Measuring the effectiveness of an integrated intervention package to improve the level of infection prevention and control: a multi-centre study in Bangladesh

BACKGROUND

Infection prevention and control (IPC) is a critical component of delivering safe, effective and high-quality healthcare services, and eliminating avoidable healthcare-associated infections (HAIs) in health facilities, predominantly in population-dense settings such as Bangladesh.

AIM

Our study aimed to assess the effect of an integrated intervention package in improving the IPC level of the health facilities in Bangladesh.

METHODS

We conducted a pre-post intervention study in six district hospitals (DHs) and 13 Upazila Health Complexes (UHCs) in the six districts of Bangladesh. Baseline and endline assessments were conducted between March and December 2021 using the adapted World Health Organization Infection Prevention and Control Assessment Framework (WHO-IPCAF) tool. The IPCAF score, ranging from 0-800, was calculated by adding the scores of eight components, and the IPC promotion and practice level was categorized as Inadequate (0-200), Basic (201-400), Intermediate (401-600) and Advanced (601-800). The integrated intervention package including IPC committee formation, healthcare provider training, logistics provision, necessary guidelines distribution, triage/flu corners establishment, and infrastructure development was implemented in all facilities.

RESULTS

The average IPCAF score across all the facilities showed a significant increase from 16% (95% CI: 11.5-20.65%) to 54% (95% CI: 51.4-57.1%). Overall, the IPCAF score increased by 34 percentage points (P<0.001) in DHs and 40 percentage points (P<0.001) in UHCs. Following the intervention, 12 (three DHs, nine UHCs) of 19 facilities progressed from inadequate to intermediate, and another three DHs upgraded from basic to intermediate in terms of IPC level.

CONCLUSION

The integrated intervention package improved IPCAF score in all facilities.

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.

Study on Blood Pressure, e-GFR, Serum Albumin, C-reactive Protein in Normal Subjects and Patients with CKD

In general, Kidney diseases are silent with no apparent early symptoms and chronic kidney disease (CKD) is marked by gradual loss of kidney function over time. High rate of inflammation is common in CKD and it causes high CRP level. High CRP levels are associated with low e-GFR and low serum albumin level. This study was conducted to determine the changes of blood pressure, estimated glomerular filtration rate, serum albumin and C-reactive protein in chronic kidney diseased patients and compared with healthy subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh from July 2021 to June 2022. A total number of 140 subjects, age range between 25-70 years were included in this study. Among them, 70 healthy subjects were taken as control group (Group I) with 35 male (IA) and 35 female (IB) and 70 chronic kidney diseased patients were taken as study group (Group II) with 35 male (IIA) and 35 female (IIB). Calculation of estimated glomerular filtration rate (eGFR) was done by chronic kidney disease epidemiology collaboration (CKD-EPI) equation. Data were expressed as mean±SD and statistical significance difference among the group were calculated by unpaired t-test. In this study, we found that eGFR (in IIA 29.83±0.73 ml/min and in IIB 30.80±0.73ml/min) and serum albumin (in IIA 2.96±0.04g/dl in IIB 2.07±0.02g/dl) were significantly decreased in study group in comparison to control group. Blood pressure (SBP in IIA 150.57±1.70 mm of Hg, in IIB 143.71±1.32 mm of Hg and DBP in IIA 94.40±0.70 and in IIB 91.20±0.70 mm of Hg) and C-reactive protein (CRP) (in IIA 12.14±0.90mg/l and in IIB 21.80±2.58mg/l) were significantly increased in study group in comparison to control group. CKD is associated with increased risks of several co-morbidities including cardiovascular complications and chronic renal failure. Detection of CKD at an early stage helps to reduce the progression of renal disease and burden of end stage renal disease.

Synthesis and antibacterial activity of nanoenhanced conjugate of Ag-doped ZnO nanorods with graphene oxide

In this paper, we report a successful synthesis of ZnO nanorods using the microwave-assisted technique, solid-state reaction method was utilized for the preparation of Zn_1-xAg_xO (x = 0.05, 0.1), Hummer's modified method for graphene oxide (GO) along with the sonication method to prepare GO-based Ag-doped ZnO (Zn_1-xAg_xO/GO: x  = 0.05, 0.1) nanocomposites. These nanorods and nanocomposites were characterized by X-ray diffraction (XRD), Fourier-transform infrared (FTIR), high-resolution transmission electron microscopy (HRTEM), and Raman spectroscopy for structural properties, scanning electron microscopy (SEM) along with energy dispersive X-ray (EDX) spectroscopy for morphological analysis, and UV-Vis spectroscopy for optical properties. XRD, FTIR, and Raman measurements substantiated that each sample is well crystallized in the single-phase polycrystalline wurtzite hexagonal structure of ZnO. The average crystallite size is found to be in decreasing order ranges 40 nm to 29 nm, respectively, along with a significant reduction in the optical bandgap. The SEM images showed a clear evidence of nanorods of ZnO, while the EDX spectra verified the presence of Zn, Ag, O, and C elements in the synthesized samples with their nominal percentage. Furthermore, the prepared nanocomposites effectively inhibited the growth ofStaphylococcus aureus and Escherichia coli. In comparison to pure ZnO nanorods, GO-based Ag-doped ZnO nanorods showed improved antibacterial activity against both S. aureus and E. coli.

Design and operation of a hybrid LED/LD-pumped phosphor-converted white-light lamp

Illumination sources based on phosphors, pumped by laser diodes (LDs), have seen rapid developments over the past decade. Here, we present a new, to the best of our knowledge, design that features both spectral richness and the capability for high brightness. Complete design details and operational characterization have been described. This basic design can be extended in various ways to customize such lamps for different operational requirements. A hybrid arrangement of both LEDs and an LD is used to excite a mixture of two phosphors. The LEDs, in addition, provide a blue fill-in to enrich output radiation and to tune the chromaticity point inside the white region. The LD power, on the other hand, can be scaled up to generate very high brightness levels that are not achievable with pumping from LEDs alone. This capability is gained using a special transparent ceramic disk that carries the remote phosphor film. We also show that the radiation from our lamp is free from speckle-producing coherence.

Antibody response to receptor-binding domain of SARS-CoV-2 spike protein following vaccination and natural infection with SARS-CoV-2

Background and objectives: Antibody to SARS-CoV-2 develops both after natural infection with SARS-CoV-2 and vaccination. This study was undertaken to determine the antibody response to SARS-CoV-2 among population after natural SARS-CoV-2 infection and vaccination. Material and methods: The study was carried out on adults aged 18 years and above. Study population consisted of four groups. Group-1 (control): healthy and history of no prior SARS-CoV-2 infection and vaccination, Group-2: had past SARS-CoV-2 infection and no vaccination, Group-3: received two doses of recombinant adenoviral vector vaccine ChAdOx1 (Oxford–AstraZeneca) without past SARS-CoV-2 infection, and Group-4: had past SARS-CoV-2 infection and received 2 doses of ChAdOx1 vaccination. Blood was collected 1 and 7 months after the second dose of vaccination from Group-3 and 4 individuals. Single blood sample was collected from participants of Gr-1 and 2 at the time of enrolment. Immunoglobulin G (IgG) antibodies to receptor-binding domain (RBD) of SARS-CoV-2 spike protein S1 (anti-RBDS1 IgG) was determined in serum by ELISA method. Results: Total 176 participants aged 18 years and above were enrolled. Anti-RBDS1 IgG positivity rates were 51.9%, 66.7%, 96.8% and 100% in individuals of Group-1, 2, 3 and 4 respectively. Gr-4 had significantly (p < 0.05) mean higher anti-RBDS1 IgG antibody level (120.8 ± 31.9 DU/ml) compared to other groups 1 month after 2nd dose of vaccination. No significant differences in antibody response were found among the individuals of four groups across gender and comorbidities. Seven months after the 2nd dose of vaccines, the antibody concentration declined in 85.3% (112.1 ± 30.4 DU/ml to 75.9 ± 48.7 DU/ml) and 81.5% (127.3 ± 20.4 DU/ml to 92.5 ± 43.6 DU/ml) individuals of Group-3 and Group-4 respectively. Decline of antibody was 40.6% and 34.7% in 7 months, but all remained positive except 1 in Group-3. Fever (34.4%) and headache (24.8%) were the most common adverse effects noted after vaccination. Conclusion: The study revealed that ChAdOx1 nCoV-19 vaccine induces high concentration of persisting anti-RBDS1 IgG antibody after 2nd dose and previous infection with SARS-CoV-2 acts as immune priming. Therefore, antibody screening test prior to booster dose could be a good option to maximize coverage of vaccination. IMC J Med Sci. 2023; 17(1): 009. DOI: https://doi.org/10.55010/imcjms.17.009 *Correspondence: J. Ashraful Haq, Department of Microbiology, Ibrahim Medical College, 1/A Ibrahim Sarani, Segunbagicha, Dhaka, Bangladesh. Email: jahaq54@yahoo.com

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Asymptomatic Helicobacter pylori infection among rural children and adolescents in Bangladesh

Background and objectives: The Helicobacter pylori infection rate varies according to the age, location of the residence and socioeconomic status. The aim of the present study was to investigate the status of H. pylori infection among the asymptomatic Bangladeshi rural children and adolescents. Material and methods: This cross-sectional study was carried out in a rural area under Pabna district about 150 km north-west of capital Dhaka. Asymptomatic and apparently healthy rural children and adolescents aged 6 to 18 years were enrolled in the study. A structured questionnaire was used to record the socio-demographic and clinical information. The rate of H. pylori infection was determined by the presence of H. pylori antigen in faeces and/or anti-H. pylori IgG and/or IgA antibodies in blood. H. pylori stool antigen was detected by lateral flow chromatographic immunoassay and serum anti-H. pylori IgG and IgA antibodies were estimated by ELISA method. Results: A total number of 185 asymptomatic and apparently healthy children and adolescents were enrolled of which 34, 131 and 20 were in 6-10, 11-15 and 16-18 years age groups respectively. The overall H. pylori infection rate was 79.5% (95% CI: 0.729, 0.85) by positive stool antigen or by the presence of serum anti-H. pylori IgG/IgA antibodies. The rate of H. pylori infection significantly (p=0.05) increased with progress of age. H. pylori infection rate was 67.6%, 80.2% and 95% in 6-10, 11-15 and 16-18 years age groups respectively. The concentration of serum anti-H. pylori IgG/IgA antibodies did not differ across the age groups. The infection rate was significantly (p<0.05) higher among the children of illiterate parents compared to the children of literate parents. Conclusion: The study demonstrated a high prevalence of H. pylori infection among children and adolescents in a rural setting. Gender and family history did not affect H. pylori prevalence but increasing age and poor educational status of parents were associated with a higher H. pylori prevalence. IMC J Med Sci 2022; 16(2): 007. DOI: https://doi.org/10.55010/imcjms.16.017 *Correspondence: J. Ashraful Haq, Department of Microbiology, Ibrahim Medical College, 1/A, Ibrahim Sarani, Segunbagicha, Dhaka 1000, Bangladesh. Email: jahaq54@yahoo.com

Engineering a DNA origami mediated multicolour quantum dot platform for sub-diffraction spectral separation imaging

The validation of super-resolution optical imaging techniques requires well-defined reference samples that can be used repeatedly and reliably as model standards. Here, we engineer a DNA origami scaffold-mediated multicolour quantum dot hybrid nanostructure and test it using a recently proposed Quantum Dot-based spectral separation technique. We show that multivalent DNA structures offer a robust and precise nanoscale quantum dot placement scaffold, while the spectral resolution method provides relatively simple and fast image acquisition capabilities using any standard confocal or fluorescence microscope capable of spectral signal separation and a single excitation laser wavelength.

The validation of super-resolution optical imaging techniques requires well-defined reference samples that can be used repeatedly and reliably as model standards.

152. Use of Antimicrobials among Suspected COVID-19 Patients at Selected 12 Hospitals in Bangladesh: Findings from the First Wave of COVID-19 Pandemic

Background

Antimicrobials are empirically used in COVID-19 patients resulting in inappropriate stewardship and increased antimicrobial resistance. Our objective was to assess antimicrobial use among suspected COVID-19 in-patients while waiting for the COVID-19 test report.

Methods

From March to August 2020, we collected data from in-patients of 12 tertiary-level hospitals across Bangladesh. We identified suspected COVID-19 patients; collected information on antimicrobial received within 24 h before and on hospitalization; and tested nasopharyngeal swab for SARS-CoV-2 using rRT-PCR. We used descriptive statistics and a regression model for data analysis.

Results

Among 1188 suspected COVID-19 patients, the median age was 34 years (IQR:2–56), 69% were male, 40% had comorbidities, 53% required oxygen, and 1% required ICU or ventilation support after admission. Antibiotics were used in 92% of patients, 47% within 24 h before, and 89% on admission. Patients also received antiviral, mostly favipiravir (1%) and antiparasitic drugs particularly ivermectin (3%). Third-generation cephalosporin use was the highest (708;60%), followed by macrolide (481;40%), and the majority (853;78%) who took antibiotics were SARS-CoV-2 negative. On admission, 77% mild and 94% moderately ill patients received antibiotics. Before admission, 3% patients had two antibiotics, and on admission, 27% received two to four classes of antibiotics at the same time. According to WHO AWaRe classification, the Watch group antibiotics were mostly used before (43%) as well as on admission (80%). Reserve group antibiotic particularly linezolid was used in 1% patients includes mild cases on admission. Antibiotic use on admission was higher among severely ill patients (AOR = 11.7;95%CI:4.5–30.1) and those who received antibiotics within 24 h before hospital admission (AOR = 1.6;95%CI:1.0–2.5).

Antimicrobials used among suspected COVID-19 patients and SARS-CoV-2 positive and negative patients 24 h before and on hospital admission at 12 selected hospitals in Bangladesh, March–August 2020

Antimicrobials used on admission among suspected COVID-19 patients according to disease severity at 12 selected hospitals in Bangladesh, March–August 2020

Conclusion

Antimicrobial use was highly prevalent among suspected COVID-19 in-patients in Bangladesh. Initiating treatment with Watch group antibiotics like third-generation cephalosporin and azithromycin among mild to moderately ill patients were common. Promoting antimicrobial stewardship with monitoring is essential to prevent blanket antibiotic use, thereby mitigating antimicrobial resistance.

Disclosures

All Authors: No reported disclosures

Use of Antimicrobials among Suspected COVID-19 Patients at Selected Hospitals, Bangladesh: Findings from the First Wave of COVID-19 Pandemic

Antimicrobials are empirically used in COVID-19 patients resulting in increased antimicrobial resistance. Our objective was to assess antimicrobial use among suspected COVID-19 in-patients. From March to August 2020, we collected data from in-patients of 12 tertiary-level hospitals across Bangladesh. We identified suspected COVID-19 patients; collected information on antimicrobial received within 24 h before and on hospitalization; tested nasopharyngeal swab for SARS-CoV-2 using rRT-PCR. We used descriptive statistics and a regression model for data analysis. Among 1188 suspected COVID-19 patients, 69% were male, 40% had comorbidities, and 53% required oxygen. Antibiotics were used in 92% of patients, 47% within 24 h before, and 89% on admission. Patients also received antiviral (1%) and antiparasitic drugs (3%). Third-generation cephalosporin use was the highest (708; 60%), followed by macrolide (481; 40%), and the majority (853; 78%) who took antibiotics were SARS-CoV-2 negative. On admission, 77% mild and 94% moderately ill patients received antibiotics. Antibiotic use on admission was higher among severely ill patients (AOR = 11.7; 95% CI: 4.5-30.1) and those who received antibiotics within 24 h before hospital admission (AOR = 1.6; 95% CI: 1.0-2.5). Antimicrobial use was highly prevalent among suspected COVID-19 in-patients in Bangladesh. Initiating treatment with third-generation cephalosporin among mild to moderately ill patients was common. Promoting antimicrobial stewardship with monitoring is essential to prevent blanket antibiotic use, thereby mitigating antimicrobial resistance.

POS0135 REDUCING IMMUNOGENICITY OF PEGLOTICASE (RECIPE) WITH CONCOMITANT USE OF MYCOPHENOLATE MOFETIL IN PATIENTS WITH REFRACTORY GOUT: A PHASE II RANDOMIZED CONTROLLED TRIAL

Background:

Pegloticase is a recombinant, pegylated uricase, used for treatment of gout patients who fail oral urate lowering therapy (ULT). Its use has been limited due to immunogenicity leading to infusion reactions.1

Objectives:

We evaluated if co-administration of an immunomodulatory agent could prolong the efficacy of pegloticase.

Methods:

Participants were recruited in a Phase II, double-blind, placebo-controlled trial over 18 months and randomized in a 3:1 ratio by site. Inclusion criteria were: a) Age ≥ 18 years who met 2015 ACR/EULAR gout classification criteria and b) chronic refractory gout defined as symptoms inadequately controlled with ULT or contraindications. After a 2-week run-in of mycophenolate mofetil (MMF) 1000 mg twice daily or matching placebo (PBO), they received a combination of pegloticase 8 mg biweekly with MMF or PBO for 12 weeks. Subsequent to this MMF or PBO were discontinued but pegloticase was continued for another 12 weeks. The primary endpoint was proportion of patients who sustained a serum urate (SU) level of ≤ 6 mg/dl at 12 weeks. Secondary endpoints included 24-week durability of SU ≤ 6 mg/dl and rate of adverse events (AEs). Fisher’s exact test and Wilcoxon two-sample test were used for analyses along with Kaplan-Meier estimates and log-rank tests to compare survival curves between groups. Hypothesis tests were two-tailed and p-value (p) < 0.05 indicated statistical significance.

Results:

Of 42 subjects screened, 35 were randomized, and 32 who received at least one dose of pegloticase were included in modified intention to treat analyses. Subjects were predominantly men (88%), mean age of 55.2 years (SD=9.7). Mean duration of gout was 13.4 years (SD=9.0), mean baseline sUA was 9.2 mg/dL (SD=1.6). Tophi were present in 88% and majority were on optimized ULT - 59% on allopurinol and 16% on febuxostat, with 63% reporting > 1 flare in the past year. At baseline both arms (MMF vs. PBO) had similar comorbidities – (82% vs 70%), diabetes mellitus/metabolic syndrome (14% vs 20%), coronary artery disease/peripheral vascular disease (41% vs.70%), BMI>30 (86% vs. 90%) and renal insufficiency (defined as eGFR < 90 mL/min; 73% vs. 70%). At 12 weeks, 19 of 22 (86%) in the MMF arm achieved SU ≤ 6 mg/dl compared to 4 of 10 (40%) in PBO arm (p-value = 0.01). At 24 weeks, the SU was ≤ 6 mg/dl in 68% of MMF arm vs. 30% in PBO (p-value = 0.06), and rates of AEs per month were similar between groups with the PBO arm having more infusion reactions (30% vs. 0%). The MMF arm had higher AEs compared to placebo: musculoskeletal (41% vs. 10%), gastrointestinal (18% vs. 10%), and infections (9% vs. 0%). Figure 1 shows that the percentage of subjects maintaining a sUA < 6 mg/dL at 12 weeks was significantly higher (p=0.02) in the MMF arm, and a significant difference (p=0.03) at 24 weeks indicates sustained benefit from MMF.

Conclusion:

To our knowledge this is the first randomized-controlled proof of concept trial to demonstrate the ability of an immunomodulatory agent in prolonging the efficacy of pegloticase. Short-term concomitant use of MMF therapy with pegloticase was well tolerated and showed a clinically meaningful improvement in the targeted SU ≤6 mg/dL at 12 and 24 weeks. This study suggests an innovative approach to utilize pegloticase therapy in patients with chronic gout.

References:

[1]Sundy et al. Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA. 2011;306(7):711-20.

Figure 1.

Proportion of subjects maintaining serum urate (SU) ≤ 6 mg/dL over 24 week study period in mycophenolate mofetil + pegloticase vs. placebo + pegloticase

Disclosure of Interests:

Puja Khanna Consultant of: Horizon Pharmaceuticals, Swedish Orphan Biovitrum A, Grant/research support from: Selecta, 2)DYVE, Dinesh Khanna Consultant of: Horizon Pharmaceuticals, Gary Cutter: None declared, Jeff Foster: None declared, Josh Melnick: None declared, Sara Jaafar: None declared, Stephanie Biggers: None declared, Fazlur Rahman: None declared, Hui-Chen Kuo: None declared, Michelle Feese: None declared, Kenneth Saag Consultant of: AbbVie, Inc., Bayer, Daiichi Sankyo Company LTD, Gilead Services, Inc., Horizon Pharma plc, Mallinkrodt, Radius Health, Inc., Roche/Genentech, Shanton Pharma Co., LTD, Teijin, Dyve Bioscience, LG Chem, Regeneron Pharmaceuticals., Swedish Orphan Biovitrum AB, Takeda Pharmaceuticals America, Inc.,

Helicobacter pylori infection in asymptomatic rural Bangladeshi population

Background and objectives: The prevalence of Helicobacter pylori infection differs in urban and rural population. In our country, no previous study investigated the H. pylori infection in rural population. The aim of the present study was to find out the status of H. pylori infection among the Bangladeshi asymptomatic rural adult population. Material and Methods: This cross-sectional study was carried out in a rural area located about 40 km north-east of capital Dhaka. Apparently healthy non-diabetic, pre-diabetic and diabetic adults (18 years and above) were enrolled in this study. A structured questionnaire was developed to record the socio-demographic and clinical information. H. pylori infection status was determined by the presence of anti- H. pylori IgG antibody in blood. Serum anti-H.pylori IgG antibodies were determined by immunochromatographic test (ICT) method. Results: A total number of 180 apparently healthy adult individuals were enrolled of which 112, 40 and 28 were non-diabetic, pre-diabetic and diabetic respectively. Out of 180 individuals, anti- H. pylori IgG was present in 70 (38.9%, CI: 32.1, 46.2) cases. Infection rate was 50%, 27.5% and 43.5% in 19-30, 31-50 and >50 years age group respectively. Infection rate was significantly (p< 0.05) low in 31-50 years age group compared to 19-30 and > 50 years age groups. H. pylori infection rates in male and female were 42.6% (CI: 29.2, 56.8) and 37.3% (CI: 28.9, 46.4) respectively (p=0.50). There was no significant (p>0.05) association of H. pylori infection with economic status, education level, occupation and tobacco consumption of the study population. The rate of H. pylori infection in non-diabetic, pre-diabetic and diabetic individuals were not significantly different from each other. Conclusion: The study revealed a low prevalence of H. pylori infection in rural population of Bangladesh. There was no significant association of H. pylori infection with several sociodemographic status and diabetes. Ibrahim Med. Coll. J. 2021; 15(1): 41-46

Helicobacter pylori infection in diabetes mellitus patients with peptic ulcer disease

Background and objectives: Helicobacter pylori infection is suspected to be associated with extra-gastrointestinal disorders such as diabetes mellitus (DM). It is still a subject of investigation whether H. pylori has a pathogenic role on DM or diabetic patients have an increased susceptibility to H. pylori infection. The aim of the present study was to find out the rate of H. pylori infection in individuals with and without DM. Materials and methods: The study was conducted on 72 diabetic and 19 non-diabetic adult individuals with dyspeptic symptoms attending the BIRDEM General Hospital for diagnostic endoscopy. All cases were tested for H. pylori stool antigen by rapid immunochromatographic test (ICT), urease production in biopsy samples by rapid urease test (RUT), and serum anti-H. pylori IgA and anti-CagA IgG antibodies by enzyme-linked immunosorbent assay (ELISA). Any case that had peptic ulcer/erosion and was positive for H. pylori stool antigen or rapid urease test (RUT) was defined as H. pylori positive case. Results: There was no significant (p=0.095) difference in H. pylori infection between diabetics and non-diabetics (68.1% vs 47.4%). Presence of ulcer and erosion were not significantly different among diabetics and non-diabetics. Anti-H. pylori IgA positivity rate in H. pylori positive diabetic and non-diabetic cases were 65.3% and 55.6% (p=0.575) respectively while anti-CagA IgG rate in those cases were 46.9% and 66.7% (p=0.276) respectively. Conclusion: The present study did not reveal any significant difference in H. pylori infection between individuals with and without DM having peptic ulcer/erosion. Ibrahim Med. Coll. J. 2020; 14(2): 27-32

Non-EPI-DWI for Detection, Disease Monitoring, and Clinical Decision-Making in Thyroid Eye Disease

BACKGROUND AND PURPOSE

The Clinical Activity Score is widely used to grade activity of thyroid eye disease and guide treatment decisions, but as a subjective measurement and being confined to the anterior orbit, it has limitations. Non-EPI-DWI of the extraocular muscles may offer advantages as a functional imaging technique with reduced skull base artifacts, but the correlation with the Clinical Activity Score and patient outcome is unknown. Our aim was to establish the correlation between the Clinical Activity Score and non-EPI-DWI and to describe the additional value provided by adjunctive non-EPI-DWI in making clinical decisions.

MATERIALS AND METHODS

This was a retrospective longitudinal study of 31 patients seen in a multidisciplinary thyroid eye disease clinic during 5 years who had at least 1 ophthalmic and endocrine assessment including the Clinical Activity Score and a non-EPI-DWI ADC calculation. The Spearman rank correlation coefficient was used to determine the relationship between the Clinical Activity Score and non-EPI-DWI. A patient flow chart was constructed to evaluate clinical decision-making, and receiver operating characteristics were generated.

RESULTS

From 60 non-EPI-DWI scans, 368 extraocular muscles were selected for analysis. There was a significant positive correlation between the Clinical Activity Score and ADC (r _s = 0.403; 95% CI, 0.312-0.489; P < .001). ADC values were significantly higher in the Clinical Activity Score ≥ 3 group compared with the Clinical Activity Score < 3 group (P < .001). Our patient flow chart identified a third intermediate-severity cohort in which the non-EPI-DWI was particularly useful in guiding clinical decisions.

CONCLUSIONS

The non-EPI-DWI correlated well with the Clinical Activity Score in our patients and was a useful adjunct to the Clinical Activity Score in making clinical decisions, especially in patients with intermediate activity and severity of thyroid eye disease.

Fetomaternal Outcome of Pregnancy in Women with Tetralogy of Fallot

This prospective study was done to determine fetomaternal outcomes of pregnancy in women with Tetralogy of Fallot (TOF) and carried out in two centres especially in the care of patients with adult congenital heart disease (CHD) from January 2005 to December 2009. Clinical, haemodynamic and obstetric data were reviewed for pregnant women with TOF. Ten (10) pregnant women were identified in the age range 18 to 47 years. Most of the patients were in the age group of 18 to 27 years, 34 to 36 weeks gestational age (in week) and primi gravida (60%). Right-sided aortic arch (20%) and major anomalies of pulmonary collaterals (30%) were common anomalies anatomical association. Normal vaginal delivery was the mode of delivery (70%) in the majority of the patients. Spontaneous abortions were occurred in 3(30%) patients. Primary maternal cardiac events complicating pregnancies were congestive heart failure (20%), arrhythmias and cardiovascular events (10%). Premature labor (40%) was the most common obstetric complication. Premature birth (40%), fetal demise (20%), neonatal death (10%) and cardiac anomaly at birth (10%) were the offspring complications in the study. Women with TOF can go through pregnancy with a low risk to themselves with frequent treatable complications, but there is a high incidence of miscarriage, premature births and low birth weight. An incidence of congenital anomaly in the fetus is higher than that found in the normal population.

Detection of antibodies to recombinant truncated flagellin and sonicated whole cell antigen of Burkholderia pseudomallei in acute melioidosis and in healthy Bangladeshi individuals

Background and objectives: Several types of Burkholderia pseudomallei antigens have been used to determine the antibody response in acute and asymptomatic cases. In the present study, we have detected immunoglobulin G (IgG) antibody to recombinant truncated flagellin antigen (RTFA) of B. pseudomallei in the sera of acute melioidosis cases and healthy individuals from melioidosis endemic areas of Bangladesh by indirect enzyme-linked immunosorbent assay (ELISA). In parallel, IgG antibody to sonicated whole cell antigen (SWCA) of B. pseudomallei was determined to compare with anti-RTFA antibody. Methodology: Serum samples from culture confirmed melioidosis cases and from healthy individuals aged 21 years and above residing in melioidosis endemic rural areas were included in the study. Serum IgG antibody to RTFA and SWCA of B. pseudomallei was determined by indirect ELISA. Results: Out of 8 culture confirmed acute melioidosis cases, 7 (87.5%) and 8 (100%) were positive for anti-B. pseudomallei IgG antibodies by RTFA and SWCA methods respectively. Among 361 healthy individuals, the rate of seropositivity by RTFA-ELISA was significantly less than that of SWCA-ELISA (16.1% versus 26.8%; p = 0.001). The mean optical density (OD) of RTFA-ELISA of positive cases was significantly less than that of SWCA-ELISA in both melioidosis and healthy individuals (0.79±0.11 versus 2.4±0.08, p = 0.0001; 0.67±0.01 versus 1.27±0.02, p = 0.0001). The sensitivity and specificity of RTFA-ELISA were 88.9% and 100% respectively. Conclusion: Findings of the study suggest that multiple or combination of antigens should be used to study the seroprevalence of B. pseudomallei infection in a community. Also, prospective study is necessary to find out the duration of persistence of antibodies to different antigenic components of B. pseudomallei after exposure. Ibrahim Med. Coll. J. 2020; 14(1): 47-52

Comparative evaluation of rapid Salmonella Typhi IgM/IgG and Widal test for the diagnosis of enteric fever

Background: Accurate and early diagnosis of enteric fever is a diagnostic challenge where facility for blood culture is not available. As a result, Widal test is still used widely in resource limited settings. Recently, user-friendly rapid immunochromatographic tests (ICT) have been introduced for quick diagnosis of enteric fever. So, we evaluated sensitivity and specificity of an immunochromatography based Salmonella Typhi IgM/IgG test kit and Widal test compared to blood culture for the diagnosis of enteric fever. Method: The study was conducted in the Department of Microbiology, Ibrahim Medical College (IMC) and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from June 2017 to September 2017. Clinically suspected enteric fever cases were included. Blood culture, Widal and Salmonella Typhi IgM/IgG detecting ICT were employed for the diagnosis of enteric fever. Results: Out of 71 suspected cases of enteric fever, blood culture was positive in 36 cases (50.7%) while 42 (59.15%) and 35 (49.29%) cases were positive by Widal test and ICT respectively. Widal and ICT had sensitivity and specificity of 100% and 89.9% and 82.9% & 91.4% respectively. Conclusion: Findings of the study suggest that both Widal and immunochromatographic tests can be used interchangeably for rapid diagnosis of enteric fever. Ibrahim Med. Coll. J. 2020; 14(1): 18-25

Helicobacter pylori CagA seropositivity in adult Bangladeshi patients with peptic ulcer and erosion

Background: CagA IgG antibody in sera might indicate presence of virulent Helicobacter pylori in patients with peptic ulcer disease. Present study was performed to find out the prevalence of CagA IgG antibody in patients with peptic ulcer/erosion. Methods: Any case that had peptic ulcer/erosion, plus positive for rapid urease test (RUT) or H. pylori stool antigen (HpSAg) or serum anti-H. pylori IgG/IgA were included in the study and named as H. pylori positive case. H. pylori positive cases were tested for CagA IgG antibody. Anti-H. pylori IgG, IgA and CagA IgG antibodies were determined by enzyme-linked immunosorbent assay (ELISA) and stool antigen by rapid immunochromatographic test (ICT). Urease production in biopsy sample was detected by RUT. Results: Total 86 H. pylori positive patients were included in the study. Out of 86 patients, CagA IgG was positive in 34 (39.5%; 95% CI: 0.30,0.50) cases. CagA seropositivity rate in ulcer and erosion cases were 58.8% (95% CI: 0.36,0.78) and 34.8% (95% CI: 0.25,0.47) respectively. H. pylori stool antigen and IgA antibodies were positive in all (100%) CagA antibody positive ulcer cases while the rates were significantly less among the CagA antibody negative cases (42.8% and 28.6%; p<0.05). However, in CagA antibody positive erosion cases, the rates were not significantly different from CagA antibody negative cases. Conclusion: The study has demonstrated that the CagA positive strain is less prevalent in erosion than ulcer cases. Ibrahim Med. Coll. J. 2020; 14(1): 36-40

Electrically Activated UV-A Filters Based on Electrochromic MoO3-x

Chromism-based optical filters is a niche field of research, due to there being only a handful of electrochromic materials. Typically, electrochromic transition metal oxides such as MoO₃ and WO₃ are utilized in applications such as smart windows and electrochromic devices (ECD). Herein, we report MoO_3-x-based electrically activated ultraviolet (UV) filters. The MoO_3-x grown on indium tin oxide (ITO) substrate is mechanically assembled onto an electrically activated proton exchange membrane. Reversible H⁺ injection/extraction in MoO_3-x is employed to switch the optical transmittance, enabling an electrically activated optical filter. The devices exhibit broadband transmission modulation (325-800 nm), with a peak of ∼60% in the UV-A range (350-392 nm). Comparable switching times of 8 s and a coloration efficiency of up to 116 cm² C^-1 are achieved.

Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI

AIM

To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden.

MATERIALS AND METHODS

A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression.

RESULTS

One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan.

CONCLUSIONS

Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.

Detection of Vascular Changes in Systemic Lupus Erythematosus by Carotid Duplex Study in A Tertiary Cardiac Hospital

Systemic lupus erythematosus (SLE) is a common autoimmune connective tissue disorder and mainly affected female patients. This cross sectional study was performed in the department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2008 to June 2012. A total fifty (50) SLE patients were diagnosed on the basis of ACR criteria, having no cardiovascular symptoms. Another 50 age-matched normal individuals were included to compare with SLE group. Congenital vascular disease, ischaemic heart disease, congenital heart disease, rheumatic heart disease, hypothyroidism and any other inflammatory disease along with SLE were excluded from study. All patients were evaluated by Carotid duplex study. Mean age of SLE was 26.70±7.3 and mean age of normal subject was 25.64±8.01. Most of the SLE patients were female (about 92%) and male (about 8%). And about 94% was female in normal group and 6% was male. In Right common carotid arteries (RCCA), mean Intema medial thickness (IMT) was 0.86±0.10 IN SLE group and 0.73±0.06 in normal group. In LCCA, mean IMT was 0.89±0.14 in SLE group and 0.76±0.10 in normal group. IMT in SLE group was increased than control group. There was a significant difference (p=0.001) in both right and left side. The percentage rate of change in PSV and EDV of Carotid arteries of the SLE group was significantly higher than the control group (Both left and right side p=0.001). In RCCA, the PSV was 91.72±19.46 in SLE group and 62.60±6.66 in normal group (p=0.001). And EDV was 27.02±8.23 in SLE group and 16.48±2.32 in normal group (p=0.001). In LCCA, the PSV was 82.06±22.28 in SLE group and 60.36±7.54 in normal group (p=0.001). And EDV was 27.82±6.61 in SLE group and 18.08±2.69 in normal group (p=0.001). In LICA, mean PSV was 83.46±23.54 in SLE group and 60.36±7.54 in normal group (p=0.001). And EDV was 29.36±8.56 in SLE group and 18.08±2.69 in normal group (p=0.001). In RICA, mean PSV was 61.56±7.66 in SLE group and 62.16±5.35 in normal group (p=0.651) which was not significant. And EDV was 26.36±2.26 in SLE group and 19.00±2.17 in normal group (p=0.001). But majority of the vessels showed significant P value which signifies that vascular changes were more evident in SLE group than normal control group. SLE patients with carotid artery blood flow velocity and structural changes in endothelial function changes more evident than control group. Compared with the normal control group, IMT, PSV and EDV were significantly higher in SLE group, the difference was statistically significant (P<0.05). Vascular changes are common in SLE when clinically asymptomatic. Carotid duplex study is a non invasive tool for early detection of vascular changes to prevent stroke in SLE patients.

Successful Multi-vessel Percutaneous Coronary Intervention for Recent Myocardial Infarction in a Patient with Dextrocardia and Situs Inversus

Dextrocardia with situs inversus is a state which is characterized by abnormal positioning of the heart and other internal organs. It is a rare congenital anomaly and the exact cause is not known. More than 60 recognized genes are significant for the proper positioning and patterning of the organs in the body. However, a specific genetic cause of dextrocardia with situs inversus has not been identified and inheritance prototypes have not been established in the majority cases. There are partial available case reports of successful percutaneous coronary intervention (PCI) in these patients who have atherosclerotic coronary artery disease, especially when presenting with myocardial infarction. PCI is technically difficult because of dextrocardia. We hereby describe a 51-year-old male, who had a recent inferior wall myocardial infarction and underwent successful coronary angiography and PCI at a tertiary level hospital in Dhaka, Bangladesh.

Dual Selective Gas Sensing Characteristics of 2D α-MoO3-x via a Facile Transfer Process

Metal oxide-based gas sensor technology is promising due to their practical applications in toxic and hazardous gas detection. Orthorhombic α-MoO₃ is a planar metal oxide with a unique layered structure, which can be obtained in a two-dimensional (2D) form. In the 2D form, the larger surface area-to-volume ratio of the material facilitates significantly higher interaction with gas molecules while exhibiting exceptional transport properties. The presence of oxygen vacancies results in nonstoichiometric MoO₃ (MoO_3-x), which further enhances the charge carrier mobility. Here, we study dual gas sensing characteristics and mechanism of 2D α-MoO_3-x. Herein, conductometric dual gas sensors based on chemical vapor deposited 2D α-MoO_3-x are developed and demonstrated. A facile transfer process is established to integrate the material into any arbitrary substrate. The sensors show high selectivity toward NO₂ and H₂S gases with response and recovery rates of 295.0 and 276.0 kΩ/s toward NO₂ and 28.5 and 48.0 kΩ/s toward H₂S, respectively. These gas sensors also show excellent cyclic endurance with a variation in ΔR ∼ 112 ± 1.64 and 19.5 ± 1.13 MΩ for NO₂ and H₂S, respectively. As such, this work presents the viability of planar 2D α-MoO_3-x as a dual selective gas sensor.

Red Cell Alloantibodies in Thalassaemia Patients Who Received Ten or More Units of Transfusion

Thalassaemia patients are the highest consumers of blood. Recurrent exposure to allogenic red cell antigen puts this population at increased risk of alloimmunization. This causes delayed hemolytic transfusion reactions. So transfusion requirement increases. But no data regarding alloimmunization was available in Bangladesh. Aim of this study was to estimate the prevalence of alloimmunization and to find out the potential factors associated with its development. This analytical cross sectional study was done by enrolling 97 patients, received at least 10 units transfusions, through convenient sampling. Indirect and direct antiglobulin tests were done to detect immunization by spin tube technique keeping an autocontrol and carried out in the Department of Haematology & Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2016 to March 2017. Polyclonal anti-AHG reagent was used. A total 21 patients developed alloimmunization (21.6%) and 4 patients (4.1%) developed autoimmunization. Age, gender, splenectomy and number of transfusion are shown significant risk factors for alloimmunization. Data from this study demonstrate that the RBC alloimmunization is significantly high in our country. So, pretransfusion antibody screening needs to be initiated in order to ensure safe transfusion and RBC phenotyping should be started before starting first transfusion to prevent alloimmunization.

Reversible resistive switching behaviour in CVD grown, large area MoOx

Non-volatile resistive memory devices are theorized to be the most promising pathway towards analog memory and neuromorphic computing. Two-dimensional MoO3 is a versatile planar transition metal oxide, whose properties can be readily tuned, making it anywhere from a wide bandgap semiconductor to a semi-metal. Successful integration of such a planar metal oxide into resistive memory can enable adaptive and low power memory applications. Here, we investigate the non-volatile and reversible resistive switching behaviour of oxygen deficient MoOx in a cross-point metal/insulator/metal (MIM) architecture. Layered MoOx films are synthesised using chemical vapour deposition (CVD) and reveal excellent resistive switching performance with relatively low electroforming and operating voltages. Switching ratios of ∼103 and stable data retention of >104 s are achieved. As such, this work demonstrates the viability of MoOx as a resistive memory element and paves the way for future two-dimensional resistive memory technologies.

Randomised clinical trial: 2% taurolidine versus 0.9% saline locking in patients on home parenteral nutrition

BACKGROUND

The catheter lock solutions 2% taurolidine and 0.9% saline are both used to prevent catheter-related bloodstream infections (CRBSIs) in home parenteral nutrition patients.

AIMS

To compare the effectiveness and safety of taurolidine and saline.

METHODS

This multicentre double-blinded trial randomly assigned home parenteral nutrition patients to use either 2% taurolidine or 0.9% saline for 1 year. Patients were stratified in a new catheter group and a pre-existing catheter group. Primary outcome was the rate of CRBSIs/1000 catheter days in the new catheter group and pre-existing catheter group, separately.

RESULTS

We randomised 105 patients, of which 102 were analysed as modified intention-to-treat population. In the new catheter group, rates of CRBSIs/1000 catheter days were 0.29 and 1.49 in the taurolidine and saline arm respectively (relative risk, 0.20; 95% CI, 0.04-0.71; P = 0.009). In the pre-existing catheter group, rates of CRBSIs/1000 catheter days were 0.39 and 1.32 in the taurolidine and saline arm respectively (relative risk, 0.30; 95% CI, 0.03-1.82; P = 0.25). Excluding one outlier patient in the taurolidine arm, mean costs per patient were $1865 for taurolidine and $4454 for saline (P = 0.03). Drug-related adverse events were rare and generally mild.

CONCLUSIONS

In the new catheter group, taurolidine showed a clear decrease in CRBSI rate. In the pre-existing catheter group, no superiority of taurolidine could be demonstrated, most likely due to underpowering. Overall, taurolidine reduced the risk for CRBSIs by more than four times. Given its favourable safety and cost profile, taurolidine locking should be considered as an additional strategy to prevent CRBSIs.

TRIAL REGISTRATION

Clinicaltrials.gov, identifier: NCT01826526.

Clinical Profile and Outcome of Peripartum Cardiomyopathy - A Study in a Tertiary Cardiac Hospital of Bangladesh

This study was done to evaluate the clinical profile, management and to analysis of pregnancy outcomes of peripartum cardiomyopathy pregnant women. Follow up was done after treatment and to see the prognosis. All patients admitted with peripartum cardiomyopathy from July 2009 to June 2014 in the department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh were considered for this observational study. Seventy two (72) women were evaluated. Primi-paras are 28 (39%) of the total study population. Fifty two patients (72%) were clinically improved and in 35 (48% ) the left ventricular functional status returned to normal with the treatment of Diuretics, selective Beta-blocker, Angiotensin converting enzyme inhibitor(ACEI) or Angiotensin receptor blocker (ARB) and vitamin B complex. Eleven cases (15%) developed persistent cardiomyopathy that is persistent left ventricular dysfunction beyond six months of presentation. Ten women (14%) presented with thromboembolic events and anti coagulant were prescribed for life long for secondary prevention. Maternal mortality was 8 (13%). Among all live births four had intra uterine growth retardation and another three had died during the neonatal period. The patients of peripartum cardiomyopathy were improved symptomatically and prognosis was good with the treatment of diuretic, selective beta-blocker, ACEI or ARB and vitamin B complex. Regular clinical follow up with echocardiography and monitoring of INR if the patients are in Anticoagulant are advised to reduce the morbidity and mortality.

Community pharmacist perceptions of their role and the use of social media and mobile health applications as tools in public health

BACKGROUND

A number of barriers prevent community pharmacists (CPs) from impacting public health (PH) outcomes. Social media (SM) and mobile health apps (MH apps) may offer ways to help the public make positive health decisions.

OBJECTIVES

To evaluate CP perceptions of their role in PH and the use of SM and MH apps in this regard.

METHODS

This was a mixed method study using a cross-sectional survey and follow-up interviews. The survey covered: CPs role in PH; CP use of SM; CP use of MH apps; non-identifiable demographic information. Following ethical approval and piloting, responses were collected on paper and online. The study population was CPs in Greater London, UK (n = 2931). A minimum sample size of 340 was calculated (95% confidence interval/5% margin of error). To achieve this, 596 surveys were distributed. Responses (n = 257) were analysed using descriptive statistics. Twenty-five respondents were willing to take part in follow-up one-to-one interviews. Twenty interviews were completed as data saturation was achieved after the 14th. Interviews were transcribed and analysed using framework methodology as described by Ritchie and Spencer in 1994.

RESULTS

Survey response rate was 43%. Respondents represented English CPs in terms of age but males and non-whites were over-represented. The majority of CPs accessed SM and MH apps for personal use but did not recommend these in a professional capacity due to lack of awareness and confidentiality/liability concerns. Most would promote an SM health page (78.6%) or MH app (83.7%) if maintained by healthcare professionals (HCPs). Under 35s were more positive about these tools in PH. Two interview themes emerged: The role of CPs in PH; Concerns and opportunities for the use of technology in PH.

CONCLUSIONS

Most CPs, particularly those under 30, were positive about the use of SM and MH apps in PH. Training on the use of such tools among the pharmacy team, and an awareness of the availability of evidence-based apps will ensure their wider adoption.

Psychiatric Morbidities among Male Juvenile Offenders: A Cross Sectional Comparison in Bangladesh

Inmates of Juvenile Developmental Centers are the special group of youth population who are in conflict with law and are vulnerable to psychiatric disorders. It was aimed to see the variation of prevalence and type of psychiatric disorders in institutionalized male juvenile offenders and non-offenders of same age, sex and socioeconomic group in the community. The association of mental disorders was examined in 138 male inmates of Juvenile Development Centers and 138 randomly selected comparison subjects in community. One stage-structured assessment of psychopathology was carried out by using a structured and valid Bangla version of the Development and Well-Being Assessment (DAWBA). Psychiatric diagnosis was established after scoring from DAWBA that is actually corresponds to diagnosis of ICD-10 for research. It was revealed that, of those who were in conflict with law, 57.2% had mental disorder, whereas 9.4% of non-offenders had psychiatric disorder. Among the offenders with psychiatric disorders, most of them (16.7%) suffered from Conduct Disorder (CD), followed by Major Depressive Disorder (MDD). On the other hand, among the non-offenders with psychiatric disorder 2.2% suffered from CD. Study revealed that psychiatric disorders are more prevalent among the male juvenile offenders with comparison to non-offenders. Broad-based multi centered and cross cultural replication study can generalize the findings.

Seroprevalence of Leptospira infection in selected rural and urban areas of Bangladesh by rLipL32 based ELISA

Background and objectives: Leptospirosis is a zoonotic infection with worldwide distribution caused by the Leptospira species and predominant in the tropical and subtropical regions. Information on leptospirosis in Bangladesh is limited. The present study was designed to detect anti-leptospiral antibodies in human serum samples in Bangladeshi population by developing an in-house ELISA using recombinant LipL32 (rLipL32) antigen. The study was conducted from April 2014 to December 2014.Method: Healthy individuals from two rural areas and fever cases from one urban healthcare center were enrolled in the study. Rural health centers were located at Sonargoan and Bajitpur sub-district (Upozilla) of Narayaganj and Kishorganj districts. Sonargoan health center is located 26 km south-east and Bajitpur is located 71 km north-east of Dhaka city. About 1-2 ml of blood was collected with aseptic measure and serum was separated and stored at -200C until used. Anti-leptospiral IgG antibody was determined by recombinant LipL32 (rLipL32) antigen based indirect enzyme linked immunosorbent assay (ELISA). Seropositive cases were further confirmed by commercial Leptospira IgG ELISA.Results: The study included 250 febrile cases and 376 healthy individuals from urban and rural areas, respectively. Out of total 626 study population, anti-LipL32 specific IgG antibody was detected in 70 individuals (11.2%). The rate of positivity of anti-LipL32 antibody among the healthy individuals from rural area was 10.6% while the rate was 12.0% in urban febrile population. The rate of positivity in rural and urban population was not significantly (p>0.05) different. Among the urban population, the rate of seropositivity was 9.1% and 16.4% in 21- 40 yrs and above 40 years age group respectively while the rate was 7.2% and 14.0% in rural population respectively. Out of 70 seropositive cases detected by LipL32 ELISA, 65 (92.9%) were positive by commercial ELISA.Conclusion: The present study has revealed that leptospirosis is prevalent in Bangladesh and should be looked for in febrile and clinically suspected cases. The study has also demonstrated that rLipL32 protein may be used as a candidate antigen for the serodiagnosis of leptospirosis.IMC J Med Sci 2017; 11(2): 50-55

Impact of Adrenocortical Insufficiency on Clinical Parameters in Haemodynamically Stable Cirrhotic Patients with Ascites

Cirrhosis has many complications regardless of the aetiology. Complications include splenomegaly, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome and hepatocellular carcinoma and also linked to abnormalities in the endocrine system, including abnormal sex hormone metabolism, thyroid disease, osteoporosis, and, most recently identified, adrenal insufficiency. This prospective cohort study was done to evaluate the impact of adrenocortical insufficiency on clinical parameters in haemodynamically stable cirrhotic patients with ascites and had been performed at the inpatient of GHPD Department, BIRDEM, Dhaka, Bangladesh from April 2011 to March 2012. A total of fifty three (53) patients fulfilling inclusion criteria were included in the study. Patients were divided into two groups: Group A (patients of normal adrenal function) and Group B (patients of insufficient adrenal function) and those were followed up for the next 6 months. In Group A, the total number of patients was 25(47%) and in Group B it was 28(53%). Between two groups, mean age difference and gender difference were not statistically significant (p value was 0.278 and 0.933, respectively). Group B patients had significant higher CLD duration (p=0.004). Haematemesis and/or maelena was significantly lower in Group B at follow up (p=0.0001) due to significant higher number of band ligation in this group (p=0.009). Hepatic encephalopathy was significantly higher in Group B at enrollment (p=0.028) and at follow up (p<0.001). During the period of follow up, significant higher number of patients had developed hepatic encephalopathy in Group B compared to Group A (p<0.05). There was statistically significant higher number of patients had SBP (p=0.031) in Group B at follow up. During the period of follow up, only 1(4%) patient in Group A and 5(18%) patients in Group B died. There was no significant difference of number of death between two groups (p=0.196). Adrenal insufficient decompensated cirrhotic patients have higher morbidities.