Level of Serum Vitamin D, To Which People Are at Risk of Developing Acute Myocardial Infarction in Bangladesh

Incidence of Myocardial Infarction is increasing day by day in developing countries. Most of the patients who sustain myocardial infarction have coronary atherosclerosis. There are several risk factors for the development of atherosclerosis. Among all the risk factors, vitamin D deficiency has been proposed to play an important role in the development of atherosclerosis. With this aim, a case-control study was carried out to explore the association of serum vitamin D with acute myocardial infarction. The enrolled study subjects were categorized into Group A which comprised of STEMI, Group B, comprised of NSTEMI and Group C comprised of age and sex matched individuals free from acute myocardial infarction. The mean values of serum vitamin D (in ng/ml) were 20.17, 20.8 and 24.77 respectively in STEMI, NSTEMI and control groups. It differed significantly among groups (p<0.001) and it was significantly low in STEMI and NSTEMI groups compared to control group (p<0.001 and p=0.004). From this study it can be concluded that low serum vitamin D is an independent risk factor for developing acute myocardial infarction. Individuals with serum vitamin D <20ng/ml have higher chance of developing acute myocardial infarction compared to those with serum vitamin D >20ng/ml.

Hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh

Hemoprotozoans are important pathogens of animals and humans, among which some species have zoonotic significance. The prevalence of different hemoprotozoa and Anaplasma spp. in larger mammals have been reported from different regions of the world. But, very few studies have been conducted to estimate the prevalence of hemoprotozoa in rodents and shrews of South-East Asia. The study assessed the prevalence of hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh. Blood samples (n=451) were collected from rodents and shrews between June 2011 and June 2013 and July-December 2015 from 4 land gradients of Bangladesh. Giemsa-stained blood smears revealed that 13% of animals were harboring hemoprotozoa (4.7% Babesia spp., 0.67% Plasmodium spp.), and Anaplasma spp. (7.5%). The study may serve as a guide for future hemoparasitic research of rodents and shrews.

Synthesis of meso-2,2’-bipyridyl-substituted calix[4]arenes and their response to metal cations

A convenient synthetic approach to meso-substituted with 2,2’-bipyridine and 1-(pyridin-2-yl)isoquinoline residues calix[4]arenes is reported. This approach involves the reaction of generated in situ 2-lithio-calix[4]arene with 1,2,4-triazine precursor with the following aromatization of the obtained adduct, and the aza-Diels-Alder reaction of the 1,2,4-triazinyl-substituted calix[4]arene with 2,5-norbornadien or in-situ generated 1,2-dehydrobenzene. The UV/fluorescence response of thus obtained meso-pyridyl-substituted calix[4]arenes to metal cations is studied.

Assessment of Essential and Potentially Toxic Elements and Possible Health Risks in Hylocereus undatus and Punica granatum

This study evaluates essential and toxic element contents in dragon (Hylocereus undatus (Haworth) Britton and Rose) and pomegranate (Punica granatum L.) and possible health risks through the consumption of these fruits. Total concentrations of 15 chemical elements (Al, Br, Ca, Cd, Cl, Cr, Cu, Fe, Hg, K, Mn, Na, Ni, Pb, and Zn) were determined by instrumental neutron activation analysis (INAA) and atomic absorption spectrometry (AAS) techniques. This study indicates that these fruits are a vital source of essential elements for human health. It is observed that Pb concentrations were higher in both fruits whereas Cd concentrations were slightly higher than WHO/FAO tolerable levels only in pomegranate. The estimated daily intake (EDI) of the chemical elements was within the maximum tolerable daily intake (MTDI) values. Furthermore, target hazard quotient (THQ) values were also within the safe level (THQ < 1). However, the calculated target carcinogenic risk (TCR) values of Cd for pomegranate and Cr for dragon fruit were higher than the maximum limit (1.0 × 10^-4) for children. Finally, this study will create public awareness about micronutrient contents as well as metal contaminations of the studied fruits.

IgG1 antibodies against phosphorylcholine are associated with protection in SLE and atherosclerosis: potential underlying mechanisms

Background

The risk of cardiovascular disease (CVD) and atherosclerosis is very high in SLE. This is a clinical problem, and could also shed light on immunity and atherosclerosis in general. IgM antibodies against phosphorylcholine (anti-PC) may be protective in atherosclerosis, cardiovascular disease (CVD) and systemic lupus erythematosus (SLE). We here study IgG1 and IgG2 anti-PC, with focus on atherosclerosis and SLE.

Methods

We determined anti-PC by ELISA in 116 SLE-patients and 110 age- and sex-matched controls. For functional studies, we used three in-house generated, fully human monoclonal IgG1 anti-PC (A01, D05, E01). Apoptosis was induced in Jurkat T-cells and pre-incubated with A01, D05, E01 or isotype control IgG1 and effects on efferocytosis by human macrophages studied. Anti-PC peptide/protein characterization was determined using a proteomics de novo sequencing approach.

Results

IgG1 but not IgG2 anti-PC levels were higher among SLE patients (p=0.02). IgG1 anti-PC was negatively associated with SLICC and SLEDAI (OR: 2,978 CI: 0.876–10.098, OR: 5.108 CI 1.3 20.067 respectively) and negatively associated with CVD, atherosclerotic plaques and echolucent (potentially vulnerable plaques) but the association for the two former was not significant after controlling for confounders. D05 had maximum effect on macrophage efferocytosis efficiency, followed by A01 and E01. The monoclonal antibodies showed differential binding specificity to PC and PC associated neo-epitopes. Peptide analysis showed difference in the CDR3 region of the three anti-PC IgG1 clones which are crucial for recognition of PC on apoptotic cell surface and other neo-epitopes.

Conclusion

Anti-PC IgG1 is negatively associated with disease activity, and disease damage in SLE, but the negative association with CVD is also dependent on confounding risk factors. One potential underlying mechanism could be increased clearance of dead cells.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swedish Heart and Lung Foundation, Reumatikerfonden

PCSK9 is associated with disease activity and implicated in immune activation and cardiovascular disease in Systemic Lupus Erythematosus

Background

The risk of atherosclerosis and cardiovascular disease (CVD) is very high in SLE. This is both a clinical problem and of interest in studies of immunity in these conditions. LDL-levels are increased by Proprotein convertase subtilisin kexin 9 (PCSK9) which targets the LDL-receptor (LDLR). We recently reported that PCSK9 ameliorates dendritic cell (DC) activation by oxidized LDL (OxLDL), which is abundant in atherosclerotic plaques and also raised and associated with cardiovascular disease (CVD) in SLE. We here investigate the role of PCSK9 in SLE.

Methods

PCSK9-levels were determined by ELISA among SLE patients (n=109) and age- and sex-matched population-based controls (n=91). Common carotid intima-media thickness (IMT) and plaque occurrence were determined by B-mode ultrasound. Plaques were graded by echogenicity. Human peripheral blood monocytes from SLE patients or controls were differentiated into DCs. Effects of PCSK9 and its inhibition by silencing were studied.

Results

PCSK9-levels were non-significantly higher among SLE-patients as compared to controls but associated significantly with SLE disease activity, as determined by SLAM (0.020) or SLEDAI (0.0178). There was no association between PCSK9-levels and atherosclerosis as determined by IMT, prevalence of plaques or echolucent (potentially vulnerable) plaques. PCSK9 levels were significantly associated with CVD among SLE-patients.

OxLDL induced PCSK9 in DCs and DC-maturation with increased expression of CD86 and HLA-DR. The effects were significantly stronger in DC from SLE patients than from controls. Silencing of PCSK9 abolished OxLDL-induced DC-maturation.

Conclusions

PCSK9 is associated with disease activity in SLE. One underlying cause could be OxLDL, promoting DC-activation which depends on PCSK9. OxLDL induces PCSK9, an effect which is higher among SLE-patients. PCSK9 could play an unexpected immunological role in SLE.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Amgen; Swedish Heart and Lung Foundation

Self-monitoring improved child feeding among low educated slum mothers in Bangladesh, a pilot study

Issue

Child undernutrition in urban slums is the most serious but least addressed health problem in many LMICs including Bangladesh. Slum children are deprived of adequate feeding as advocated by WHO. Face-to-face contact to monitor adherence to child feeding recommendations is costly. We aimed to identify if a visual aid for self-monitoring, in the form of a pictorial calendar, could assist illiterate slum mothers to self-regulate their child feeding behaviours and increase adherence to recommended child feeding practices.

Description of the practice: A mixed method study was conducted (Randomised Controlled Trial + semi-structured qualitative interviews) over four weeks in a slum area of Dhaka city. Thirty-four mothers to child aged 6-23 months having &lt;5 years of education were recruited. Mothers randomized to intervention arm (n = 17) received an hour of complementary feeding education along with a pictorial calendar and color-coded stickers representing food groups. The control arm received the education session only. The primary outcome was Minimum Dietary Diversity (MDD: ≥4 food groups in past 24 hours); the Generalised Estimation Equations (GEE) with a log link and binomial family was used to test treatment by time interactions.

Results

The proportion of achieving MDD was more common (RR 1.2, 95%CI 0.8, 1.8) among mothers from intervention arm compared to control mothers. Intervention mothers were more likely to identify the appropriate food groups compared to control mothers. More than 80% of the mothers completed the calendar for all 28 days of study duration. During qualitative interviews, most mothers (4/5) stated that the pictorial calendar acted as a reminder for them.

Lessons

An encouraging tendency towards better complementary feeding and better knowledge was seen among the intervention mothers compared to controls. Future research with a larger sample is needed to establish the significance of effect size.

Key messages

Pictorial calendar appeared to help sustain knowledge and improve feeding practices. Self-monitoring using a pictorial calendar could be a good visual aid for low-educated mothers from low socio-economic status.

Direct synthesis of 5-arylethynyl-1,2,4-triazines via direct CH-functionalization

An efficient synthetic approach towards 5-arylethynyl-1,2,4-triazines via direct C-H-functionalization of 5-H-1,2,4-triazines in reaction with lithium acetylenes is reported.

Gold Standard Cholera Diagnostics Are Tarnished by Lytic Bacteriophage and Antibiotics

A fundamental, clinical, and scientific concern is how lytic bacteriophage, as well as antibiotics, impact diagnostic positivity. Cholera was chosen as a model disease to investigate this important question, because cholera outbreaks enable large enrollment, field methods are well established, and the predatory relationship between lytic bacteriophage and the etiologic agent Vibrio cholerae share commonalities across bacterial taxa. Patients with diarrheal disease were enrolled at two remote hospitals in Bangladesh. Diagnostic performance was assessed as a function of lytic bacteriophage detection and exposure to the first-line antibiotic azithromycin, detected in stool samples by mass spectrometry. Among diarrheal samples positive by nanoliter quantitative PCR (qPCR) for V. cholerae (n = 78/849), the odds that a rapid diagnostic test (RDT) or qPCR was positive was reduced by 89% (odds ratio [OR], 0.108; 95% confidence interval [CI], 0.002 to 0.872) and 87% (OR, 0.130; 95% CI, 0.022 to 0.649), respectively, when lytic bacteriophage were detected. The odds that an RDT or qPCR was positive was reduced by more than 99% (OR, 0.00; 95% CI, 0.00 to 0.28) and 89% (OR, 0.11; 95% CI, 0.03 to 0.44), respectively, when azithromycin was detected. Analysis of additional samples from South Sudan found similar phage effects on RDTs; antibiotics were not assayed. Cholera burden estimates may improve by accommodating for the negative effects of lytic bacteriophage and antibiotic exposure on diagnostic positivity. One accommodation is using bacteriophage detection as a proxy for pathogen detection. These findings have relevance for other diagnostic settings where bacterial pathogens are vulnerable to lytic bacteriophage predation.

Proximate composition and antioxidant activity of Syzygium cumini fruit grown at different regions in Bangladesh

The risk of degenerative diseases decreases with the consumption of high antioxidant containing fruits. This study aimed to analyze the proximate composition and antioxidant activity of pulp and seed of Syzygium cumini. Proximate composition was determined by following the AOAC method. Minerals and heavy metals were analyzed using a flame photometer and an atomic absorption spectrometer. In-vitro antioxidant activity was evaluated by using phosphomolybdenum, ferrous ion chelating ability assay and reducing power assay methods. In proximate composition analysis pulp contained significantly (p<0.05) greater amount of minerals than seed but seed contained a higher amount of protein and lipid than pulp. In the bioactive compound analysis, seed extracts possessed significantly (p<0.05) greater amount of Chlorophyll A, Chlorophyll B and total carotenoids. Additionally, seed extracts exhibited significantly (p<0.05) more total antioxidant capacity, reducing power and ferrous ion chelating ability compared to pulp extracts. This study revealed that the seed of Syzygium cumini contains significantly (p<0.05) higher amount of minerals, bioactive compounds and showed better antioxidant property. Therefore, Syzygium cumini seed can be a potential source of natural antioxidant in medicine and food production.

THU0230 IGG1 ANTIBODIES AGAINST PHOSPHORYLCHOLINE ARE NEGATIVELY ASSOCIATED WITH DISEASE ACTIVITY, DISEASE DAMAGE, CARDIOVASCULAR DISEASE AND ATHEROSCLEROSIS IN SLE: POTENTIAL UNDERLYING MECHANISMS

Background:

Phosphorylcholine (PC) is an important component in cellular membranes and in lipoproteins that is exposed and recognized by the immune system, when cells undergo apoptosis or lipoproteins like LDL undergo oxidation. PC is also exposed in some microorganisms including nematodes and bacteria (non-self). We reported that IgM anti-PC is associated with protection in atherosclerosis, SLE, RA and other chronic inflammatory conditions.1We also reported potential underlying protective mechanisms: 1: increase in clearance of human dead cells,22: inhibition of uptake of oxLDL in macrophages, 3: inhibition of cell death.14: anti-inflammatory; 5: promotion of polarization of T regulatory cells in SLE-patients´ T cells from a low level and also in plaque T cells.3We generated in-house fully human IgG1 anti-PC clones for experimental studies to study anti-PC properties in humans. In contrast to mice, anti-PC are not germ-line encoded with a dominant clone.4

Objectives:

We here study IgG1 and IgG2 anti-PC, with focus on atherosclerosis and SLE and properties of fully human IgG1 clones, in relation to SLE.

Methods:

We determined anti-PC by ELISA in 116 SLE-patients and 110 age- and sex-matched controls. For functional studies, we used three in-house generated, fully human monoclonal IgG1 anti-PC (A01, D05, E01). Apoptosis was induced in Jurkat T-cells and pre-incubated with A01, D05, E01 or isotype control IgG1 and effects on efferocytosis by human macrophages studied. Anti-PC peptide/protein characterization was determined using a proteomics de novo sequencing approach.

Results:

IgG1 but not IgG2 anti-PC levels were higher among SLE patients (p=0.02). IgG1 anti-PC was negatively associated with SLICC and SLEDAI (OR: 2,978 CI: 0.876-10.098, OR: 5.108 CI 1.3 20.067 respectively) and negatively associated with CVD, atherosclerotic plaques and echolucent (potentially vulnerable plaques) but the association for the two former was not significant after controlling for confounders. D05 had maximum effect on macrophage efferocytosis efficiency, followed by A01 and E01. The monoclonal antibodies showed differential binding specificity to PC and PC associated neo-epitopes. Peptide analysis showed difference in the CDR3 region of the three anti-PC IgG1 clones which are crucial for recognition of PC on apoptotic cell surface and other neo-epitopes.

Conclusion:

Anti-PC IgG1 is negatively associated with disease activity, and disease damage in SLE, but the negative association with CVD is also dependent on confounding risk factors. One potential underlying mechanism could be increased clearance of dead cells.

References:

[1]Frostegard J. Immunity, atherosclerosis and cardiovascular disease.BMC Med. 2013;11:117.

[2]Rahman M, Sing S, Golabkesh Z, Fiskesund R, Gustafsson T, Jogestrand T, Frostegard AG, Hafstrom I, Liu A and Frostegard J. IgM antibodies against malondialdehyde and phosphorylcholine are together strong protection markers for atherosclerosis in systemic lupus erythematosus: Regulation and underlying mechanisms.Clin Immunol. 2016;166-167:27-37.

[3]Sun J, Lundstrom SL, Zhang B, Zubarev RA, Steuer J, Gillgren P, Rahman M, Ajeganova S, Liu A and Frostegard J. IgM antibodies against phosphorylcholine promote polarization of T regulatory cells from patients with atherosclerotic plaques, systemic lupus erythematosus and healthy donors.Atherosclerosis. 2018;268:36-48.

[4]Fiskesund R, Steen J, Amara K, Murray F, Szwajda A, Liu A, Douagi I, Malmstrom V and Frostegard J. Naturally occurring human phosphorylcholine antibodies are predominantly products of affinity-matured B cells in the adult.J Immunol. 2014;192:4551-9.

Disclosure of Interests: :

Divya Thiagarajan: None declared, Roland Fiskesund: None declared, Johanna Steen: None declared, Mizanur Rahman: None declared, Susanna Lundström: None declared, Johan Frostegård Grant/research support from: Unconditional competitive grant from Amgen, related only to PCSK9, not the topic of this abstract

AB0129 PCSK9 IS ASSOCIATED WITH DISEASE ACTIVITY AND IMPLICATED IN IMMUNE ACTIVATION IN SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

LDL-levels are increased by Proprotein convertase subtilisin kexin 9 (PCSK9) which targets the LDL-receptor (LDLR). We reported that PCSK9 has immune modulatory properties in addition to LDL-lowering and ameliorates dendritic cell (DC) activation by oxidized LDL (OxLDL)1, which is abundant in atherosclerotic plaques. OxLDL is also raised and associated with cardiovascular disease (CVD) in SLE.1-3

Objectives:

We here investigate the role of PCSK9 in SLE both in a clinical context and in experimental ex vivo studies. The objective is to investigate if PCSK9 and its inhibition could be of relevance in SLE in addition to LDL-level related properties

Methods:

PCSK9-levels were determined by ELISA among SLE patients (n=109) and age- and sex-matched population-based controls (n=91). Common carotid intima-media thickness (IMT) and plaque occurrence were determined by B-mode ultrasound. Plaques were graded by echogenicity. Human peripheral blood monocytes from SLE patients or controls were differentiated into DCs. Effects of PCSK9 and its inhibition by silencing were studied.

Results:

PCSK9-levels were non-significantly higher among SLE-patients as compared to controls but associated significantly with SLE disease activity, as determined by SLAM (0.020) or SLEDAI (0.0178). There was no association between PCSK9-levels and atherosclerosis as determined by IMT, prevalence of plaques or echolucent (potentially vulnerable) plaques. PCSK9 levels were significantly associated with CVD among SLE-patients but not after adjustment for age.

OxLDL induced PCSK9 in DCs and DC-maturation with increased expression of CD86 and HLA-DR. The effects were significantly stronger in DC from SLE patients than from controls. Silencing of PCSK9 abolished OxLDL-induced DC-maturation.

Conclusion:

PCSK9 is associated with disease activity in SLE. One underlying cause could be OxLDL, promoting DC-activation which depends on PCSK9. OxLDL induces PCSK9, an effect which is higher among SLE-patients.PCSK9 could play an unexpected immunological role in SLE and inhibition of PCSK9 could potentially play a role in disease amelioration, pending on clinical studies.

References:

[1]Liu A and Frostegard J. PCSK9 plays a novel immunological role in oxidized LDL-induced dendritic cell maturation and activation of T cells from human blood and atherosclerotic plaque.J Intern Med. 2018.

[2]Frostegard J, Svenungsson E, Wu R, Gunnarsson I, Lundberg IE, Klareskog L, Horkko S and Witztum JL. Lipid peroxidation is enhanced in patients with systemic lupus erythematosus and is associated with arterial and renal disease manifestations.Arthritis Rheum. 2005;52:192-200.

[3]Frostegard J. Immunity, atherosclerosis and cardiovascular disease.BMC Med. 2013;11:117.

Disclosure of Interests:

Anquan Liu: None declared, Mizanur Rahman: None declared, Ingiäld Hafström: None declared, Sofia Ajeganova: None declared, Johan Frostegård Grant/research support from: Unconditional competitive grant from Amgen, related only to PCSK9, not the topic of this abstract

Different subclasses and isotypes of antibodies against phosphorylcholine in haemodialysis patients: association with mortality

The risk of premature death is high among patients on haemodialysis (HD patients). We previously determined that immunoglobulin (Ig)M antibodies against phosphorylcholine (anti‐PC) are negatively associated with increased risk of cardiovascular disease (CVD), atherosclerosis, some autoimmune diseases and mortality among HD patients in this cohort. Here, we also study other subclasses and isotypes of anti‐PC in HD patients in relation to mortality, inflammation and gender. The study group is a cohort of 209 prevalent HD patients [median age = 66 years, interquartile range (IQR) = 51–74], vintage time = 29 months (IQR = 15–58; 56% men) with a mean follow‐up period of 41 months (IQR = 20–60). Fifty‐six per cent were men. We also divided patients into inflamed C‐reactive protein (CRP) > 5·6 mg/ml and non‐inflamed CRP. Antibody levels were determined by in‐house enzyme‐linked immunosorbent assay. IgG1 anti‐PC below median was significantly associated with increased all‐cause mortality (after adjustment for confounders: P = 0·02), while IgG, IgA and IgG2 anti‐PC were not associated with this outcome. Among non‐inflamed patients, IgM and IgG1 anti‐PC were significantly associated with mortality (P = 0·047 and 0·02). IgG1 anti‐PC was significantly associated with mortality among men (P = 0·03) and trending among women (P = 0·26). IgM (as previously reported) and IgG1 anti‐PC are negatively associated with survival among HD patients and non‐inflamed HD patients, but among inflamed patients there were no associations. IgG, IgA or IgG2 anti‐PC were not associated with survival in these groups and subgroups. Further studies are needed to determine if raising anti‐PC levels, especially IgM and IgG1 anti‐PC, through immunization is beneficial.

Immunoglobulin G1 Antibodies Against Phosphorylcholine Are Associated With Protection in Systemic Lupus Erythematosus and Atherosclerosis: Potential Underlying Mechanisms

OBJECTIVE

Immunoglobulin M antibodies against phosphorylcholine (anti-PCs) may be protective in atherosclerosis, cardiovascular disease (CVD), and systemic lupus erythematosus (SLE). We study immunoglobulin G1 (IgG1) and immunoglobulin G2 (IgG2) anti-PCs, with a focus on atherosclerosis and SLE.

METHODS

We determined anti-PCs by using the enzyme-linked immunosorbent assay in 116 patients with SLE and 110 age- and sex-matched controls. For functional studies, we used three in-house-generated, fully human monoclonal IgG1 anti-PCs (A01, D05, and E01). Apoptosis was induced in Jurkat T cells and preincubated with A01, D05, E01, or IgG1 isotype control, and effects on efferocytosis by human macrophages were studied. Anti-PC peptide/protein characterization was determined using a proteomics de novo sequencing approach.

RESULTS

IgG1, but not IgG2, anti-PC levels were higher among patients with SLE (P = 0.02). IgG1 anti-PCs were negatively associated with Systemic Lupus International Collaborating Clinics (SLICC) damage index and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores (odds ratio [OR]: 2.978 [confidence interval (CI): 0.876-10.098] and OR: 5.108 [CI 1.3-20.067], respectively) and negatively associated with CVD, atherosclerotic plaques, and echolucent plaques (potentially vulnerable plaques), but the association for the two former was not significant after controlling for confounders. D05 had a maximum effect on macrophage efferocytosis efficiency, followed by A01 and E01. The monoclonal antibodies showed differential binding specificity to PC and PC-associated neoepitopes. A peptide analysis showed a difference in the complementarity-determining region 3 of the three IgG1 anti-PC clones that are crucial for recognition of PC on apoptotic cell surfaces and other neoepitopes.

CONCLUSION

IgG1 anti-PCs are negatively associated with disease activity and disease damage in SLE, but the negative association with CVD is also dependent on confounding risk factors. One potential underlying mechanism could be increased clearance of dead cells.

National Clinical Guidance for the Management of Cardiovascular Intervention in the COVID-19 Pandemic: From Bangladesh Society of Cardiovascular Interventions (BSCI)

Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.

HANSEN’S DISEASE DIAGNOSED AFTER ANTI-CANCER CHEMOTHERAPY

Background. Leprosy or Hansen’s disease is a chronic granulomatous disease involving predominantly skin, peripheral nerves and nasal mucosa but capable of affecting any tissue or organ. Histoid leprosy is a very rare well-defined clinicopathological variant of multibacillary lepromatous leprosy, which is very difficult to diagnose due to different specific clinical and histopathological findings that mimic a fibromatous disorder. Histoid leprosy occurs generally after treatment failure and sometimes de novo. Objective. The aim of the study was to explore histoid leprosy throughout a case report. Methods. A case report of histoid leprosy diagnosed after cancer chemotherapy is presented. Results. A 25-year-old healthy male presented with multiple skin coloured, discrete, well defined, painless papules and nodules scattered over nape of neck, right side of the trunk and both arms along with numbness as well as tingling sensation over both the arms and trunk. It was a case of non-seminomatous germ cell tumour (NSGCT), left testis, diagnosed and treated with a high inguinal orchidectomy with adjuvant chemotherapy in 2016. Ziehl Neelsen (ZN) stain for Acid Fast Bacilli (Mycobacterium leprae) – a modified Fite stain method showed numerous acid-fast bacilli. Histopathological diagnosis of Hansen’s disease (Histoid) was conducted. The patient was admitted and started on triple drug multi-bacillary multi-drug therapy (MB-MDT). A remarkable improvement was noticed in the lesion status within one month of institution of the therapy. Conclusions. Histoid leprosy is a discrete infrequent form of multibacillary leprosy with distinctive clinical, bacteriological and histomorphological features. Histopathologic examination with modified Fite stain is still the mainstay of diagnosis.

Lifestyle and Depression in Urban Elderly of Selected District of Bangladesh

Global population is ageing and Bangladesh has one of the fastest growing ageing populations in this region. Growth in the elderly population relative to other age groups challenges existing health services, family relationships and social security. Combined with this, depression has become a major mental health problem for elderly people especially for urban elderly for nuclear family norm in urban areas. The study was descriptive type of cross-sectional in nature and was conducted in Rangpur Medical College Hospital, Rangpur & Prime Medical College Hospital, Rangpur, Bangladesh. The objective of this study was to assess the lifestyle and level of depression in urban elderly. Depression was measured by questionnaire of geriatric depression scale among 254 respondents. 87.8% of the respondents were age between 60-70 years. Majorities (63%) of the respondents were male, 54% of the respondents lived in nuclear type family and the rest (46%) in joint type of family. Among respondents near half (47.2%) of the respondents found Mild depressive, around one third (32.7%) were severe depressive, and the rest (20.1%) were normal. There was significant association between occupational status of the respondents and depression (x² = 45.600, df=14, p=0.000). Farmers unemployed found severely depressive (52.1%) followed by day-labourer (50%) and businessmen (37.5%). There was significant association between financial self dependency and depression of the respondents (x²= 34.072, df=4, p=0.000). Severe depression (43.8%) was found among those who were not financially self dependent. There was also significant association between monthly income and depression of the respondents (x²= 67.327, df=8, p=0.000). The study also found that lower income group (<Tk 10000) suffer more from severe depression (42.1% vs. 16.67%) than that of higher income group (Tk 50000-99999). Another significant association found between respondents living with family and depression (x²=16.025, df=2, P=0.000). Respondents those not living with family were suffering more from severe depression (55.55%). Association between social activity and depression (x²=31.724, df=4, p=0.000) revealed that those not involved in social activities were in severe depression (40.55%). The study concluded that lifestyle factors and socio-demographic conditions directly influence the state of depression. Those who lead a healthy social life with friends and family, with a stable income source are less prone to severe depression and vice versa. The study recommended the formulation of strategies for the well being of urban elderly that should include social awareness about positive lifestyle changes, social mobilization, health assurance, and response from the government so that depression and its associated serious diseases can be prevented.

Study of Diameter of Lymphoid Follicle of Vermiform Appendix in Bangladeshi People of Different Age and Sex

A cross sectional descriptive study was performed on 40 postmortem vermiform appendix (male 24 and female 16) to find out the diameter of lymphoid follicle of vermiform appendix of Bangladeshi people. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique and were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). For this purpose, about 3mm long of whole thickness transverse section was taken from the middle of the vermiform appendix and thus the permanent slides were made for microscopic examination. To measure the diameter of the lymphoid follicle two measurements were taken. One was taken at the maximum diameter and another was perpendicular to it by ocular micrometer. Diameter of one largest and one smallest lymphoid follicles were measured and find out the mean diameter of lymphoid follicle between them. Diameter of lymphoid follicle = (Maximum transverse diameter + perpendicular diameter) /2. All data were recorded in the predesigned data sheet, analyzed by SPSS program (version 21, 2012) and compared with the findings of other national and international studies and standard text books. It was observed that diameter of lymphoid follicle of vermiform appendix gradually decreased as age advanced. The mean±SD diameter of lymphoid follicle was 580.31±37.07, 545.58±38.37, 485.68±40.20 and 428.12±68.41μm in Group A, B, C and D respectively. Statistical analysis shows that the mean differences of diameter of lymphoid follicle between A&B, C&D were statistically non significant at p= or >0.05 level, difference between Group B&C was statistically moderately significant at p<0.01 level and differences between Group A&C, B&D, A&D were statistically highly significant at p<0.001 level. Mean diameter of lymphoid follicle of vermiform appendix in male was higher (584.30±12.65μm in Group A, 549.42±38.36μm in Group B, 487.38±39.91μm in Group C, 430.68±70.30μm in Group D) than in female (576.31±53.77μm in Group A, 536.61±45.14μm in Group B, 483.14±46.68μm in Group C, 424.28±75.95μm in Group D) but mean difference between sexes in the different groups was statistically non significant at p=or >0.05 level. The present study will help to increase the information pool on the diameter of lymphoid follicle of vermiform appendix of Bangladeshi people.