnancy.

Water related diseases are of great concern in developing countries like Bangladesh. Every year, many people die due to consumption of unsafe drinking water. In order to protect public health it is compulsory that the accessible drinking water should be maximum quality. In this descriptive observational study 150 samples of bottled water and 150 jar water samples were collected from different shops and restaurants. Each sample were filtered through a membrane filter and then placed on MacConkey agar media for total and fecal coliform count and 0.1 ml of water spread on nutrient agar media for heterotrophic plate count (HPC). Among 150 bottled water samples 11 (7.33%) were culture positive and 92 (61.33%) were culture positive in 150 jar water samples. Out of 150 jar water samples 38 (25.33%) were total coliform and among them 19 (12.67%) were fecal coliform. Among 300 water samples 55 (53.40%) samples showed HPC greater than 500 CFU/ml. A total of 9 bacterial isolates: Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter spp. CONS, Aeromonas spp., Enterobacter spp., Klebsiella spp. and Citrobacter were found.

Pressure sore is an important post-stroke complication that results in increased morbidity, mortality and poor prognosis of the patients. The objective of the present study was to find out the prevalence and the factors associated with pressure sore among stroke patients. This prospective cross-sectional study includes 50 stroke patients admitted in the Department of Neurology of Dhaka Medical College Hospital, Bangladesh from July to December 2018. Data were collected from the by direct interview of the patients or their relatives or caregiver using a structured case report form. Descriptive statistics were used to represent patients' characteristics and the chi-square test was used to determine the difference between patients' groups. The mean ±SD age of the stroke patients was 59.16±11.53 years and half of them were male. Fifty percent of the patients had been suffering from ischemic stroke and the rest from hemorrhagic stroke. Of all, one-fourth of the patients (24.0%) developed post-stroke pressure sore during the hospital stay and type-specific prevalence was 20.0% in ischemic stroke and 30.0% in hemorrhagic stroke. Common sites of the pressure sore were sacrum (50.0%), buttock (25.0%), heels (17.0%), and greater trochanter (8.0%). Only 8.0% of the patients developed grade IV wounds. Pressure sores of 42.0% of patients healed spontaneously, 25.0% needed conservative management and 25.0% needed a skin graft. This study found that a large portion of stroke patients develop a pressure sore during hospital stay which can deteriorate clinical outcomes and compromise the quality of life of the patients. Adequate preventive measures and proper rehabilitation should be encouraged for better stroke management and to reduce long-term complications.

This was a multicenter cohort study to evaluate the relationship between radiological findings and disability in moderate and severe head injury patients. The study places were the Neurosurgery department of Sylhet M A G Osmani Medical College Hospital, Sylhet Women's Medical College Hospital (SWMCH) and King Faisal Hospital (KFH), Taif, KSA. Sample size was 104 and the study period was 36 months (July 2021 to December 2022). On the basis of radiological findings the participants were divided into three arms. The different arms were diffused traumatic brain injury (arm-1), focal traumatic brain injury (arm-2) and both (diffused and traumatic) types traumatic brain injury (arm-3). Outcome was assessed by modified Rankin Score (mRS). Mean age was significantly higher in female. Overall mean age was 40.28 year. Highest number was in the below 20-year age group followed by the 41-50-year age group. Lowest number of participants was in the above 60-year group. Improved group was significantly higher than 'not improved' and the 'died' group (p<0.00001). Improved participants were significantly higher in the arm-1 and arm-2. Mortality was significantly higher (p<0.00001) in the arm-3 group.

This study was intended to evaluate the pathological outcome of cardiopulmonary bypass whilst considering socio-demographic variables and surgical technique on early postoperative results following coronary artery bypass graft (CABG) surgery in patients at a tertiary level hospital in Bangladesh. This observational study evaluated a total of 880 patients with ischemic heart disease in Bangabandhu Sheikh Mujib Medical University, Bangladesh from 2011 to 2019 who were undergoing an isolated CABG surgery. In this current study, the population divided into two groups- Group A: Off-pump CABG (n=440) and Group B: On-pump CABG (n=440). The mean age of the patients was 55.25±5.0 years in off-pump and 50.75±5.2 years in the on-pump group. Risk factors, including smoking, hypertension, and hyperlipidemia, were predominant in both study groups. Total operative time was notably higher in the on-pump CABG group. However, grafting time was more in the off-pump CABG procedures. Postoperative neurological deficits were higher amongst the on-pump CABG population. The mean time of mechanical ventilation, intensive care unit (ICU) stay, total hospital stay, and mortality was notably higher in the on-pump CABG group. Moreover, the number of mortalities in on-pump CABG patients was primarily due to the low output syndrome, failure of weaning from cardiopulmonary bypass (CPB) and sudden cardiac arrest. Off-pump CABG is now more acceptable due to its potentiality to avoid CPB induced complications, aortic cannulation, and cross-clamping. Cardiac arrest in on-pump CABG induces global ischemia and reperfusion injury to the cardiac muscle. Besides, the Off-pump CABG provides a conspicuous survival advantage compared to the on-pump CABG, in association with a notable reduction in postoperative morbidity and mortality.

Clustering of hypertension, dyslipidemia, and other metabolic abnormalities is increasing the burden of non-communicable diseases, especially cardiovascular disease. The objective of this study was to explore the pattern of lipid profiles in newly diagnosed hypertensive patients attending Shaheed Mansur Ali Medical College, Dhaka, Bangladesh from August 2020 to December 2020. A total of 59 newly diagnosed hypertensive patients were studied through a cross-sectional approach. Prior to the study, ethical clearance was ensured, and informed written consent was obtained. A pre-structured questionnaire was used for data collection. Collected data were analyzed using SPSS 24.0 version. Slight male preponderance (54.2%) was observed along with an average age of 45 years among studied patients. Raised levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) were observed in 91.5%, 98.3%, and 88.1% of patients accordingly. Low level of high-density lipoprotein (HDL) was observed in 47.5% of the patients. Mean TC, TG, LDL, HDL were 286.11±347.37, 311.74±122.76, 163.27±33.67 and 38.29±6.66 mg/dl, respectively. Almost all patients were obese. There is no correlation between the serum lipid profile and blood pressure of the patients. Dyslipidemia was highly prevalent among newly diagnosed hypertensive patients.

Soft tissue injuries of the hand or forearm often results in exposure of tendon or bone which needs coverage with a suitable flap. This prospective observational study was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from February 2019 to January 2020, to evaluate the use of the pedicled paraumbilical perforator flaps as a reliable flap to cover such defects. Total 34 patients having soft tissue defects in the hand and forearm with exposed tendons, bones or implant were included in this study. All the defects were covered by paraumbilical perforator flap. The defects were caused by road traffic accident (n=22), machinery injury (n=10) and burn injury (n=2). Sixteen patients had defects involving the forearm, six over dorsum of hand, another two over first web space and the rest had defects over two or more areas of forearm, hand and wrist. Lateral extent of flaps was upto anterior axillary line in 41.18% cases and upto mid-axillary line in 55.88% cases. Flap division and final inset was done in second stage after 3 weeks. Donor site closed primarily in all cases, except in two cases where it was covered by skin graft. All the flaps survived with no incidence of flap necrosis, dehiscence or infection after first stage. However, after the division of the flap, two patients developed marginal necrosis of the proximal margin which healed spontaneously by conservative treatment. The mean flap surface area utilized was 108 cm2. Donor area healed well without any major complications. Three patients developing scar hypertrophy were treated with intra-lesional triamcinolone injections. The paraumbilical perforator flap is a reliable option to cover soft tissue defects of hand and forearm due to easier planning and harvesting of the flap, adequate skin paddle and minimum donor site morbidity.

The extremely contagious global outbreak of the novel Coronavirus disease 2019 (Covid-19) caused by Severe acute respiratory syndrome coronavirus-2(SARS- CoV-2) is causing concern worldwide since its emergence. Healthcare workers (HCWs) are more susceptible for acquiring Covid-19 due to direct or indirect exposure to Covid-19 patients. Therefore, it is important to investigate demographic, clinical characteristics and outcome of affected persons and possible source of infection with exposure details. This study aimed at determining the demographic and clinical profile, outcome and possible risk factors for infection among the HCWs at Kurmitola General Hospital (KGH), Bangladesh. This retrospective observational study was done among the SARS-CoV-2 positive HCWs of Kurmitola General Hospital (KGH) from April 2020 to January 2021. Out of total 1323 HCWs, 180(13.9%) cases were detected Covid-19 positive. Among the infected HCWs, 76(42.2%) were male and 104(57.8%) were female. The mean age was 32.8±6.95 years. Eighty nine (89) were nurses (49.4%) and 67 were physicians (37.2%). Among them, 23(13.0%) had no definite symptoms. Mild symptoms had in 137(76.11%) and 40(22.22%) had moderate symptoms. Most common symptoms were fever 112(62.0%), weakness 108(60.0%), cough 102(57.0%) and myalgia 54(30.0%). Pre-existing comorbidities had 43(24.0%). Bronchial asthma 27(15.0%), HTN 24(13.0%) and DM 21(12.0%) were the most prevalent comorbidities. All completely were recovered ultimately. Fatigue 52(28.89%), shortness of breath 15(8.3%), cough 13(7.2%) were the most common long-term complications. Among them, 53(29.0%) pointed toward lack of maintaining a hygienicatmosphere, as their possible cause of being infected, whereas 37(21.0%) could not identify the cause. Maximum HCWs, 170 cases (94.44%) used PPE during their duty. Adequate training get 26(14.44%) on PPE use and Infection prevention and control (IPC). This study concludes almost 1.4 in 10 HCWs at KGH were infected with SARS-CoV-2 while working in hospital during the Covid-19 pandemic. Affected HCWs have relatively female predominance with younger age, milder symptoms, and less underlying diseases in this study. Fatigue and shortness of breath are most common long-term complications, which hampers their working ability. Most of them did not get any training on PPE use and IPC.

This study investigated the prevalence, correlates, and reasons for discontinuing gender-affirming medical treatment (GAMT) among transgender and gender-diverse adolescents and young adults living in Canada and the United States of America.

To estimate the effect of geographic variation in historic slavery on perinatal outcomes [chronic hypertension, hypertensive disorders of pregnancy (HDP), very preterm birth (VPTB), or very low birth weight birth (VLBW)] among Black people living in states where slavery was legal in 1860 and test mediation by Black homeownership.

Evidence is limited regarding the effect of prenatal benzodiazepine and z-hypnotic exposure and long-term neurodevelopment in childhood. The objective of this study was to investigate the effects of initiating benzodiazepine or z-hypnotic treatment in early, mid and late pregnancy on fifth-grade numeracy and literacy scholastic skills in children, by emulating three target trials. The trials are identical except for the timing of enrollment and the number of eligible individuals. Eligibility to the trials required a history of anxiety and/or depression prior to pregnancy. We used data from the Norwegian Mother, Father and Child Cohort Study, linked to the Medical Birth Registry of Norway, to emulate the trials. We adjusted for baseline covariates that were available at time 0 for each trial by inverse probability of treatment weighting using the propensity score. The findings of this study did not show any effect of mothers' initiation of treatment with benzodiazepines or z-hypnotics in early, mid or late pregnancy on the children's 5th grade test scores in numeracy and literacy. The study results provide reassurance for patients in need of benzodiazepines and z-hypnotics during pregnancy; however, these findings need to be interpreted with caution due to low study power in some of the analyses.

Antibiotic resistance, a significant public health hazard, is predicted to cause 10 million deaths worldwide by 2050. The study aimed to identify culturable bioaerosols in the indoor air of dental units in Lahore and assess their antibiotic resistance. Air samples were collected from 10 dental unit locations at different distances, with average concentrations of fungi and bacteria falling within intermediate ranges, per the Global Index of Microbial Contamination (GIMC/m3) index. The study found higher antibiotic-resistant strains in hospital dental units, particularly during winter. The most vigorous strain, -NAJIH18, exhibited 70% resistance to ceftazidime. The research highlights the importance of quantifying microbial pollutants for evaluating their source and complexity. It suggests proactive mitigation techniques, such as focused cleaning and air filtration, to improve indoor air quality can mitigate the spread of antibiotic-resistant strains. These insights offer hope in combating the growing public health threat of antibiotic resistance.

The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant.

Accurately measuring gender and sex is crucial in public health and epidemiology. Iteratively reexamining how variables-including gender and sex-are conceptualized and operationalized is necessary to achieve impactful research. Reexamining gender and sex advances epidemiology toward its goals of health promotion and disease elimination. While we cannot reduce the complexities of sex and gender to simply an issue of measurement, striving to capture these concepts and experiences accurately must be an ongoing dialogue and practice-to the benefit of the field and population health. We assert that epidemiology must counteract misconceptions and accurately measure gender and sex in epidemiology. We aim to summarize existing critiques and guiding principles in measuring gender and sex that can be applied in practice.

Households have high burden of health care payments. Alternative financing approaches could reduce this burden for some households.

We aimed at examining the shared and unique associations of metabolites with multiple cardiometabolic diseases (CMD), i.e. type 2 diabetes (T2D), coronary heart disease (CHD) and stroke. In this study, a total of 168 plasma metabolites were measured by targeted high-throughput nuclear magnetic resonance spectroscopy among 98,162 participants free of T2D, CHD, and stroke at baseline. Cox proportional hazard models estimated hazard ratios for one SD increase in metabolite concentration levels, and false discovery rate (at 10%) was used to correct for multiple comparisons. Over 12.1 years of follow-up on average, 3,463 T2D, 6,186 CHD, and 1,892 stroke events were recorded. Most lipoprotein metabolites were associated with risks of T2D and CHD but not with the risk of stroke, with stronger associations for T2D than for CHD. Phospholipids within intermediate-density lipoprotein or large low-density lipoprotein particles showed positive associations with CHD and inverse associations with T2D. Metabolites indicating very small very low-density lipoprotein, histidine, creatinine, albumin, and glycoprotein acetyls were associated with risks of all three conditions. This large-scale metabolomics study revealed common and distinct metabolic biomarkers for T2D, CHD and stroke, providing instrumental information to possibly implement precision medicine for preventing and treating these conditions.

The patient perspective is essential for assessing disease severity, but it is not always adequately considered. We describe how a comprehensive clinical disease severity index (DSI) for inflammatory bowel disease (IBD) correlates with patient global self-assessment (PGSA).

In the US, the COVID-19 pandemic led to a significant rise in unemployment and economic loss that disproportionately impacted low-income individuals. It is unknown how health care and prescription medication affordability changed among low-income adults during the COVID-19 pandemic overall and compared with their higher-income counterparts.

While there is a large body of evidence indicating that sexual minority youth experience inequitably high rates of mental health problems (eg, depression, suicidality), we know little about how temporal changes in sexual attractions, identities and behaviour may impact mental health (and other) outcomes. In this essay, we review existing research regarding sexual fluidity and mental health among young adults in order to identify critical knowledge gaps with respect to an epidemiological understanding of the relationship between these factors. We describe three gaps that in turn inform a larger public health research agenda on this topic. First, there are a number of methodological challenges given that fluidity can occur over short or long periods of time and across multiple dimensions of sexual orientation (eg, attractions, identities and behaviour) with various patterns (eg, directionality of change). Tailored measures that accurately and inclusively reflect diversities of sexual fluidity trajectories are needed. Second, causal relationships between sexual fluidity and mental health remain uncertain and unquantified. Third, little is known about how features of context (eg, gender norms and political climate) influence youth experiences with sexual fluidity and mental health. Finally, we propose a set of recommendations to address these knowledge gaps to improve the quality of epidemiological research involving young people.

Immune response to COVID-19 vaccine is diminished in patients with hematologic malignancy. There is limited data regarding response to vaccine doses in these patients.

Maternal immunisation is a powerful tool to protect both pregnant women and their children. A new maternal RSV vaccine holds promise to protect newborns from RSV-associated illness in the first few months of life, but no official recommendation has been made in Germany. Since RSV causes a significant burden of paediatric hospital admissions, we consider it a pertinent opportunity to review barriers to maternal vaccination in Germany, which might also apply to other settings. Access to vaccination for pregnant women in Germany is shaped by an interplay of legal, regulatory, institutional, and sociocultural factors, with a less permissive clinical research environment, delays in recommendation and roll-out, and lower acceptance by healthcare professionals and the population. Actionable recommendations to improve availability and uptake include coordination with other national regulatory bodies to reduce delays, awareness and literacy campaigns for health professionals and the general public, and capacity building for vaccine clinical research.

Infectious bursal disease virus (IBDV) is an acute and highly infectious RNA virus known for its immunosuppressive capabilities, chiefly inflicting rapid damage to the bursa of Fabricius (BF) of chickens. Current clinical control of IBDV infection relies on vaccination. However, the emergence of novel variant IBDV (nVarIBDV) has posed a threat to the poultry industry across the globe, underscoring the great demand for innovative and effective vaccines. Our previous studies have highlighted the critical role of IBDV VP5 as an apoptosis-inducer in host cells. In this study, we engineered IBDV mutants via a reverse genetic system to introduce amino acid mutations in VP5. We found that the mutant IBDV-VP5/3m strain caused reduced host cell mortality, and that strategic mutations in VP5 reduced IBDV replication early after infection, thereby delaying cell death. Furthermore, inoculation of chickens with IBDV-VP5/3m effectively reduced damage to BF and induced neutralizing antibody production comparable to that of parental IBDV WT strain. Importantly, vaccination with IBDV-VP5/3m protected chickens against challenges with nVarIBDV, an emerging IBDV variant strain in China, reducing nVarIBDV loads in BF while alleviating bursal atrophy and splenomegaly, suggesting that IBDV-VP5/3m might serve as a novel vaccine candidate that could be further developed as an effective vaccine for clinical control of IBD. This study provides a new clue to the development of novel and effective vaccines.

Suspected allergic reactions after mRNA COVID-19 vaccination withheld multiple individuals from getting fully vaccinated during the pandemic. We vaccinated adults who had experienced possible allergic symptoms after their first intramuscular dose of a COVID-19 mRNA vaccine with a 1/5th fractional intradermal test dose of the mRNA-1273 (Moderna) COVID-19 vaccine. No anaphylactic reactions were observed after intradermal vaccination (n = 56). Serum anti-S1 IgG concentrations were measured using a bead-based multiplex assay four weeks after vaccinations. Antibody concentrations were compared with a previously collected nationwide cohort that had received two intramuscular doses of mRNA-1273. Antibody responses in all subjects tested (n = 47) were comparable to standard of care intramuscular dosing. Fractional intradermal dosing of mRNA COVID-19 vaccines may provide a pragmatic solution that is safe, time efficient compared to skin prick testing, dose sparing and immunogenic in individuals with suspected vaccine allergy.

Sensory disability in older adults is associated with increased rates of depressive symptoms and loneliness. Here, we examined the impact of hearing, vision, and olfaction disability on mental health outcomes in older US adults.

BACKGROUND Congenital hypoplasia of the thumb type IV, also known as floating thumb, is a condition in which 2 small phalanges are attached to the hand with a thin skin bridge. Surgical management options for this condition vary from amputation to flap reconstruction. MATERIAL AND METHODS This retrospective study analyzed 11 infants with congenital hypoplasia of the thumb type IV who underwent surgical reconstruction using a modified vascularized polydactylous hallux flap. The study included 6 male and 5 female infants, aged 6 to 24 months. Functional evaluations and radiographic studies were conducted postoperatively. RESULTS All 11 patients underwent the complete surgical protocol. Successful vascular and nerve anastomoses were performed during the initial procedure, ensuring sufficient blood supply and neural connectivity to the transferred toes. The second operation showed promising outcomes, including improvements in thumb opposition, grasp strength, and overall function. Postoperative assessments demonstrated satisfactory radiographic alignment and no major complications during the follow-up period. CONCLUSIONS The modified vascularized polydactylous hallux flap reconstruction is a viable surgical option for managing congenital hypoplasia of the thumb type IV in infants. This technique effectively restores thumb opposition, grasp strength, and overall hand function, with satisfactory radiographic alignment and minimal complications. The study findings support the efficacy and safety of this surgical approach in addressing this rare congenital anomaly.

Gunshot injuries are the leading cause of death among children in the United States. The goal of this study was to better understand if certain age groups, mechanisms of injury, and type of firearms were associated with the increasing rates of pediatric gun-related trauma. We hypothesized that the extremities were disproportionately targeted when compared with the random likelihood of striking specific body-surface areas.

There has been tremendous effort to improve quality following colorectal surgery, including the proliferation of minimally invasive techniques, enhanced recovery protocols, and surgical site infection prevention bundles. While these programs have demonstrated improved postoperative outcomes at the institutional level, it is unclear whether similar benefits are present on a national scale.

Macrolide antibiotics, pivotal in clinical therapeutics, are confronting resistance challenges mediated by enzymes like macrolide esterases, which are classified into Ere-type and the less studied Est-type. In this study, we provide the biochemical confirmation of EstX, an Est-type macrolide esterase that initially identified as unknown protein in the 1980s. EstX is capable of hydrolyzing four 16-membered ring macrolides, encompassing both veterinary (tylosin, tidipirosin, and tilmicosin) and human-use (leucomycin A5) antibiotics. It uses typical catalytic triad (Asp233-His261-Ser102) from alpha/beta hydrolase superfamily for ester bond hydrolysis. Further genomic context analysis suggests that the dissemination of estX is likely facilitated by mobile genetic elements such as integrons and transposons. The global distribution study indicates that bacteria harboring the estX gene, predominantly pathogenic species like Escherichia coli, Salmonella enterica, and Klebsiella pneumoniae, are prevalent in 74 countries across 6 continents. Additionally, the emergence timeline of the estX gene suggests its proliferation may be linked to the overuse of macrolide antibiotics. The widespread prevalence and dissemination of Est-type macrolide esterase highlight an urgent need for enhanced monitoring and in-depth research, underlining its significance as an escalating public health issue.

IncX3 plasmids carrying the New Delhi metallo-β-lactamase-encoding gene, bla, are rapidly spreading globally in both humans and animals. Given that carbapenems are listed on the WHO AWaRe watch group and are prohibited for use in animals, the drivers for the successful dissemination of Carbapenem-Resistant Enterobacterales (CRE) carrying bla-IncX3 plasmids still remain unknown. We observe that E. coli carrying bla-IncX3 can persist in chicken intestines either under the administration of amoxicillin, one of the largest veterinary β-lactams used in livestock, or without any antibiotic pressure. We therefore characterise the bla-IncX3 plasmid and identify a transcription regulator, VirBR, that binds to the promoter of the regulator gene actX enhancing the transcription of Type IV secretion systems (T4SS); thereby, promoting conjugation of IncX3 plasmids, increasing pili adhesion capacity and enhancing the colonisation of bla-IncX3 transconjugants in animal digestive tracts. Our mechanistic and in-vivo studies identify VirBR as a major factor in the successful spread of bla-IncX3 across one-health AMR sectors. Furthermore, VirBR enhances the plasmid conjugation and T4SS expression by the presence of copper and zinc ions, thereby having profound ramifications on the use of universal animal feeds.

The widespread administration of COVID-19 vaccines has prompted a need to understand their safety profile. This investigation focuses on the safety of inactivated and mRNA-based COVID-19 vaccines, particularly concerning potential cardiovascular and haematological adverse events. A retrospective cohort study was conducted for 1.3 million individuals residing in Abu Dhabi, United Arab Emirates, who received 1.8 million doses of the inactivated BBIBP CorV (by SinoPharm) and mRNA-based BNT162b2 (Pfizer-BioNTech) vaccines between June 1, 2021, and June 30, 2022. The study's primary outcome was to assess the occurrence of selected cardiovascular and haematological events leading to hospitalization or emergency room visits within 21 days post-vaccination. Results showed no significant increase in the incidence rates of these events compared to the subsequent 22 to 42 days following vaccination. Analysis revealed no elevated risk for adverse outcomes following first (IRR 1·03; 95% CI 0·82-1·31), second (IRR 0·92; 95% CI 0·72-1·16) and third (IRR 0·82; 95% CI 0·66-1·00) doses of either vaccine. This study found no substantial link between receiving either mRNA and inactivated COVID-19 vaccines and a higher likelihood of cardiovascular or haematological events within 21 days after vaccination.

This study aimed to examine prospective associations of different intensity levels and types of physical activity (PA) in early pregnancy with premature rupture of membranes (PROM) among Chinese pregnant women.

An improper host immune response to Mycoplasma pneumoniae generates excessive inflammation, which leads to the impairment of pulmonary ventilation function (PVF). Azithromycin plus inhaled terbutaline has been used in the treatment of Mycoplasma pneumoniae pneumonia (MPP) in children with impaired pulmonary function, but previous randomized controlled trials (RCTs) showed inconsistent efficacy and safety. This study is aimed to firstly provide a systematic review of the combined therapy.

To estimate the cumulative incidence of COVID-19 and its determinants among a nationally representative sample of adults from Spain who smoke.

Cannabis is one of the most commonly utilized recreational drugs. However, increasing evidence from the literature suggests harmful implications on cognition. Thus, the main aim of the current review is to summarize literature findings pertaining to the impact of cannabis on neurocognitive skills, focusing on the imaging biomarkers provided by MRI. Two reviewers navigated the literature independently using four main search engines including PubMed and Cochrane. Articles were first evaluated through their title and abstract, followed by full-text assessment. Study characteristics and findings were extracted, and the studies' quality was appraised. 47 articles were included. The majority of the studies were of a case-control design (66%), and the most studied neurocognitive skill was memory (40.4%). With task-based fMRI being the most commonly utilized MRI technique, findings have shown significantly varying decreased and increased neuronal activity within brain regions associated with the cognitive tasks performed. Results suggest that cannabis users are significantly suffering from cognitive deficits. The major significance of this review is attributed to highlighting the role of MRI. Future research needs to delve more into validating the negative effects of cannabis, to enable stakeholders to take action to limit cannabis usage, to foster public health and wellbeing.

Charcot neuroarthropathy (CN) is a complex disease of the bone and joints that can lead to serious and life-threatening complications. This study investigates epidemiologic trends in diabetic CN in Texas and the impact of age on these values.

For patients with congenital heart disease-related pulmonary arterial hypertension (CHD-PAH), cardiopulmonary exercise testing (CPET) can reflect cardiopulmonary reserve function. However, CPET may not be readily accessible for patients with high-risk conditions or limited mobility due to disability. Echocardiography, on the other hand, serves as a widely available diagnostic tool for all CHD-PAH patients. This study was aimed to identify the parameters of echocardiography that could serve as indicators of cardiopulmonary function and exercise capacity.

After cholecystectomy, elderly patients require special attention, due to the influence of involution processes in the body on the formation of complications. To identify prognostic criteria for the formation of fatty liver degeneration in the long-term period of minimally invasive cholecystectomy, 159 men were examined. Dysregulation of the biliary tract was determined using magnetic resonance cholangiopancreatography, elastography and magnetic resonance imaging of the liver. Microbial markers of the wall microbiome of the intestine were determined using chromatography-mass spectrometry. The relationship between an increase in body mass index and a decrease in the amount of obligate microbiome (r=-0,43, p<0,050), as well as with the formation of fatty liver degeneration in elderly patients, was revealed. The features of vegetative regulation in elderly people with fatty liver degeneration have been determined. It has been proven that in old age, a decrease in the number of obligate anaerobic association of microorganisms of the small intestine (on average from 15 659 to 7 630 in persons of the 2nd age subgroup and from 1 457 to 17 837 in the 3rd) is a predictor of fatty liver degeneration. The prognostic algorithm developed on the basis of the analysis of highly informative signs makes it possible to identify with an accuracy of at least 75% a high risk of fatty liver degeneration in the long-term period of cholecystectomy.

Despite well-established recommendations and psycho-education programmes, the health of family carers is most often impaired, which means that the support they provide is seen only in terms of burden. A phenomenological approach based on strength-based care shows that they develop skills and strategies for the well-being of their loved one, and are nurtured by a sense of hope that enables them to acquire experiential knowledge.

Suicide prevention is a major public health issue, both nationally and internationally. The management of suicidal patients leaving emergency departments is crucial to preventing the risk of suicidal recurrence. Advanced practice nurses in psychiatry and mental health can provide real added value thanks to their specialist training, their ability to carry out a comprehensive and detailed clinical assessment, their mastery of medicinal and non-medicinal therapeutic interventions, their skills in coordinating the various players involved in the care pathway, their commitment to prevention and their skills in supporting the development of the skills of care and research teams.

The aim of the study was to investigate the peculiarities of morphometric parameters of peripheral blood lymphocytes in chronic pyelonephritis in elderly patients in comparison with young and middle-aged patients. A total of 81 patients with chronic pyelonephritis in the exacerbation phase were examined. All patients were divided into three age groups according to WHO recommendations: the 1st - 42patients of young age (18-44 years); the 2nd - 17 patients of middle age (45-59 years); the 3rd - 22 elderly patients (60-74 years). Computer morphometry of lymphocytes was performed in all examined patients. In elderly patients with chronic pyelonephritis the size and сytoplasmic-nuclear ratio of lymphocytes increase. This indicates the preservation of lymphocyte defense responses at this age. In male patients with chronic pyelonephritis in the 1st and 2nd age groups the size of lymphocytes increases, and in female patients - decreases. The сytoplasmic-nuclear ratio increases in males of these age groups, while it remains unchanged or decreases in females. Indirect indications of reduced immunity in young and middle-aged women with chronic inflammation in the kidneys have been obtained.

Communication is considered as one of the basic human needs. For a long time, loneliness and social isolation were mainly considered as a psychosocial problem. However, in the recent years, there has been increasing evidence of the possible impact of loneliness and social isolation on the development and clinical course of somatic diseases. Research objectives were studying and analysis of current literature data about the medical consequences of loneliness and social isolation in the elderly cases. An analysis of the literature data shows that loneliness and social isolation affect not only the psycho-emotional status of elderly patients, but also their physical health. It has been shown that the number of available social connections affects the development and clinical course of diabetes mellitus, cardiovascular diseases, and outcomes of the brain stroke, immune system reactions, average life expectancy, and the risk of death caused by any causes. It has been established that the influence of social ties on the risk and clinical course of chronic non-communicable diseases is comparable to the effect of such generally accepted risk factors like smoking, alcohol consumption, physical inactivity, hypertension, obesity, hypercholesterolemia, environmental pollution, as well as various medical interventions (vaccination, drug therapy, etc.). Social isolation affects the risk of hospitalization and the frequency of outpatient care, poor socialization increases the risk of death from a heart attack. The results of the study show that loneliness and social isolation of the elderly cases have certain medical consequences that need to be taken into account when managing such patients.

One of the most difficult tasks in medical practice is pharmacotherapy in elderly and senile patients. The complexity of pharmacotherapy in elderly patients is due to age-related physiological changes, high frequency of multimorbidity. The age of patients no longer precludes surgical intervention, and surgical procedures are often performed on elderly patients with complex comorbidities. Over the past 15 years, the number of emergency hospitalizations has increased significantly worldwide.

Geriatric in-patient dermatoses are diverse. Few data in Morocco describe the epidemiological profile and factors associated with average length of stay (LOS). Our aim was to identify these dermatoses and determine the factors associated with LOS.

The foundation of healthy aging is the prevention of disability. In modern medical usage, a syndrome refers to a collection of symptoms and signs with a single underlying cause that may not yet be known. Geriatric syndromes, on the other hand, refer to multifactorial health conditions and occur when the accumulated effects of impairments in multiple systems make an older person vulnerable to situational changes. The use of the term "syndrome" in geriatrics emphasizes the multiple causes of a single manifestation involving an abundance of factors involving multiple organs and systems and is characterized by unique features of common health problems in older adults. It is the geriatric syndromes that can have a significant impact on quality of life and disability. Therefore, early detection of these medical conditions using targeted geriatric assessment is essential in geriatrics. Understanding the essence and feminology of geriatric syndromes, their correct positioning and interpretation is an extremely urgent problem. The main purpose of the presented review is precisely to try to answer these questions. In addition, it has not yet been determined whether geriatric syndromes should be included in the diagnosis (the only exception is sarcopenia syndrome, which was officially included in the 10th International Classification of Diseases in 2016).

A review of the use of comprehensive geriatric assessment and its components in oncology is introduced. The evidence base for the increasing incidence of cancer in the elderly worldwide also presented. The management of older adults with cancer is challenging. Comprehensive Geriatric Assessment (CGA) has been shown by many authors to be a strong predictor of adverse events in geriatric oncology patients. CGA is recommended in oncology practice for many reasons: to identify health problems not usually detected in routine oncologic screening, to perform non-oncologic interventions, and to modify the cancer treatment plan. Comprehensive geriatric assessment is the gold standard in geriatric oncology for identifying patients at high risk for adverse outcomes and optimizing cancer treatment and overall management. Nevertheless, it can be stated that the final point in the search for evidence-based and effective frailty assessment tools in the practice of geriatric oncology has not yet been reached. It is concluded that the development of new scales and index scores, as well as the application of the CGA model in general, can provide adequate care for elderly cancer patients.

This review presents data from the literature on the characteristics of the course of chronic kidney disease from the perspective of the geriatric patient. Chronic kidney disease and progression of renal failure is a prototype model of premature and accelerated aging. Many authors have stated that a better mechanistic understanding of the phenomenon of premature aging, early diagnosis of chronic kidney disease, and a geriatric approach to the patient can improve the effectiveness of management and prolongation of life in this category of patients. Comprehensive geriatric assessment is one of the most important tools used by geriatricians and their teams to globally assess elderly patients and plan effective interventions. It is concluded that the use of comprehensive geriatric assessment in patients with chronic kidney disease may improve the clinical status of patients and allow selection of patients who may benefit most from renal replacement therapy compared to a conservative approach. And even in the early stages of chronic kidney disease, a comprehensive geriatric assessment may be useful in formulating a complete intervention plan and optimizing quality of life, autonomy, and prognosis. However, despite recognition of the importance of comprehensive geriatric assessment, the means to implement this tool in nephrology departments have not been developed and require special training programs and appropriate skills. It is concluded that much more needs to be done to realize the continuity of nephrologists and geriatricians in the provision of meaningful skilled care to older patients with chronic kidney disease.

It is widely known that in economically developed countries there is an increase in the proportion of older people. However, the problem of the influence of territorial features of economic development on the rate of population aging is not sufficiently covered. The goal was to study the impact of economic development indicators (EDI) on the processes of premature aging of the population. The materials were statistical collections of the Ministry of Health of Russia and Russian Statistics Service for 2011-2019. The highest incidence was characteristic of cataracts and glaucoma. A direct correlation has been established between the EDI and the age-specific incidence index (ASII) of cataracts (r=0,31; p=0,00436). A group of regions with a high level of economic development was characterized by a higher value of ASII, which, as a rule, corresponds to the later development of the disease.

Medication iatrogenia is a real public health problem. Elderly people are particularly at risk, due to their multiple pathologies, including heart failure; residents of residential care facilities for the dependent elderly (Ehpad) are no exception. Studies show that this risk is avoidable in 60% of cases, and that advanced practice nurses (APNs) can play a pivotal role in preventive measures. How would the role of the APN be perceived by other healthcare professionals working with these heart failure patients institutionalized in Ehpad?

Uveal melanoma is an ocular malignancy whose prognosis severely worsens following metastasis. In order to improve the understanding of molecular physiology of metastatic uveal melanoma, we identified genes and pathways implicated in metastatic vs non-metastatic uveal melanoma.

The purpose of this review is to demonstrate the importance of using a comprehensive geriatric examination in cardiology, including geriatric aspects of the management of this patient population. Until now, the Russian Federation has completely lacked a geriatric approach to the management of cardiological patients, which provides for consideration of international experience in this survey. The curation of elderly and elderly patients is complicated by the presence of geriatric syndromes and age-associated diseases leading to deterioration of quality of life, repeated hospitalizations, disability and risk of death. The leading geriatric syndrome in geriatric practice is senile asthenia and multiple comorbid polymorbid pathologies of the geriatric patient. A patient admitted to an acute care hospital with a history of cardiovascular comorbid pathology is primarily viewed as a patient at high risk for cardiovascular complications, omitting the risk of adverse outcomes, including loss of independence and impaired functional status. The following literature review demonstrates the importance of defining senile asthenia outside of the geriatrician's office, justifying the need for advanced training for cardiologists in geriatrics.

Patients with hypoxic bladder cancer benefit from hypoxia modification added to radiotherapy, but no biomarkers exist to identify patients with hypoxic tumours. We, herein, aimed to implement oxygen-enhanced MRI (OE-MRI) in xenografts derived from muscle-invasive bladder cancer (MIBC) for future hypoxia biomarker discovery work; and generate gene expression data for future biomarker discovery.

In recent years, complications of drug therapy are an important medical problem. Data on adverse drug reactions (ADR) in patients of older age groups were analyzed. The object of the study was notification cards for unwanted reactions received from medical organizations of the Irkutsk region for period 2009-2020 years. The Narangio scale was used to assess the causality between ADR and medicines. Of the 1021 ADR notifications in patients over 65 years of age, 2/3 (668) are presented with ADR notifications in women, 353 (34,6%) in men. The presence of background diseases was registered in 915 notifications (89,6%). There were no gender differences except for a higher incidence of chronic obstructive pulmonary disease in men (7,2 and 3,5% respectively, p<0,05) and diabetes mellitus in women (14 and 3,5% respectively, p<0,05). ADRs for antibacterial agents amounted to 31,8%, drugs for the treatment of cardiovascular diseases - 10,5%, cases of therapeutic inefficiency - 5,1%. The ADR data statement was in line with the recommended form of 76%. The most common filling defect was incomplete patient information. The validity of the Narango causation was high. The deadlines for reporting data were observed in 89,1%. For effective interaction in the pharmacovigilance system, it is necessary in each medical organization to constantly inform about the procedure for pharmacovigilance, types of ADRs, the rules for their detection and the timing of data reporting. The work should be supervised by a trained specialist.

A study was conducted to investigate the associations of the diseases of the organ of vision and its accessory apparatus with anxiety and depression in the elderly people. The study included 678 participants of the ESSE-RF3 population study in the Arkhangelsk region in the age of 60-74 years. We used a questionnaire, including the hospital scale of anxiety and depression score (HADS), and the assessment of the ophthalmological status. It was found that all the study participants had diseases of the visual organ. Elevated depression scores were associated with sex, age, marital status (being single), and disability, elevated anxiety scores - with sex. The scores on the anxiety scale were on average 25% higher in participants whose visual acuity decreased to 0,5 units, and showed no independent associations with diagnosed ophthalmological diseases. The scores on the depression scale were on average 33% higher in participants with visual acuity 0,5 units, and 22% higher in the presence of retinopathy. In conclusion, anxiety and depression in the elderly people were more associated with visual deficits rather than with the presence of ophthalmological diseases underlying a decrease in functional status.

From the age of 25-30, the likelihood of developing pathological processes associated with aging begins to increase. Age-associated diseases (AAD) are a heterogeneous group of pathologies that are more likely to develop as they age. Clinically, the early development of AAD is identical to premature aging with all the ensuing consequences. Timely targeted detection of AAD will slow down age-related processes. In order to study the peculiarities of age-related morbidity (by circulation), age-associated pathology, the study included 5 600 people with a newly diagnosed diagnosis who applied to the municipal polyclinic of St. Petersburg in 2017-2023. During the study, heterogeneity of the timing of the manifestation of AAD at the population level was found. In addition, the median age of patients was comparable to the value of the developed age-specific incidence index, which serves as a basis for continuing research in order to comprehensively assess the properties and limitations of the considered indicator.