Rajshahi Medical College

<b><i>Introduction:</i></b> Although severe acute respiratory syndrome coronavirus-2 infection is causing mortality in considerable proportion of coronavirus disease-2019 (COVID-19) patients, however, evidence for the association of sex, age, and comorbidities on the risk of mortality is not well-aggregated yet. It was aimed to assess the association of sex, age, and comorbidities with mortality in COVID-2019 patients. <b><i>Methods:</i></b> Literatures were searched using different keywords in various databases. Relative risks (RRs) were calculated by RevMan software where statistical significance was set as <i>p</i> < 0.05. <b><i>Results:</i></b> COVID-19 male patients were associated with significantly increased risk of mortality compared to females (RR 1.86: 95% confidence interval [CI] 1.67–2.07; <i>p</i> < 0.00001). Patients with age ≥50 years were associated with 15.4-folds significantly increased risk of mortality compared to patients with age <50 years (RR 15.44: 95% CI 13.02–18.31; <i>p</i> < 0.00001). Comorbidities were also associated with significantly increased risk of mortality; kidney disease (RR 4.90: 95% CI 3.04–7.88; <i>p</i> < 0.00001), cereborovascular disease (RR 4.78; 95% CI 3.39–6.76; <i>p</i> < 0.00001), cardiovascular disease (RR 3.05: 95% CI 2.20–4.25; <i>p</i> < 0.00001), respiratory disease (RR 2.74: 95% CI 2.04–3.67; <i>p</i> < 0.00001), diabetes (RR 1.97: 95% CI 1.48–2.64; <i>p</i> < 0.00001), hypertension (RR 1.95: 95% CI 1.58–2.40; <i>p</i> < 0.00001), and cancer (RR 1.89; 95% CI 1.25–2.84; <i>p</i> = 0.002) but not liver disease (RR 1.64: 95% CI 0.82–3.28; <i>p</i>= 0.16). <b><i>Conclusion:</i></b> Implementation of adequate protection and interventions for COVID-19 patients in general and in particular male patients with age ≥50 years having comorbidities may significantly reduce risk of mortality associated with COVID-19.

This report presents two cases of Lichen Sclerosus et atrophicus. Patients were prepubertal females having itchy white plaques in the vulvar region with on and off burning micturition. No extragenital involvement was seen. Diagnosis was confirmed by histopathology. They were treated with local application of corticosteroid for a variable time period. Both the cases resolved by the age of menarche. These cases are being reported here in the context of its rare occurrence in children and to the best of our knowledge has not yet been reported in children in Bangladesh. The etiopathogenesis, diagnosis and treatment modalities of the disease are reviewed from the literature. doi: 10.3329/taj.v17i1.3490 TAJ 2004; 17(1) : 47-51

Most drosophilid species can be classified either as temperate or tropical. Adults of species were submitted to a cold treatment (0 degrees C) and then brought back to ambient temperature. They generally exhibited a chill coma and the time needed to recover was measured. We found in a set of 26 temperate species that recovery was rapid (average 1.8 min, range 0.15-4.9). In contrast, a long recovery time (average 56 min, range 24-120) was observed for 48 tropical species. A few species, like Drosophila melanogaster, are cosmopolitan and can proliferate under temperate and tropical climates. In 9 of 10 such species, slight genetic differences were found: a shorter recovery in temperate than in tropical populations. Comparing physiological data to phylogeny suggests that chill-coma tolerance has been a recurrent adaptation that is selected for in cold climates but tends to disappear under a permanently warm environment. This major climatic adaptation, evidenced in drosophilids, seems to occur in other insect groups also.

Standard scale to assess the symptoms of depression, anxiety and stress among MBBS students are essential to take necessary steps to treat or prevent any psychiatric morbidity. But there was no such convenient tool in Bangla to measure the stated symptoms. With an objective to obtain a convenient scale to measure severity of above symptoms, short version of Depression Anxiety Stress Scales (DASS 21) was translated into Bangla and the study was carried out to validate this Bangla version with permission from the author of the original instrument. Two translations and back translations were carried out. A harmonized version was produced after meetings by persons involved in translation process in meetings. After pretesting on ten students and reviewing by panel of experts, finalized Bangla version of DASS 21 (DASS 21 -BV) was obtained. A cross sectional study was carried out among MBBS students of Pabna Medical College, Pabna using purposive sampling technique to validate this scale. They were given both Bangla and English version of the scale 3 to 7 days apart. Analysis was done on 15 samples. Correlation for depression subscale was 0.976, anxiety subscale was 0.917 and stress subscale was 0.931. Correlation was significant at the 0.01 level (2-tailed). Cronbach’s Alpha for Depression, Anxiety and Stress subscales were 0.987, 0.957, 0.964 respectively. This Validated Bangla version of DASS 21 can be used to measure severity of depression among medical students and persons having similar academic background treatable.Bang J Psychiatry Dec 2014; 28(2): 67-70

The noninvasive diagnosis of amebic liver abscess is challenging, as most patients at the time of diagnosis do not have a concurrent intestinal infection with Entamoeba histolytica. Fecal testing for E. histolytica parasite antigen or DNA is negative in most patients. A real-time PCR assay was evaluated for detection of E. histolytica DNA in blood, urine, and saliva samples from amebic liver abscess as well as amebic colitis patients in Bangladesh. A total of 98 amebic liver abscess and 28 amebic colitis patients and 43 control subjects were examined. The real-time PCR assay detected E. histolytica DNA in 49%, 77%, and 69% of blood, urine, and saliva specimens from the amebic liver abscess patients. For amebic colitis the sensitivity of the real-time PCR assay for detection of E. histolytica DNA in blood, urine, and saliva was 36%, 61%, and 64%, respectively. All blood, urine, and saliva samples from control subjects were negative by the real-time PCR assay for E. histolytica DNA. When the real-time PCR assay results of the urine and saliva specimens were taken together (positive either in urine or saliva), the real-time PCR assay was 97% and 89% sensitive for detection of E. histolytica DNA in liver abscess and intestinal infection, respectively. We conclude that the detection of E. histolytica DNA in saliva and urine could be used as a diagnostic tool for amebic liver abscess.

Poisoning after eating puffer fish containing highly lethal tetrodotoxin (TTX) is widespread in Asia. In 2008, naïve inland populations in Bangladesh were exposed to cheap puffer fish sold on markets. In three outbreaks, 141 patients with history of puffer fish consumption were hospitalized. Symptoms of poisoning included perioral paraesthesia, tingling over the entire body, nausea and vomiting, dizziness, headache, abdominal pain and muscular paralysis of the limbs. Seventeen patients (12%) died from rapidly developing respiratory arrest. Blood and urine samples from 38 patients were analyzed using a TTX-specific enzyme-linked immunoassay (ELISA). Medium to high TTX levels were detected (1.7-13.7 ng/ml) in the blood of 27 patients. TTX was below detection level (< 1.6 ng/ml) in 11 blood samples but the toxin was detected in urine. Ten patients had blood levels above 9 ng/ml and developed paralysis; seven of these died. The remaining patients recovered with supportive treatment. High concentrations of TTX and its analogues 4-epiTTX and 4,9-anhydroTTX were also found in cooked puffer fish by post-column liquid chromatography-fluorescence detection. To prevent future instances of puffer fish poisoning of this magnitude, measures should be implemented to increase awareness, to control markets and to establish toxicological testing. To improve the management of this and other poisoning in Bangladesh, facilities for life-saving assisted ventilation and related training of healthcare personnel are urgently needed at all levels of the health system.

Abstract Background The number of infection and death by COVID-19 has been rapidly increasing since December 2019 in all over the world. Until now, there is no specific treatment or vaccine for this disease; WHO suggests only some protective measures like maintaining social distance, staying home, washing hands with soap or sanitizer, wearing mask etc. The objective of this study was to survey knowledge, attitude, practice and perception regarding COVID-19 among students in Rajshahi University, Bangladesh. Methods We collected data from 305 students of Rajshahi University for this cross-sectional study using mixed sampling from March 11 to March 19, 2020. Frequency distribution, Mann-Whitney and Kruskal-Wallis tests were used in this study. Results Out of 305 participants, 224 (73.4%) and 81 (26.6%) were male and female students respectively. The study revealed that Rajshahi university students had average knowledge on symptoms, protective way and transmission of COVID-19. Female students were more knowledgeable than male. More than one third of the students had negative attitude to avoiding public transport and going out to public places with friends and family. The practice of students practice during our data collection period and in future was not satisfactory. More than one third of students were not keen to stay at home and avoid going to crowded places. The perception towards COVID-19 was not good; they had no idea whether the outbreak would affect their daily routine, study and financial matters, study field work and restrict leisure time of meeting family and relatives. Conclusions We found that general knowledge, attitude, practice and perception of the university students regarding COVID-19 were not satisfactory. This indicated that the situation was worse among common people. In Bangladesh, the number of healthcare providers is insufficient. University students can be employed as potential workforce to create awareness among mass people on prevention of COVID-19.

BACKGROUND: Chikungunya virus causes mosquito-transmitted infection that leads to extensive morbidity affecting substantial quality of life. Disease associated morbidity, quality of life, and financial loss are seldom reported in resources limited countries, such as Bangladesh. We reported the acute clinical profile, quality of life and consequent economic burden of the affected individuals in the recent chikungunya outbreak (May to September 2017) in Dhaka city, Bangladesh. METHODS: We conducted a cross-sectional study during the peak of chikungunya outbreak (July 24 to August 5, 2017) to document the clinical profiles of confirmed cases (laboratory test positive) and probable cases diagnosed by medical practitioners. Data related to clinical symptoms, treatment cost, loss of productivity due to missing work days, and quality of life during their first two-weeks of symptom onset were collected via face to face interview using a structured questionnaire. World Health Organization endorsed questionnaire was used to assess the quality of life. RESULTS: A total of 1,326 chikungunya cases were investigated. Multivariate analysis of major clinical variables showed no statistically significant differences between confirmed and probable cases. All the patients reported joint pain and fever. Other more frequently reported symptoms include headache, loss of appetite, rash, myalgia, and itching. Arthralgia was polyarticular in 56.3% of the patients. Notably, more than 70% patients reported joint pain as the first presenting symptom. About 83% of the patients reported low to very low overall quality of life. Nearly 30% of the patients lost more than 10 days of productivity due to severe arthropathy. CONCLUSIONS: This study represents one of the largest samples studied so far around the world describing the clinical profile of chikungunya infection. Our findings would contribute to establish an effective syndromic surveillance system for early detection and timely public health intervention of future chikungunya outbreaks in resource-limited settings like Bangladesh.

BACKGROUND: The global burden from cancer is rising, especially as low-income countries like Bangladesh observe rapid aging. So far, there are no comprehensive descriptions reporting diagnosed cancer group that include hematological malignancies in Bangladesh. METHODS: This was a multi-center hospital-based retrospective descriptive study of over 5000 confirmed hematological cancer cases in between January 2008 to December 2012. Morphological typing was carried out using the "French American British" classification system. RESULTS: A total of 5013 patients aged between 2 to 90 years had been diagnosed with malignant hematological disorders. A 69.2% were males (n=3468) and 30.8% females (n=1545), with a male to female ratio of 2.2:1. The overall median age at diagnosis was 42 years. Acute myeloid leukemia was most frequent (28.3%) with a median age of 35 years, followed by chronic myeloid leukemia with 18.2% (median age 40 years), non-Hodgkin lymphoma (16.9%; median age 48 years), acute lymphoblastic leukemia (14.1%; median age 27 years), multiple myeloma (10.5%; median age 55 years), myelodysplastic syndromes (4.5%; median age 57 years) and Hodgkin's lymphoma (3.9%; median age 36 years). The least common was chronic lymphocytic leukemia (3.7%; median age 60 years). Below the age of 20 years, acute lymphoblastic leukemia was predominant (37.3%), followed by acute myeloid leukemia (34%). Chronic lymphocytic leukemia and multiple myeloma had mostly occurred among older patients, aged 50-over. CONCLUSIONS: For the first time, our study presents the pattern and distribution of diagnosed hematological cancers in Bangladesh. It shows differences in population distributions as compared to other settings with possibly a lower presence of non-Hodgkin lymphoma. There might be under-reporting of affected women. Further studies are necessary on the epidemiology, genetics and potential environmental risk factors within this rapidly aging country.

BACKGROUND: Visceral leishmaniasis (VL) remains as one of the most neglected tropical diseases with over 60% of the world's total VL cases occurring in the Indian subcontinent. Due to the invasive risky procedure and technical expertise required in the classical parasitological diagnosis, the goal of the VL experts has been to develop noninvasive procedure(s) applicable in the field settings. Several serological and molecular biological approaches have been developed over the last decades, but only a few are applicable in field settings that can be performed with relative ease. Recently, loop-mediated isothermal amplification (LAMP) has emerged as a novel nucleic acid amplification method for diagnosis of VL. In this study, we have evaluated the LAMP assay using buffy coat DNA samples from VL patients in Bangladesh and compared its performance with leishmania nested PCR (Ln-PCR), an established molecular method with very high diagnostic indices. METHODS: Seventy five (75) parasitologically confirmed VL patients by spleen smear microcopy and 101 controls (endemic healthy controls -25, non-endemic healthy control-26, Tuberculosis-25 and other diseases-25) were enrolled in this study. LAMP assay was carried out using a set of four primers targeting L. donovani kinetoplast minicircle DNA under isothermal (62 °C) conditions in a heat block. For Ln-PCR, we used primers targeting the parasite's small-subunit rRNA region. RESULTS: LAMP assay was found to be positive in 68 of 75 confirmed VL cases, and revealed its diagnostic sensitivity of 90.7% (95.84-81.14, 95% CI), whereas all controls were negative by LAMP assay, indicating a specificity of 100% (100-95.43, 95% CI). The Ln-PCR yielded a sensitivity of 96% (98.96-87.97, 95% CI) and a specificity of 100% (100-95.43, 95% CI). CONCLUSION: High diagnostic sensitivity and excellent specificity were observed in this first report of LAMP diagnostic evaluation from Bangladesh. Considering its many fold advantages over conventional PCR and potential to be used as a simple and rapid test in the VL endemic areas of the Indian subcontinent, our findings are encouraging, but further evaluation of LAMP is needed.

BACKGROUND: This investigation was aimed to determine the current status of prevalence and antimicrobial susceptibility of uropathogens isolated in a teaching hospital in Bangladesh. A retrospective analysis was done at the department of Microbiology of Islami Bank Medical College, Rajshahi (IBMCR), Bangladesh during January to December, 2012. Midstream clean-catch urine samples were collected from 443 suspected urinary tract infection patients of different age and sex groups. Uropathogens were identified by standard and specific microbiological techniques and antimicrobial susceptibility pattern was determined by Kirby Bauer Disc diffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines. FINDINGS: Culture yielded a total of 189 (42.66%) significant growths of uropathogens including 179 (94.71%) unimicrobial (single bacterial species) and 10 (5.29%) polymicrobial (pair of two different bacterial species) growths. Gender distribution showed 34.44% male and 48.29% female UTI patients with male to female ratio of 1:1.46, respectively. E. coli was the predominant isolate (59.30%), followed by Staph saprophyticus (19.09%), Enterococcus spp. (11.56%), Klebsiella spp. (5.53%), Pseudomonas spp. (2.01%), Proteus spp. (1.51%) and Enterobacter spp. (1.00%). Very high frequency of resistance ranging from 72.03 to 91.53% to cotrimoxazole, ciprofloxacin, cefuroxime, cephradin, amoxicillin and nalidixic acid, moderately high resistance to ceftriaxone (55.08%) and gentamicin (40.68%) and low resistance to nitrofurantoin (16.10%) were shown by E. coli. Similarly, Staph. saprophyticus and Enterococcus spp. showed low resistance (18.42 and 21.74%) to nitrofurantoin, but moderately high against cefaclor, gentamycin, cefuroxime and ceftriaxone. Klebsiella spp. and Proteus spp. were 72.73 and 66.67% susceptible, respectively to gentamycin only but low frequency of susceptibility (<50%) was found to all other antimicrobial agents. Peudomonas spp. was 75% susceptible to nitrofurantoin only and showed 75-100% resistance to all other agents. Enterobacter spp. were 50% resistant to nitrofurantoin, gentamycin, cefuroxime, cefaclor and ceftriaxone but showed 100% resistance to all remaining antimicrobials. CONCLUSIONS: Current uropathogens showed the highest rate of susceptibility to nitrofurantoin and gentamicin which can be adapted for empirical treatment of urinary tract infections.

We have applied a loop-mediated isothermal amplification (LAMP) technique to detect Leishmania donovani DNA. The LAMP technique detected 1 fg of L. donovani DNA, which was 10-fold more sensitive than a conventional polymerase chain reaction (PCR). All nested PCR-positive blood samples from visceral leishmaniasis patients were positive with the LAMP technique, and DNA samples from L. infantum, L. major, L. mexicana, L. tropica, L. braziliensis, Plasmodium falciparum, and healthy humans were negative with the LAMP technique. The advantages of the LAMP method are its shorter reaction time, a lack of requirement of sophisticated equipment, and visual judgment of positivity based on the turbidity of reaction mixture. Our LAMP technique can be a better alternative to a conventional PCR, especially under field conditions.

Bangladesh is now experiencing the COVID-19 outbreak; however, there has been minimal focus on mental health over physical health problems during this pandemic in Bangladesh. The present study was conducted using self-rated scales on a sample of 500 Bangladeshi people to address this gap. Results suggested two-fifths of the participants had depression and anxiety symptoms, and one-third were highly worried and felt stressed. Females, students, unmarried, and 18-30-year-olds were in more vulnerable positions in terms of their mental health. These findings would be helpful to assess and formulate psychological interventions to improve the mental health of vulnerable groups.

Background: Recent trends suggest that university graduates seeking jobs are more susceptible to common mental disorders, such as depression, anxiety, or stress. But, the mental health issues among unemployed graduates has not been explored in Bangladesh yet. Aims: This study aimed to assess for the first time the prevalence and associated risk factors of depression, anxiety and stress among the Bangladesh Civil Service (BCS) job seekers. 304 graduates residing in Rajshahi, Bangladesh, who were preparing to attend the 40th Bangladesh Civil Service (BCS) examination, the most sought-after employment opportunity in the country, were surveyed. Methods: Measures included socio-demographics, field of study and career-related variables, and the Bangla Depression, Anxiety and Stress Scale (DASS-21). Chi-square test, Fisher Exact test and Binary Logistic Regression with ‘Depression’, ‘Anxiety’ and ‘Stress’ as the dependent variable were carried out to identify the factors associated with those. Results: Overall, the prevalence of moderate to extremely severe depression, anxiety and stress was 49.3%, 53.6%, and 28.3% respectively, with no detectable differences between genders. Insecurity related to BCS job (OR=0.41; CI=0.26-0.65, p<0.001; ref: job insecurity), family and social pressure to obtain BCS job (OR=4.58; CI=1.67-12.56, p<0.001) and stress (OR=8.33; CI=4.47-15.51, p<0.001) emerged as independent predictors for depression. In addition, having part-time job was associated with anxiety (OR=2.38; CI=1.34-4.23, p=0.003), and security in BCS job and serving the nation through this job were negatively associated with stress (OR=0.59; CI=0.35-0.98, p=0.042 versus OR=0.59; CI=0.36-1.00, p=0.05). Conclusion: The relatively high rates of depression, anxiety and stress among graduate job seekers should prompt implementation of market force initiatives that incorporate interventions related to the major risk factors uncovered herein.

BACKGROUND: Arsenic poisoning is a public health problem worldwide. A few studies have reported the effects of arsenic exposure on adult cognitive function, but with limitations in the subject selection and exposure markers. Moreover, information regarding the association between arsenic exposure and biomarker of cognitive impairment is scarce. OBJECTIVES: We examined the associations between arsenic exposure and adult cognitive impairment using the Mini-Mental State Examination (MMSE) and the serum levels of brain-derived neurotrophic factor (BDNF), a potential biomarker of cognitive health status. METHODS: We designed a cross-sectional study that recruited 693 adult (18-60 years old) subjects from the areas of low- and high‑arsenic exposure in rural Bangladesh. The subjects' arsenic exposure levels (drinking water, hair, and nail arsenic concentrations) were measured by inductively coupled plasma-mass spectroscopy. The Bangla version of the MMSE was used as a cognitive assessment tool. Serum BDNF (sBDNF) levels were assessed by immunoassay. RESULTS: In this study, we found that average MMSE score and sBDNF level of the subjects in arsenic-endemic areas were significantly (p < 0.001 for both) lower than those of the subjects in non-endemic area. Our analyses revealed that both MMSE scores and sBDNF levels were decreased with the increasing concentrations of arsenic in drinking water, hair, and nails in a dose-dependent fashion. In regression analyses, significant associations of arsenic exposure metrics with MMSE scores and sBDNF levels were observed even after adjustment for several variables. Intriguingly, MMSE scores showed a significantly positive correlation with sBDNF levels. CONCLUSION: Our findings demonstrate that chronic exposure to arsenic dose-dependently decreases cognitive function in adults, with a concomitant reduction of sBDNF levels. A decreased BDNF level may be part of the biochemical basis of chronic arsenic exposure-related cognitive impairment.

Medical students confront significant academic, psychosocial and existential stressors for coping with new college and schedule,. So assessment of the symptoms of depression, anxiety and stress among medical students are essential to take necessary steps to treat or prevent any psychiatric morbidity. The objective of the study was to assess depression, anxiety and stress among the first year MBBS students. This was a cross sectional and descriptive study conducted in Khulna Medical College, Bangladesh from December 2009 to July 2010. For this purpose, 105 students fulfilling inclusion and exclusion criteria were taken as sample. They filled up personal data and the short-form Bangla version of DASS (DASS-21 BV) scale. The results showed that, the mean age of students was 18.8 years with male predominance (54.3%). Symptoms of depression, anxiety and stress were found among 54.3%, 64.8% and 59.0% of students respectively. Eighty five (81%) students either had depression, anxiety or stress alone or in combination. Combination of depression, anxiety and stress was highest (36.2%). No significant association was found between gender difference and depression, anxiety or stress. Age was positively correlated with depression (p=0.004) and stress (p=0.001). Percentage of 1st year MBBS students suffering from depression, anxiety and stress were very high. Adequate psychiatric services should be provided to manage these symptoms among medical students.Bang J Psychiatry June 2015; 29(1): 23-29

BACKGROUND: In developing country like BANGLADESH, people depend more on pharmacies due to expediency, shorter waiting time, cost reduction, availability of credit and flexible opening hours. The aim of this study was to investigate medicines dispensing patterns of the pharmacies in RAJSHAHI, BANGLADESH and to identify and analyze contribution of drugsellers and quacks in irrational drug use. METHODS: This cross-sectional study was conducted during January 2016 - April, 2016 in 75 randomly selected private pharmacies including both licensed and unlicensed pharmacies of covering LAKSHMIPUR area. RESULT: During the whole study process, total 7944 clients visited the pharmacies under observation and 24,717 medicines were dispensed. 22.70% of all these drugs were sold without a prescription. Out of the 5610 items dispensed without prescription, 66.2% were dispensed on the request of clients themselves and 33.8% on the recommendation of a drug seller. Number of medicine in a prescription was highly variable ranging from 2 to 5 medicines per prescriptions (mean = 3.03). The average number of medicines dispensed from each of the pharmacies during the observation period was 392, varied pharmacy to pharmacy - ranging from 194 to 588. Lowest selling medicines were sedative and hypnotics and highest selling medicines were antimicrobials. The recommendation rate for antibiotics was highest for the quacks (26.48%) though the major amount of the antimicrobials (n = 3039, 65.83%) were dispensed on prescription. Macrolides, quinolones, metronidazoles and cephalosporins are most favourite drug of quacks, clients and pharmacists. CONCLUSION: Majority of medicines were dispensed irrationally without any prescription and over the counter dispensing of many low safety profile drugs was common. The results and discussion presented in this paper will be helpful to provide a baseline to redirect further studies in this area.

BACKGROUNDS: Approximately, half of the population in the world including tropical and sub-tropical climates region is at risk of dengue. Being an endemic country, Bangladesh has experienced the largest dengue epidemic in 2019. The present study aimed at evaluating the clinical and laboratory profile of dengue patients in northern Bangladesh during the epidemic. METHODS: This cross-sectional study included 319 serologically confirmed dengue patients admitted in Shaheed Ziaur Rahman Medical College Hospital in Bogra district. It is one of the main tertiary care hospitals in northern Bangladesh. Data were collected from July to September 2019. Patients' clinical and laboratory data were extracted from clinical records. Patients were classified into two classes according to the WHO 2009 dengue classification such as (i) non-severe dengue and (ii) severe dengue. Chi-square test and independent t-test were used in this study. RESULTS: Of the 319 patients, 94.1% had non-severe dengue and the remaining 5.9% had severe dengue (severe plasma leakage 68.4%, severe organ involvement 68.4%, and severe clinical bleeding 10.5%). Most of the patients were suffering from primary dengue infection. The most common clinical presentation was fever followed by headache and myalgia. Vomiting and abdominal pain were the most prevalent warning signs. The common hematological findings on admission were leukopenia (63.3%), thrombocytopenia (30.4%) and increased hematocrit (26.6%). Raised serum ALT or AST was observed in 14.1% cases whereas raised serum creatinine was observed in 6.6% cases. Signs of plasma leakage (pleural effusion, respiratory distress, and ascites, rise of hematocrit >20% during hospital stay) and hepatic or renal involvement (serum ALT >42UI/L or serum creatinine >1.2 mg/dL) on admission were mostly associated with severe dengue. CONCLUSION: The study provides clinical evidence on presentation as well as hematological and biochemical profile of dengue patients in northern Bangladesh that should be implicated in effective patient management.

There have been numerous studies about the health implication of COVID-19 on patients, but little attention has been paid to the impacts of the pandemic on physicians. Our paper attends to this gap by exploring the mental health of physicians in Bangladesh during the COVID-19 pandemic. This is particularly important since the mental health of physicians impacts not only on themselves, but also their professional performance and hence the care of patients. This study examined physicians' mental health outcomes by evaluating the prevalence and associated potential risk factors of anxiety and depression. Using a web-based cross-sectional survey, we collected data from 114 physicians. Seven-item Generalized Anxiety Disorder (GAD-7) scale and Nine-item Patient Health Questionnaire (PHQ-9) were used to measure the anxiety and depression, respectively. Multivariate logistic regression models were used to explore the potential risk factors related to anxiety and depression. The prevalence of anxiety and depression were 32.5 and 34.2%, respectively. Findings revealed that marital status, work per day and current job location were the main risk factors for anxiety while sex, age, and marital status were the main risk factors for depression. Our results highlight the need to implement policies and strategies for positively impacting the mental health of physicians during and after the COVID-19 pandemic.

BACKGROUND: Arsenic is a potent pollutant that has caused an environmental catastrophe in certain parts of the world including Bangladesh where millions of people are presently at risk due to drinking water contaminated by arsenic. Chronic arsenic exposure has been scientifically shown as a cause for liver damage, cancers, neurological disorders and several other ailments. The relationship between plasma cholinesterase (PChE) activity and arsenic exposure has not yet been clearly documented. However, decreased PChE activity has been found in patients suffering liver dysfunction, heart attack, cancer metastasis and neurotoxicity. Therefore, in this study, we evaluated the PChE activity in individuals exposed to arsenic via drinking water in Bangladesh. METHODS: A total of 141 Bangladeshi residents living in arsenic endemic areas with the mean arsenic exposure of 14.10 +/- 3.27 years were selected as study subjects and split into tertile groups based on three water arsenic concentrations: low (< 129 microg/L), medium (130-264 microg/L) and high (> 265 microg/L). Study subjects were further sub-divided into two groups (<or=50 microg/L and > 50 microg/L) based on the recommended upper limit of water arsenic concentration (50 microg/L) in Bangladesh. Blood samples were collected from the study subjects by venipuncture and arsenic concentrations in drinking water, hair and nail samples were measured by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS). PChE activity was assayed by spectrophotometer. RESULTS: Arsenic concentrations in hair and nails were positively correlated with the arsenic levels in drinking water. Significant decreases in PChE activity were observed with increasing concentrations of arsenic in water, hair and nails. The average levels of PChE activity in low, medium and high arsenic exposure groups were also significantly different between each group. Lower levels of PChE activity were also observed in the > 50 microg/L group compared to the <or=50 microg/L group. Moreover, PChE activity was significantly decreased in the skin (+) symptoms group compared to those without (-). CONCLUSIONS: We found a significant inverse relationship between arsenic exposure and PChE activity in a human population in Bangladesh. This research demonstrates a novel exposure-response relationship between arsenic and PChE activity which may explain one of the biological mechanisms through which arsenic exerts its neuro-and hepatotoxicity in humans.