Defining the hidden burden of disease in rural communities in Bangladesh, Cambodia and Thailand: a cross-sectional household health survey protocol

INTRODUCTION

In low-income and middle-income countries in Southeast Asia, the burden of diseases among rural population remains poorly understood, posing a challenge for effective healthcare prioritisation and resource allocation. Addressing this knowledge gap, the South and Southeast Asia Community-based Trials Network (SEACTN) will undertake a survey that aims to determine the prevalence of a wide range of non-communicable and communicable diseases, as one of the key initiatives of its first project-the Rural Febrile Illness project (RFI). This survey, alongside other RFI studies that explore fever aetiology, leading causes of mortality, and establishing village and health facility maps and profiles, will provide an updated epidemiological background of the rural areas where the network is operational.

METHODS AND ANALYSIS

During 2022-2023, a cross-sectional household survey will be conducted across three SEACTN sites in Bangladesh, Cambodia and Thailand. Using a two-stage cluster-sampling approach, we will employ a probability-proportional-to-size sample method for village, and a simple random sample for household, selection, enrolling all members from the selected households. Approximately 1500 participants will be enrolled per country. Participants will undergo questionnaire interview, physical examination and haemoglobin point-of-care testing. Blood samples will be collected and sent to central laboratories to test for chronic and acute infections, and biomarkers associated with cardiovascular disease, and diabetes. Prevalences will be presented as an overall estimate by country, and stratified and compared across sites and participants' sociodemographic characteristics. Associations between disease status, risk factors and other characteristics will be explored.

ETHICS AND DISSEMINATION

This study protocol has been approved by the Oxford Tropical Research Ethics Committee, National Research Ethics Committee of Bangladesh Medical Research Council, the Cambodian National Ethics Committee for Health Research, the Chiang Rai Provincial Public Health Research Ethical Committee. The results will be disseminated via the local health authorities and partners, peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

NCT05389540.

Assessment of Primary Hemostasis by Platelet Function Analyzer-100 and its Relation with TSH and FT₄ Levels in Newly Diagnosed Overt and Subclinical Hypothyroid Patients

Various abnormalities of coagulation such as primary hemostasis, secondary hemostasis and fibrinolysis have been reported in patients with subclinical and overt hypothyroidism. Platelets are major elements of primary hemostasis and endothelial repair. Platelet size, shape and number are the determinant of platelet function. The objective of this study was to assess primary hemostasis by PFA-100 (Platelet Function Analyzer-100) and its relation with TSH and FT₄ levels in newly diagnosed overt and subclinical hypothyroid patients. This cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Bangladesh from January 2016 to December 2016. Twenty overt and 20 subclinical hypothyroid patients with age ranging from 18 to 55 years were selected as study group and twenty age and sex matched healthy subjects were considered as control group. Patients were selected from Outpatients Department of Endocrinology and Nuclear Medicine & Allied Sciences of Dhaka Medical College Hospital, Dhaka on the basis of exclusion and inclusion criteria. For assessment of primary hemostasis, PFA-100 was analyzed by SIEMENS-INNOVANCE-PFA-200. For statistical analysis Unpaired Student's 't' test, Chi square test and Pearson's correlation co-efficient (r) test were performed. PFA-100 was significantly higher (p<0.001) in overt and subclinical hypothyroid patients as compared to healthy adult subjects. In overt and subclinical hypothyroidism using PFA-100, we found that the existence of a hypocoagulable state is due to a defect in primary hemostasis. Moreover, PFA-100 may replace the in-vivo bleeding time as a screening test for primary hemostasis in routine clinical practice.

Ending TB in South-East Asia: flagship priority and response transformation

Over the decades, the global tuberculosis (TB) response has evolved from sanatoria-based treatment to DOTS (Directly Observed Therapy Shortcourse) strategy and the more recent End TB Strategy. The WHO South-East Asia Region, which accounted for 45% of new TB patients and 50% of deaths globally in 2021, is pivotal to the global fight against TB. "Accelerate Efforts to End TB" by 2030 was adopted as a South-East Asia Regional Flagship Priority (RFP) in 2017. This article illustrates intensified and transformed approaches to address the disease burden following the adoption of RFP and new challenges that emerged during the COVID-19 pandemic. TB case notifications improved by 25% and treatment success rates improved by 6% between 2016 and 2019 due to interventions ranging from galvanising political commitments to empowering and engaging communities. Cumulative TB programme budget allocations in 2022 reached US$ 1.4 billion, about two and a half times the budget in 2016. An ambitious Regional Strategic Plan towards ending TB, 2021-2025, identifies priority interventions that will need investments of up to US$ 3 billion a year to fully implement them. Moving forward, countries in the Region need to leverage RFP and take up intensified, people-centred, holistic interventions for prevention, diagnosis, treatment and care of TB with commensurate investments and cross-ministerial and multi-sectoral coordination.

A qualitative exploration of challenges in childhood TB patients identification and diagnosis in Bangladesh

Background

As childhood tuberculosis is difficult to identify and diagnose, the experiences of the caregivers and healthcare providers of childhood tuberculosis patients remain a potential area of study. This study aims to illustrate the challenges caregivers and healthcare providers encounter in identifying and diagnosing childhood tuberculosis in two sub-districts of Bangladesh.

Methods

We conducted semi-structured in-depth interviews with eight caregivers of childhood tuberculosis patients and key informant interviews with 36 healthcare providers from September 2020 to December 2020 from different levels of the tuberculosis control program in Keraniganj (with high childhood tuberculosis cases notification), Faridpur Sadar (with low childhood tuberculosis cases notification), and Dhaka city.

Results

There is a dearth of understanding among caregivers about childhood tuberculosis. Passive case finding process and focus on cough during community mobilisation contribute to the delay in childhood tuberculosis identification. The stigmatisation that caregivers anticipate and experience has an impact on their mental health and implies that there are misunderstandings about tuberculosis in the community. Furthermore, diagnostic dilemma among healthcare providers accounts for diagnosis delays. Some, but not all, institutions in different geographical locations provide free diagnostic tests and have GeneXpert devices.

Conclusions

Various factors, including caregivers' knowledge and experience, the process of case finding and community mobilization, healthcare providers' way of service provision and diagnosis, and the unavailability of required logistics at facilities challenge the identification and diagnosis of childhood tuberculosis that need to be minimized for childhood tuberculosis's early identification, diagnosis, treatment initiation, and successful completion of treatment. Awareness should also be raised in the community of childhood tuberculosis.

Different RT-PCR Protocol used in SARS-Cov2 PCR Laboratory of Mymensingh Medical College, Bangladesh

The novel corona virus (SARS CoV-2) was first detected on Wuhan, China. After that it spread worldwide and has caused many deaths till now. This virus is also known as novel corona virus because of being newly discovered. Scientifically it is named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has positive-single stranded RNA and several proteins such as spike (S), envelope (E), membrane (M), nucleocapsid (N) and the other helper proteins. On the basis of phylogenic evidence, it is the new member of beta corona viruses and this group of viruses causes respiratory illness in human. This virus is detected in laboratory by using RT-PCR, by which different target gene such as E gene, S gene, N gene and RdRP (ORF1a-ORF1b) etc. are detected. This study was carried out at Mymensingh Medical College from April 2020 to December 2020. Around 65000 samples (nasopharyngeal swab) were tested during this period by three PCR protocols. By Sansure PCR kit N and ORF1a target genes were detected, Basphore's target genes were E and ORF and by Neoplex PCR kit N and RdRp genes were detected. Most of samples were tested by Sansure kit (62500), 2000 samples were screened by Bosphore kit and 500 samples by Neoplex. Among them, 6876(11.0%) samples were positive by Sansure, 120(6.0%) by Bosphore and 66(13.2%) by Neoplex. Among the positive samples, N gene 6188(90.0%) was mostly found by Sansure kit, whereas ORF was 120(100.0%) mostly found by Bosphore.

Distribution and Pattern of Anti-Tubercular Drug Resistance in Patients with Pulmonary Tuberculosis in Mymensingh Region of Bangladesh

Globally, the emergence of multidrug-resistant strains of Mycobacterium tuberculosis is an increasing problem that adversely affects patient care and public health. This cross sectional descriptive study was carried out in the Department of Microbiology, Mymensingh Medical College from January 2010 to December 2010 to isolate M. tuberculosis from smear-positive sputum samples by Lowenstein-Jensen (L-J) media and investigate the drug resistance pattern. Among 101 smear-positive cases 80(79.20%) yielded growth of Mycobacteria, 5(4.95%) were contaminated and 16(15.84%) showed no growth. Among 80 isolates 76(95.0%) were M. tuberculosis and the remaining 4(5.0%) were Non-tuberculous Mycobacteria (NTM). Out of 76 M. tuberculosis 27(35.52%) were resistant to at least one drug, 4(5.26%) to Isoniazid (INH), 1(1.32%) to Rifampicin (RMP), 8(10.53%) to Streptomycin (SM) and 0(0.0%) to Ethambutol (EMB) and multi-drug resistant tuberculosis (MDR-TB) was 9(11.84%). The present study creates the impression that fairly high rate of anti-tuberculosis drug resistance among the tuberculosis cases and also high MDR-TB (Resistant to both Rifampicin and Isoniazide). The emergence of MDR-TB poses significant trouble to TB control activities throughout the world. The complexity of MDR-TB operation makes it essential to produce new skills to design, plan, application and monitor interventions for the management of MDR-TB. More surveillance and immediate remedial interventions should be performed to combat the trouble of MDR-TB to the general population.

Correlation among the structural, electric and magnetic properties of Al3+ substituted Ni-Zn-Co ferrites

This study explored the structural, electrical, and magnetic properties of diamagnetic aluminium (Al³⁺) substituted nickel-zinc-cobalt (Ni–Zn–Co) mixed spinel ferrites, though the research on this area is in the infancy stage. Single-phase cubic spinel structures with the Fd3̄m space group of the synthesized Ni_0.4Zn_0.35Co_0.25Fe_(2−x)Al_xO₄ (0 ≤ x ≤ 0.12) ferrite samples were confirmed by X-ray diffraction (XRD) analysis. The average particle size ranged from 0.67 to 0.39 μm. Selected area electron diffraction (SAED) patterns were indexed according to the space group Fd3m, representing the particle's crystallinity. The optical band gaps ranged from 4.784 eV to 4.766 eV. Frequency-dependent dielectric constants and ac conductivity measurement suggested that the prepared ferrites were highly resistive. Relaxation times were reduced to a low value from 45.45 μs to 1.54 μs with the composition x. The Curie temperatures (T_c) were 615–623 K for all samples. Real part permeabilities (μ^/) were relatively stable up to an extended frequency range of 10⁶ Hz with relative quality factors (RQF) of around 10³. Tuning of the properties indicates that the fabricated ferrites may be promising for high-frequency electronic devices.

This study explored the structural, electrical, and magnetic properties of diamagnetic aluminium (Al³⁺) substituted nickel–zinc–cobalt (Ni–Zn–Co) mixed spinel ferrites, though the research on this area is in the infancy stage.

Antioxidant, anticholinesterase and neurotrophic potentials of indigenous medicinal herbs of Bangladesh

In Ayurvedic system of medicine, a variety of medicinal herbs are being prescribed for brain disorders, including mental dysfunction, indifference, and memory impairment. Neuropharmacological mechanisms of these herbs are poorly understood. A total of nineteen indigenous medicinal herbs of Bangladesh were investigated for their neuropharmacological potentials, including antioxidant, anticholinesterase, and neurotrophic activities. The antioxidant activity of plant ethanolic extracts was determined based on their DPPH free radical scavenging capacity. Acetylcholinesterase (AChE) inhibitory activity was determined by the colorimetric assay based on Ellman’s method. The neurotrophic activity of plant extracts was measured based on their capacity to promote neurite outgrowth in a primary culture of hippocampal neurons. Of the herbs, Camellia sinensis, Terminalia chebula, Cinnamomum tamala, Terminalia bellirica, Phyllanthus emblica, and Curcuma longa exhibited remarkable antioxidant activity with IC50 values of <100 µg/mL. The highest anticholinesterase activity was shown by C. longa (IC50 9.37 µg/mL) followed by C. sinensis (IC50 86.01 µg/mL) and C. tamala (IC50 86.37 µg/mL). Notably, C. tamala showed the highest neurotrophic activity (an increase in the length of primary neurites by 82% compared to control), whereas C. sinensis and C. longa showed moderate activities. The neurotrophic activity of C. tamala was reported for the first time. The present findings indicate that these indigenous herbs, particularly C. tamala, C. sinensis, and C. longa possess a remarkable neuropharmacological potential and suggest that these neuroactive herbs could be used in disease-modifying therapies for brain disorders.

Diagnostic Value of Clinical Profile and Proposed a Clinical Diagnostic Criterion of Enteric Fever

Enteric fever is a common bacterial infection in the tropics and endemic to Bangladesh. The volatile manifestations of enteric fever construct this disease a true diagnostic confrontation. There are limited current objective data on the value of individual clinical features of enteric fever in the diagnosis of enteric fever. The aim of the study was analysis of clinical features and also proposed a clinical diagnostic criterion of enteric fever among adult in Bangladesh. This cross-sectional comparative study was performed among which of fifty confirmed enteric fever and hundred non enteric febrile adult patients in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2015 to December 2015. Purposive sampling technique was implied for convenience of the study. In this study, history of step ladder fever, diarrhoea and relative bradycardia, ceacal gurgle, abdominal distension were proved to be powerful markers of enteric fever with high specificity (100.0%, 90.0%, 95.0%, 92.0% and 95.0% respectively). Tender right iliac fossa (RIF) and coated tongue, hepatomegaly were moderately powerful with 86.0%, 88.0%, 89.0% specificity respectively. Positive predictive value (PPV) was highest for step ladder fever (100%) and negative predictive value (NPV) was highest for headache (92.5%). Highest sensitivity, PPV and NPV were found for relative bradycardia and tender RIF but most of the signs had good specificity. Regarding accuracy it was highest for step ladder fever (91.3%), relative bradycardia (94%), tender RIF (87%), coated tongue (82%) and splenomegaly (84%). Therefore, a clinical diagnostic criterion was submitted with diagnostic accuracy more than 70% were taken into deliberation. The Major criteria were considered step ladder fever, relative bradycardia, tender RIF with diagnostic accuracy 91.0%, 94.0% and 87.0% respectively. Minor criteria included splenomegaly, diarrhoea, coated tongue, ceacal gurgle, chills with diagnostic accuracy 85.0%, 85.0%, 82.0%, 76.0%, 72.0% respectively and after amalgamation of various major and minor criteria a final diagnostic criterion was submitted having accuracy more than 60.0%. In conclusion the clinical profile of enteric fever in culture proven patients with a view to highlight the predictive value of those features which would help general practitioners in the diagnosis and empiric treatment.

Frequency of Eosinophilic Esophagitis among Patients with Gastroesophageal Reflux Symptoms in an Academic Hospital of Bangladesh: A Cross Sectional Study

Eosinophilic esophagitis (EoE) is a disease of modern era. It was first described 40 years back. Since then it has drawn an immense interest among the clinicians. It is diagnosed by the presence of eosinophils count ≥15/HPF on esophageal biopsied mucosa in patients with symptoms of esopohageal dysfunction. It is more prevalent among patients with gastroesophageal reflux disease. As its symptoms overlap with that of gastroesophageal reflux disease (GERD), it is frequently overlooked & misdiagnosed which increases patients' sufferings. No data is available in Bangladesh. The objective of the study was to find out the frequency of eosinophilic esophagitis among patients with gastroesophageal reflux symptoms. The study was conducted at the Outpatient department of the department of Gastroenterology of Dhaka Medical College Hospital, Dhaka, Bangladesh from September 2018 to April 2019. One hundred and thirty three (133) consecutive patients with symptoms suggestive of gastroesophageal reflux disease based on validated questionnaire underwent upper GI endoscopy. Biopsies were taken from proximal and distal esophagus as well as any other endoscopically abnormal esophageal mucosal lesion. Among 133 patients with gastroesophageal reflux symptoms, 7 patients (5.3%) were found to be positive for eosinophilic esophagitis. Mean age at diagnosis was 37.28±13.38 years. It was more common in younger age group. Female patients (56%) were more than male patients (44%). Heart burn was the major symptom followed by acid regurgitation. Nocturnal cough showed statistically significant relationship with eosinophilic esophagitis. Although the frequency is low, it may be considered as a differential diagnosis among patients with GERD.

405 Radiological Analysis of Gentamicin Eluting Synthetic Bone Graft Substitute Used in The Management of Gustilo IIIB Open Fractures

Background

Management of traumatic bone void associated with Gustilo IIIB open fractures is challenging. Gentamicin eluting synthetic bone graft substitute (Cerament-G) had been recently utilised for the management of patients with these injuries. This study aims to assess radiological signs of Cerament-G remodelling.

Method

Retrospective data analysis of all patients admitted to our unit with IIIB open fractures who had Cerament-G applied as avoid filler. Postoperative radiographic images of the fracture site at 6-weeks, 3-months, 6-months and at the last follow-up were reviewed. The radiological signs of Cerament-G integration, percent of void healing, and bone cortical thickness at the final follow-up were assessed.

Results

34 patients met our inclusion criteria, mean age: 42 years. Mean follow-up time was 20 months. 59% of patients had excellent (&gt;90%) void filling, 26.4% of patients had 50-90% void filling, and 14.6% had &lt; 50% void filling. Normal bone cortical thickness was restored on AP and Lateral views in 55.8% of patients. No residual Cerement-G was seen on X-rays at the final follow-up in any of the patients.

Conclusions

Our results showed successful integration of Cerament-G with excellent void filling and normal cortical thickness achieved in more than half of the patients.

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.

Molecular Detection of Human Coronavirus from North Central Part of Bangladesh Depending on ORF1ab and N Gene

The Coronavirus disease 2019 (COVID-19) resulted severe respiratory illness such as pneumonia and lung dysfunctions that was first identified at Wuhan, the capital of Hubeiin China during the end of December 2019. The etiological cause of COVID-19 has been confirmed as a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which was similar with the zoonotic virus SARS-CoV (2002). Now a days for early diagnosis of COVID-19 the nucleic acid based test like RT PCR (real time reverse transcription polymerase chain reaction) is most consistent and used all over the world. In this study among 11,280 cases 825(7.31%) were positive by molecular RT PCR method on June 2020 at Microbiology department of Mymensingh Medical College and the samples are collected from different areas of Northern part of Bangladesh. Among this positive cases 588(71%) N gene, 10 ORF1ab (2%) and 227(27%) both N and ORF gene showed significant curve which is specific for COVID-19 positive patients. Because N and ORF gene of this virus inhibit immune system of human body especially interferon. Out of SARS-CoV-2 positive cases maximum number of N gene were found in male patients and above 40 years old aged group. So, Molecular diagnosis of this pandemic virus especially by N and ORF gene might be helpful to reduce the spread of SARS-CoV-2 as well as early treatment for saving many lives.

What Constitutes Health Care Seeking Pathway of TB Patients: A Qualitative Study in Rural Bangladesh

Given the targeted 4–5% annual reduction of tuberculosis (TB) cure cases to reach the “End TB Strategy” by 2020 milestone globally set by WHO, exploration of TB health seeking behavior is warranted for insightful understanding. This qualitative study aims to provide an account of the social, cultural, and socioeconomic breadth of TB cases in Bangladesh. We carried out a total of 32 In-depth Interviews (IDIs) and 16 Key Informant Interviews (KIIs) in both rural and urban areas of Bangladesh. We covered both BRAC [a multinational Non-governmental Organization (NGO)] and non-BRAC (other NGOs) TB program coverage areas to get an insight. We used purposive sampling strategy and initially followed “snowball sampling technique” to identify TB patients. Neuman’s three-phase coding system was adopted to analyze the qualitative data. Underestimation of TB knowledge and lack of awareness among the TB patients along with the opinions from their family members played key roles on their TB health seeking behavior. Quick decision on the treatment issue was observed once the diagnosis was confirmed; however, difficulties were in accepting the diseases. Nevertheless, individual beliefs, intrinsic ideologies, financial abilities, and cultural and social beliefs on TB were closely inter-connected with the “social perception” of TB that eventually influenced the care seeking pathways of TB patients in various ways. Individual and community level public health interventions could increase early diagnosis; therefore, reduce recurrent TB.

A Study of Association between H. Pylori Genotype and Chronic Gastritis

The prevalence of Helicobacter pylori (HP) infection is very high in Bangladesh. Chronic gastritis due to H. pylori is commonly associated with important gastric diseases such as peptic ulcer diseases or gastric carcinoma and MALT-oma. The natural course of chronic gastritis is HP-associated antral gastritis or pangastritis or rarely atrophies. This study was done to see the association of H. pylori genotypes with chronic gastritis. This observational cross sectional study was carried out at Bangabandhu Sheikh Mujib Medical University from July 2012 to April 2013 to find out the association of H. pylori genotypes with chronic gastritis in dyspeptic patients of Bangladesh. A total of 50 dyspeptic subjects were involved in the study whose upper GI endoscopies were carried out in presence of an experienced endoscopist. During the procedure four biopsies were taken, two from the antrum and two from body of the stomach. Endoscopic diagnosis was categorized into normal and erosive gastritis. Two (one from antrum and one from body) biopsy samples were collected in phosphate buffer saline and PCR analysis carried out by Multiplex PCR assay. Another two were collected in 10% formalin and histopathological examination was done according to updated Sydney system of classification. Among 50 patents only 34 were PCR positive. So, only 34 subjects were included in the study. Among them 21 patients (61.8%) were male and 13 patients (38.2%) were female, with the mean age of 29.91 years. Endoscopy revealed erosive gastritis in 5(14.7%) patients and normal findings in 29(86.3%) patients. Amongst the strains, cagA gene was detected in 58.8% and was not significantly associated with severity of any parameter of chronic gastritis such as H. pylori density, inflammation (mononuclear infiltration), activity (neutrophilic infiltration), atrophy and intestinal metaplasia. All the strains were positive for vacA allele. s1m1 (55.9%) genotype was most predominant. No vacA allele (s1m1, s1m2, s2m1 and s2m2) were significantly associated with severity of chronic gastritis. In this study, H. pylori genotype -cagA, vacA-s1, s2, m1, m2 allele and histological grading of chronic gastritis according to updated Sydney system of classification is identified. This study will identify the genotypes associated with severe gastritis in our country and thereby help us to take appropriate preventive measure. Further study with larger sample size may be carried out to establish proper association between different genotypes and parameters of chronic gastritis.

Detection of 2019-Novel Coronavirus (2019-nCoV) by rRT-PCR at Mymensingh Medical College, Mymensingh, Bangladesh

The coronavirus disease (COVID-19) is highly pathogenic viral infection caused by SARS-CoV-2. Currently, COVID-19 has caused global health concern. WHO has declared COVID-19 as a pandemic disease on March 11, 2020 and characterized by fever, dry cough, fatigue, myalgia and chest pain with pneumonia in severe cases. The virus has spread to at least 213 countries and more than 9093827 confirmed cases and 471490 deaths have been recorded. In the beginning, the world public health authorities tried to eradicate the disease in China through quarantine but are now transitioning to prevention strategies worldwide to delay its spread. There are some newly developed and promising methods for detection of SARS-CoV-2, in order to facilitate the development of novel approaches for early diagnosis. Nucleic acid based tests currently offer the most sensitive and early detection and confirmation for SARS-CoV-2 infection. Among them Real-time reverse transcription polymerase chain reaction (rRT-PCR) is the most popular and the "gold standard" testing method for the detection of SARS-CoV-2. The present study was carried out to detect 2019-Novel Coronavirus (2019-nCoV) by rRT-PCR method at Mymensingh Medical College, Mymensingh, Bangladesh from 1st April, 2020 to 31st May, 2020. A total of 14356 samples were tested from four districts of Mymensingh division namely, Mymensingh, Jamalpur, Sherpur, Netrokona and some parts of Sunamganj for rRT-PCR. Among them 1086 (7.5%) patients were positive for SARS-CoV-2. Out of 1086 positive cases 716(65.9%) were male and 370(34.1%) were female with a Mean±SD age 34.1±12 years. Maximum positivity was found in Mymensingh district followed by Netrokona, Jamalpur, Sherpur and Sunamganj respectively. This is the first base line study for genetic detection of 2019-nCoV in Mymensingh division which may reflect the total scenario of Bangladesh situation. We hope this paper will help the researcher to increase the availability, accuracy, and speed of widespread COVID-19 testing throughout the world in this crisis moment.

Estimating Catastrophic Costs due to Pulmonary Tuberculosis in Bangladesh

To eliminate TB from the country by the year 2030, the Bangladesh National Tuberculosis (TB) Program is providing free treatment to the TB patients since 1993. However, the patients are still to make Out-of-their Pocket (OOP) payment, particularly before their enrollment Directly Observed Treatment Short-course (DOTS). This places a significant economic burden on poor-households. We, therefore, aimed to estimate the Catastrophic Health Expenditure (CHE) due to TB as well as understand associated difficulties faced by the families when a productive family member age (15–55) suffers from TB. The majority of the OOP expenditures occur before enrolling in. We conducted a cross-sectional study using multistage sampling in the areas of Bangladesh where Building Resources Across Communities (BRAC) provided TB treatment during June 2016. In total, 900 new TB patients, aged 15–55 years, were randomly selected from a list collected from BRAC program. CHE was defined as the OOP payments that exceeded 10% of total consumption expenditure of the family and 40% of total non-food expenditure/capacity-to-pay. Regular and Bayesian simulation techniques with 10,000 replications of re-sampling with replacement were used to examine robustness of the study findings. We also used linear regression and logit model to identify the drivers of OOP payments and CHE, respectively. The average total cost-of-illness per patient was 124 US$, of which 68% was indirect cost. The average CHE was 4.3% of the total consumption and 3.1% of non-food expenditure among the surveyed households. The poorest quintile of the households experienced higher CHE than their richest counterpart, 5% vs. 1%. Multiple regression model showed that the risk of CHE increased among male patients with smear-negative TB and delayed enrolling in the DOTS. Findings suggested that specific groups are more vulnerable to CHE who needs to be brought under innovative safety-net schemes.

Mapping the travel patterns of people with malaria in Bangladesh

BACKGROUND

Spread of malaria and antimalarial resistance through human movement present major threats to current goals to eliminate the disease. Bordering the Greater Mekong Subregion, southeast Bangladesh is a potentially important route of spread to India and beyond, but information on travel patterns in this area are lacking.

METHODS

Using a standardised short survey tool, 2090 patients with malaria were interviewed at 57 study sites in 2015-2016 about their demographics and travel patterns in the preceding 2 months.

RESULTS

Most travel was in the south of the study region between Cox's Bazar district (coastal region) to forested areas in Bandarban (31% by days and 45% by nights), forming a source-sink route. Less than 1% of travel reported was between the north and south forested areas of the study area. Farmers (21%) and students (19%) were the top two occupations recorded, with 67 and 47% reporting travel to the forest respectively. Males aged 25-49 years accounted for 43% of cases visiting forests but only 24% of the study population. Children did not travel. Women, forest dwellers and farmers did not travel beyond union boundaries. Military personnel travelled the furthest especially to remote forested areas.

CONCLUSIONS

The approach demonstrated here provides a framework for identifying key traveller groups and their origins and destinations of travel in combination with knowledge of local epidemiology to inform malaria control and elimination efforts. Working with the NMEP, the findings were used to derive a set of policy recommendations to guide targeting of interventions for elimination.

The Role of Histological Assessment of Distal Doughnut in Low Anterior Resection for Low Rectal Cancer

Anterior resection (AR), especially low anterior resection (LAR), for low rectal cancer and colorectal anastomosis is a technical challenge to surgeons. But by using circular stapling devices now it is possible make more LARs technically feasible. A stapled end-to-end colorectal anastomosis is increasingly adopted following a low anterior resection for low rectal cancer. This descriptive cross-sectional study was carried out in the department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from December 2015 to December 2016. The ensuing doughnuts created from the stapling device are routinely sent for histological analysis. However, its efficacy remains debatable. This study aims to determine the role of sending distal doughnut for histological examination following a stapled end-to-end colorectal anastomosis done in low anterior resection for low rectal cancers.

Renal failure and progressive pancytopenia

Hyperparathyroidism may be a precipitating factor to the development of myelofibrosis; however, this is extremely rare with only a few documented case reports of myelofibrosis caused by secondary hyperparathyroidism. We describe a case of a 24-year-old female who had a failed live donor renal transplant and secondary hyperparathyroidism. While on haemodialysis she became increasingly pancytopenic despite erythropoietin injections and adequate iron, vitamin B12 and folate replacement. Her secondary hyperparathyroidism evolved to tertiary hyperparathyroidism despite vitamin D supplementation and phosphate binders. In order to determine the cause of her pancytopenia, a bone marrow biopsy was performed that confirmed myelofibrosis due to her secondary hyperparathyroidism. Following a successful parathyroidectomy in a tertiary hospital, her pancytopenia resolved and she is now awaiting a second transplant.

Detection of Tubercular Pleural Effusion by Molecular Technique PCR

Tuberculosis is a common cause of death in developing countries like Bangladesh. About 30% of pulmonary tubercular infected patients developed tubercular pleural effusion. Tubercular pleural effusion was diagnosed by cytological, biochemical and bacteriological methods. But these methods showed low sensitivity. In some cases pleural biopsy showed also negative results. Now a days molecular technique like Polymerase chain reaction (PCR) is promising method for diagnosis of pleural TB. PCR was done in 100 pleural fluid collected from suspected tubercular pleural effusion cases admitted in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2011 to January 2013. Among the 100 samples 3% were culture positive and PCR positive was 6%. Sensitivity and Specificity of PCR considering culture as a gold standard method was 100% and 96.71% respectively in this cross sectional study. Among them Adenosine deaminase (ADA) level is >40IU/L in all PCR positive sample. Where PCR is available, measurement of ADA activity as well as PCR can be done simultaneously.

Coupled Active Shape Models for Automated Segmentation and Landmark Localization in High-Resolution CT of the Foot and Ankle

Purpose

We develop an Active Shape Model (ASM) framework for automated bone segmentation and anatomical landmark localization in weight-bearing Cone-Beam CT (CBCT). To achieve a robust shape model fit in narrow joint spaces of the foot (0.5 - 1 mm), a new approach for incorporating proximity constraints in ASM (coupled ASM, cASM) is proposed.

Methods

In cASM, shape models of multiple adjacent foot bones are jointly fit to the CBCT volume. This coupling enables checking for proximity between the evolving shapes to avoid situations where a conventional single-bone ASM might erroneously fit to articular surfaces of neighbouring bones. We used 21 extremity CBCT scans of the weight-bearing foot to compare segmentation and landmark localization accuracy of ASM and cASM in leave-one-out validation. Each scan was used as a test image once; shape models of calcaneus, talus, navicular, and cuboid were built from manual surface segmentations of the remaining 20 scans. The models were augmented with seven anatomical landmarks used for common measurements of foot alignment. The landmarks were identified in the original CBCT volumes and mapped onto mean bone shape surfaces. ASM and cASM were run for 100 iterations, and the number of principal shape components was increased every 10 iterations. Automated landmark localization was achieved by applying known point correspondences between landmark vertices on the mean shape and vertices of the final active shape segmentation of the test image.

Results

Root Mean Squared (RMS) error of bone surface segmentation improved from 3.6 mm with conventional ASM to 2.7 mm with cASM. Furthermore, cASM achieved convergence (no change in RMS error with iteration) after ~40 iterations of shape fitting, compared to ~60 iterations for ASM. Distance error in landmark localization was 25% to 55% lower (depending on the landmark) with cASM than with ASM. The importance of using a coupled model is underscored by the finding that cASM detected and corrected collisions between evolving shapes in 50% to 80% (depending on the bone) of shape model fits.

Conclusion

The proposed cASM framework improves accuracy of shape model fits, especially in complexes of tightly interlocking, articulated joints. The approach enables automated anatomical analysis in volumetric imaging of the foot and ankle, where narrow joint spaces challenge conventional shape models.

Detection of Oncoprotein by a Novel Immunochromatoghaphic Test Depending on Age and Parity of the Patients Attending at Mymensingh Medical College Hospital, Bangladesh

In world wide cervical cancer is the fourth most common among women, with the majority of cases occurring in developing countries. Some HPV infections persist, and a subset of persistent infections may lead to development of cervical intraepithelial neoplasia (CIN) or invasive cancer. Because neoplastic change typically takes some years to occur and it depends on multiple factors among them age and parity play important role. The objective of the cross sectional observational study was detection of oncoprotein depending on age and parity by immunochromatographic test (OncoE6 cervical test). Informed consent was taken from patients and the protocol was approved by IRB, Mymensingh Medical College, Mymensingh, Bangladesh. From April 2016 to March 2017 following universal safety precautions a total of 280 endocervical swabs were collected from VIA outdoor and Colposcopy clinic of Obstetrics and Gynaecology department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Laboratory work was done in the department of Microbiology, Mymensingh Medical College. The E6 strip test is an immunochromatographic test based on the detection of HPV-E6 oncoprotein in cervical swab samples. In this study VIA and OncoE6 cervical test were done on 280 cases and among them 120 were VIA positive and sent for colposcopy. From 120 VIA positive cases 70 were positive for colposcopy test. Afterwards 50 cases were selected for histopathological examination and classified into different grades. The present study showed 21(7.5%) cases were OnE6 cervical test positive by OncoE6 cervical test and most of them were found in advance aged <50 (38.09%) and multi parity (women more than two, 32.5%). Based on the findings of the present study, it may be concluded that age and multi parity plays important factor to cause cervical cancer. Now for prevention of cervical cancer we need screening which is an early detection tool. This is a low cost device, easily performed which can detect this HRHPV (High Risk HPV) and it will be helpful to reduce over treatment and high predictability of the disease.

Giant Cell Tumour of the Talus: A Rare Case Report

Giant-cell tumor constitutes 4-20% of all primary bone tumors in south East Asian population. They are benign locally aggressive bone tumour first described by cooper in 1818. These tumors occur predominantly in meta-epiphyseal region. Most often they are located around the knee joint. Although most of the tumors are diagnosed on plain radiograph alone, varying CT and MRI presentations of these tumors are essential to narrow down the differentials has an extended pre operative assessment.

Mapping imported malaria in Bangladesh using parasite genetic and human mobility data

For countries aiming for malaria elimination, travel of infected individuals between endemic areas undermines local interventions. Quantifying parasite importation has therefore become a priority for national control programs. We analyzed epidemiological surveillance data, travel surveys, parasite genetic data, and anonymized mobile phone data to measure the spatial spread of malaria parasites in southeast Bangladesh. We developed a genetic mixing index to estimate the likelihood of samples being local or imported from parasite genetic data and inferred the direction and intensity of parasite flow between locations using an epidemiological model integrating the travel survey and mobile phone calling data. Our approach indicates that, contrary to dogma, frequent mixing occurs in low transmission regions in the southwest, and elimination will require interventions in addition to reducing imported infections from forested regions. Unlike risk maps generated from clinical case counts alone, therefore, our approach distinguishes areas of frequent importation as well as high transmission.

Large-scale secretome analyses unveil the superior immunosuppressive phenotype of umbilical cord stromal cells as compared to other adult mesenchymal stromal cells

Mesenchymal stromal cells (MSCs), given their regenerative potential, are being investigated as a potential therapeutic tool for cartilage lesions. MSCs express several bioactive molecules which act in a paracrine fashion to modulate the tissue microenvironment. Yet, little is known about the divergence of these signalling molecules in different MSC populations. The present study investigated secretomes of stromal cells harvested from Hoffa's fat pad (HFPSCs), synovial membrane (SMSCs), umbilical cord (UCSCs) and cartilage (ACs) by quantitative liquid chromatography-mass spectrometry (LC-MS/MS) proteomics. Also, multiplex protein arrays and functional assays were performed to compare the constitutive immunomodulatory capabilities of different MSCs. Proteins involved in extracellular matrix degradation and inflammation, such as matrix metalloproteinases (MMPs), interleukin (IL)-17 and complement factors, were downregulated in UCSCs as compared to adult cell sources. Additionally, secretion of transforming growth factor (TGF)-β1 and prostaglandin E2 (PGE2) was enhanced in UCSC supernatants. UCSCs were superior in inhibiting peripheral blood mononuclear cell (PBMC) proliferation, migration and cytokine secretion as compared to adult stromal cells. SMSCs significantly suppressed the proliferation of PBMCs only if they were primed with pro-inflammatory cytokines. Although all cell types repressed human leukocyte antigen-DR isotype (HLA-DR) surface expression and cytokine release by activated macrophages, only UCSCs significantly blocked IL-6 and IL-12 production. Furthermore, UCSCs supernatants increased aggrecan gene expression in two-dimensional chondrocyte cultures. The data demonstrated that UCSCs displayed superior anti-inflammatory and immunosuppressive properties than stromal cells from adult tissues. This allogeneic cell source could potentially be considered as an adjuvant therapy for articular cartilage repair.

Urban-rural and sex differentials in tuberculosis mortality in Bangladesh: results from a population-based survey

OBJECTIVE

To assess tuberculosis mortality in Bangladesh through a population-based survey using a Verbal Autopsy tool.

METHODS

Nationwide mortality survey employing the WHO-recommended Verbal Autopsy (VA) tool, and using InsilicoVA, a data-driven method, to assign the cause of death. Using a three-stage cluster sampling method, 3997 VA interviews were conducted in both urban and rural areas of Bangladesh. Cause-specific mortality fractions (CSMF) were estimated using Bayesian probabilistic models.

RESULTS

6.8% of total deaths in the population were due to TB [95% CI: (5.1, 8.9)], comprising 12.0% [95% CI: (11.1, 12.8)] and 6.42% [95% CI: (5.4, 7.3)] of total male and female deaths, respectively. This proportion was highest among adults age 15-49 years [12.2%, 95% CI: (9.4, 14.6)]. The urban population is more likely to die from TB, and urban males have highest CSMF [13.6%, 95% CI: (9.1, 16.9)].

CONCLUSION

Our survey results show that TB is the fifth major cause of death in the general population and that sex and place of residence (urban/rural) have a significant effect on TB mortality in Bangladesh. The underlying causes of higher rates of TB-related deaths in urban areas and particularly among urban males, who have better knowledge and higher enrollment in the DOTS Program, need to be explored.

Health seeking behaviour and delayed management of tuberculosis patients in rural Bangladesh

Background

Early diagnosis of tuberculosis (TB) and involvement of the public-private partnership are critical to eradicate TB. Patients need to receive proper treatment through the National Tuberculosis Control Programme (NTP). This study describes various predictors for health seeking behaviour of TB patients and health system delay made by the different health care providers.

Methods

A cross-sectional study was conducted in a public health facility of a rural area in Bangladesh. Newly diagnosed smear positive pulmonary TB (PTB) patients who were ≥ 15 years of age were sequentially enrolled in this study. The socio-demographic characteristics and proportion of health care utilization by the patients, and health system delay made by the health care providers were calculated. Multivariate analysis was conducted to determine the independent association of the risk factors with the time to seek medical care.

Results

Two hundred and eighty patients were enrolled in this study. Among them, 73.6% were male and 26.4% were female. A hundred percent of patients primarily sought treatment for their cough, 170 (60.7%) first consulted a non-qualified practitioner while 110 patients (39.3%) first consulted with qualified practitioners about their symptoms. Pharmacy contact was the highest (27.9%) among the non-qualified practitioners, and 58.9% non-qualified practitioners prescribed treatment without any laboratory investigation. The average health system delay was 68.5 days. Multiple logistic regressions revealed a significant difference between uneducated and educated patients (OR 2.33; CI 1.39–3.92), and qualified and non-qualified practitioners (OR 2.34; CI 1.38–3.96) to be independent predictors of health system delay.

Conclusions

Compared to men, fewer women sought TB treatment. Uneducated patients and questionably qualified practitioners made for a longer delay in detecting TB. Increasing public health awareness and improving health seeking behavior of females and uneducated patients, and greater participation of the qualified practitioners in the NTP are highly recommended.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3430-0) contains supplementary material, which is available to authorized users.