Application of machine learning and multivariate approaches for assessing microplastic pollution and its associated risks in the urban outdoor environment of Bangladesh

Microplastics (MPs) are an emerging global concern due to severe toxicological risks for ecosystems and public health. Therefore, this is the first study in Bangladesh to assess MP pollution and its associated risks for ecosystems and human health in the outdoor urban environment using machine learning and multivariate approaches. The occurrences of MPs in the urban road dust were 52.76 ± 20.24 particles/g with high diversity, where fiber shape (77%), 0.1-0.5 mm size MPs (75%), blue color (26%), and low-density polyethylene (24%) polymer was the dominating MPs category. Pollution load index value (1.28-4.42), showed severe pollution by MPs. Additionally, the contamination factor (1.00-5.02), and Nemerow pollution index (1.38-5.02), indicate moderate to severe MP pollution. The identified polymers based on calculated potential ecological risk (2248.52 ± 1792.79) and polymer hazard index (814.04 ± 346.15) showed very high and high risks, respectively. The occurrences of MPs could effectively be predicted by random forest, and support random vector machine, where EC, salinity, pH, OC, and texture classes were the influencing parameters. Considering the human health aspect, children and adults could be acutely exposed to 19259.68 and 5777.90 MP particles/ year via oral ingestion. Monte-Carlo-based polymers associated cancer risk assessment results indicate moderate risk and high risk for adults and children, respectively, where children were more vulnerable than adults for MP pollution risks. Overall assessment mentioned that Dhaka was the most polluted division among the other divisions.

The effect of social media entrepreneurship on sustainable development: Evidence from online clothing shops in Bangladesh

The study examines the effect of rural women's participation in social media entrepreneurship on sustainable development in Bangladesh. The study collects 376 responses from the entrepreneurs of online clothing shops employing the simple random sampling technique. The data analysis was conducted using the PLS-SEM technique using Smart PLS 3.3v software. Developing the quantitative research design, the authors test the conceptual model by employing the deductive approach. The study finds a positive effect of women's participation in social media entrepreneurship on sustainable development within online clothing shops in Bangladesh. Bangladesh is capable of creating employment opportunities for rural women through ICT project offerings. Consistently this study also proves social media entrepreneurship increases women's contribution to their family income. Furthermore, this study finds that rural women's family income contribution positively affects sustainable development in Bangladesh. The study can help to achieve SDG 5: Gender Equality and Vision 2041 of Bangladesh at the earliest. Thus, the government, policymakers, and academics can use the study findings as a policy dialogue.

Determinants of eco-innovation initiatives toward sustainability in manufacturing SMEs: Evidence from Bangladesh

This study identifies the key factors accelerating the eco-innovation initiatives of manufacturing Small & Medium Enterprises (SMEs) in Bangladesh. The study further attempted to measure the impact of eco-innovation on a firm's economic, environmental, and societal performance, broadly called sustainability. Following the convenience sampling technique, data was collected from 876 respondents through a structured questionnaire considering the 7-point Likert scale. The Structural Equation Model (PLS-SEM) has been employed using Smart PLS v3.3 software to simultaneously show the constructs' relationships. Moreover, the study incorporated several tests to check the reliability and validity of the data. Furthermore, the degree to which data collected for this study fits well with the model has been tested by calculating model fit indices- NFI and SRMR. The findings reveal that all other factors Technological Capabilities (TC), Environmental Regulations (ER), Green products (GP), Competitive Pressure (CP), and Energy Price (EP) has a significant positive association with the firm's Eco-innovation initiatives except FR. Moreover, Eco-innovation (EI) greatly enhances the two domains of Sustainability- Environmental Performance (EnP) and Societal Performance (SoP) in manufacturing SMEs in Bangladesh. However, the relationship between EI and EcP was found to be insignificant. Apart from Economic Performance (EcP) andEnvironmental Performance(EnP), Societal Performance (SoP) as a sustainability domain remains unattended in the prior study, which has been incorporated in this research. Thus, the findings of this study will provide some unique implications for business managers and policymakers.

Prescription Pattern of Glucose-lowering Drugs in Patients with Controlled Type 2 Diabetes Mellitus Attending Dhaka Medical College Hospital

The increasing number of patients with diabetes mellitus imposes an enormous burden on both the healthcare authorities and healthcare providers. The study's objective was to explore the prescription pattern of glucose-lowering drugs for patients with controlled type 2 Diabetes Mellitus (T2DM) attending a tertiary hospital in Bangladesh. This cross-sectional study was conducted at the Endocrinology Outpatient Department of Dhaka Medical College Hospital, Dhaka, Bangladesh, for one year (February 2017 to January 2018). A total of 120 patients aged >12 years with T2DM were included in the study. Prescription analysis and demographic data were collected and recorded in the pre-designed case record form. Among the 120 prescriptions, the number of drugs prescribed per encounter ranged from 1 to 4. Oral drugs were prescribed most frequently (n=88, 73.3%), followed by different preparations of insulin; both (oral and insulin) were prescribed in 13.3% (n=16) of cases. Single drugs were used in 76.7% (n=92) of patients, whereas combined fixed-dose formulation and both types of formulation (single drug and combined fixed dose) were used in 17.5% and 5.8%, respectively. Of all, Metformin was the single most common (67.5%; n=81) drug prescribed by the physicians, followed by Gliclazide (n=19, 15.84%), Glibenclamide (n=14, 11.67%), and short-acting insulin (n=14, 11.67%). Besides, the overall drug use pattern in prescription showed most frequently used drugs were Metformin + Sulphonylureas (21.7%), Metformin (19.2%), Metformin + DPP-4 inhibitors (14.2%), Insulins (13.3%), DPP-4 inhibitors (9.2%) and Metformin + Insulin (9.2%) with a small share of other drugs. Moreover, short-acting insulin was used more commonly (n=14, 11.67%) than other formulations of insulin: long-acting insulin (n=13, 10.83%), premixed insulin (n=12, 10%), intermediate-acting insulin (n=5, 4.16%) and ultra short-acting insulin (n=2, 1.67%).

Clinical Profile of Pediatric Cases of Dengue during the 2019 Epidemic in Bangladesh: A Multicenter Cross-Sectional Study

Bangladesh experienced the largest dengue epidemic during 2019, with more than 100,000 confirmed cases and 164 deaths. Almost one-third of these cases were children. The present study aimed to investigate the clinical and hematological manifestations of pediatric dengue cases during the epidemic. This was a multicenter cross-sectional study conducted in Dhaka Medical College Hospital, Dhaka, Dr. Sirajul Islam Medical College Hospital and Tangail Sadar Hospital, Tangail, Bangladesh between the period of June 2019 and September 2019. The study included 208 pediatric patients (age <18 years) with confirmed dengue fever. Patient's demographics, clinical and laboratory features of dengue were collected through patients' interview, clinical examination and laboratory investigations. Descriptive statistics were used to represent the patients' socio-demographic information, clinical presentations and hematological parameters. The majority of the patients were aged between 6 and 17 years with male predominance. The most commonly presented clinical manifestations were fever (100.0%), headache (59.0%), myalgia (42.0%), rash (36.0%), retro-orbital pain (28.0%) and diarrhea (24.0%). Warning signs abdominal pain (40.0%) and persistent vomiting (29.0%), bleeding manifestations such as melena (17.0%), gum bleeding (7.0%) and epistaxis (6.0%) and evidence of plasma leakage such as oliguria (3.4%), ascites (2.4%), pleural effusion (1.4%), and shock (1.0%) were also present in the patients. Raised HCT levels, leucopenia and thrombocytopenia were present in almost 23.0%, 43.0% and 28.0% of children, respectively. Warning signs and plasma leakage were present in a substantial number of patients indicating potential risk of severe dengue. Prompt diagnosis and management based on best clinical judgment might prevent severe dengue at an early stage.

Clinico-epidemiological Characteristics of Asymptomatic and Symptomatic COVID-19-Positive Patients in Bangladesh

As of August 15, 2020, Bangladesh lost 3591 lives since the first Coronavirus disease 2019 (COVID-19) case announced on March 8. The objective of the study was to report the clinical manifestation of both symptomatic and asymptomatic COVID-19-positive patients. An online-based cross-sectional survey was conducted for initial recruitment of participants with subsequent telephone interview by the three trained physicians in 237 adults with confirmed COVID-19 infection in Bangladesh. The study period was 27 April to 26th May 2020. Consent was ensured before commencing the interview. Collected data were entered in a pre-designed case record form and subsequently analyzed by SPSS 20.0. The mean±SD age at presentation was 41.59±13.73 years and most of the cases were male (73.0%). A total of 90.29% of patients reside in urban areas. Among the positive cases, 13.1% (n=31) were asymptomatic. Asymptomatic cases were significantly more common in households with 2 to 4 members (p=0.008). Both symptomatic and asymptomatic patients shared similar ages of presentation (p=0.23), gender differences (p=0.30) and co-morbidities (p=0.11). Only 5.3% of patients received ICU care during their treatment. The most frequent presentation was fever (88.3%), followed by cough (69.9%), chest pain (34.5%), body ache (31.1%), and sore throat (30.1%). Thirty-nine percent (n=92) of the patients had co-morbidities, with diabetes and hypertension being the most frequently observed. There has been an upsurge in COVID-19 cases in Bangladesh. Patients were mostly middle-aged and male. Typical presentations were fever and cough. Maintenance of social distancing and increased testing are required to meet the current public health challenge.

Prevalence and Risk Factors of Secondary Hyperparathyroidism among CKD Patients and Correlation with Different Laboratory Parameters

Hyperthyroidism is one of the major complications in CKD patients who results in a number of metabolic disorders and contributes to morbidity and mortality. The objective of the study was to investigate the prevalence and risk factors for secondary hyperparathyroidism among CKD patients as well as its correlation with different laboratory parameters. This was a cross-sectional study conducted among the admitted CKD patients of Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January 2019 to December 2019. Following recruitment, clinical parameters were extracted from the patients' medical records. Afterward, blood sample blood was collected to measure the biochemical parameters and serum parathyroid hormone levels. A binary logistic regression model was used to assess the factors associated with hyperparathyroidism. The mean±SD serum PTH in all CKD patients was 215.04±168.15 pg/ml. The overall prevalence of secondary hyperparathyroidism among CKD patients was 75.0% (32.0% in stage 3, 88.0% in stage 4 and 93.0% in stage 5 CKD). Serum PTH levels had a significant positive correlation with serum creatinine and serum phosphate levels and a significant negative correlation with serum albumin and serum calcium levels. However, only female sex was revealed as a significant risk factor in the adjusted regression model (aOR 0.26, 95% CI 0.07-0.98 for male sex compared to female sex). As the prevalence of secondary hyperparathyroidism increases in advanced stages of CKD, early detection and management of CKD are crucial to prevent metabolic disorders that could trigger the development of this complication.

Clinical Profile, Severity Spectrum, and Hospital Outcome of Dengue Patients in a Tertiary Care Hospital in Dhaka City

Background

Bangladesh saw its most severe dengue outbreak in 2019, with the highest number of deaths reported. This study investigated the clinical characteristics, severity spectrum, and potential outcomes of dengue in patients admitted to a tertiary care institution in Dhaka.

Methods

This prospective observational study was done between May 2019 to April 2020. A total of 478 nonstructural protein 1 (NS1) antigen positive confirmed dengue cases were finally enrolled. The dengue patient's stratification and severity grading were performed according to the World Health Organization (WHO) dengue guidelines, for diagnosis, treatment, prevention, and control (2009). In addition, in-hospital outcomes were assessed in terms of mortality.

Results

The patient’s mean age was 33.90±15.82 (SD) years. The male-to-female ratio was 1.23:1. In addition to fever, the most common symptoms were myalgia (67.78%) and rashes (58.58%). According to WHO classification 33.90% of patients (n=162) were in group A, 49.40% (n=236) were in group B, and 16.70% (n=80) were in group C. The overall mortality was 1.23% in groups A, 2.97% in group B, and 11.25% in group C. The mortality was higher in the more severe group with statistical significance (p<0.001). The mean hospital stay time was significantly less in the surviving group (survival vs. death: 3.07±1.78 vs. 5.61±3.13 SD {days}, p<0.001). Leukopenia and thrombocytopenia were commonly seen in all of the severity groups.

Conclusion

Dengue epidemics are increasing in Bangladesh. Many group B and C cases are fatal. To reduce mortality and morbidity, health care providers must remain alert. This challenge requires public health interventions and hospital readiness.

National TB Control Program of Bangladesh: System Failure and Loss of Effectiveness

The National Tuberculosis Control Program (NTP) is one of the largest programs run by the state with many successes. However, underreporting is considered a real flaw of the current program. To report the characteristics and outcomes of TB patients registered in an upazila health complex in Kazipur, Sirajganj district, Bangladesh between September 2018 and February 2019 under the control of NTP was the objective of the study. This retrospective cohort study was conducted using routinely collected program data from the aforementioned site. Data retrieved from the hospital record form. Formal permission was obtained from the local authority. Consent statements and ethical aspects were waived due to the retrospective nature of the study. Analysis was performed using SPSS 20.0. A total of 207 tuberculosis cases were included with an average age of presentation of 43 years. Approximately 82.0% had pulmonary tuberculosis (PTB) and the rest had extrapulmonary tuberculosis (EPTB). PTB was more common in males, whereas EPTB was common in females (p=0.01). Of all cases, 84.0% were diagnosed by a positive sputum smear and 16.0% were diagnosed clinically with a negative sputum smear. Attendance at follow-up was 82.12%, 70.04% and 68.59% at months 2, 5 and 6 following index admission respectively. Overall, the cure rate was higher in PTB than EPTB [146 (85.9%) vs. 5 (13.5%), p<0.001). The rate of treatment completion was 25.1% (n=52) and the death count was 1.4% (n=3) [PTB-1.2 (n=2) vs. EPTB-2.7% (n=1)]. A gradual decline in reporting or completion of treatment was observed in this setting. However, a nationwide study is warranted to explore this issue in detail.

Open Label Randomized Controlled Comparison of Three Alternative Regimes of Ciprofloxacin, Azithromycin and Cefixime for Treatment of Uncomplicated Typhoid Fever in Bangladesh

Multi-drug resistant Typhoid fever (resistant to previously used chloramphenicol, ampicillin, amoxicillin, and trimethoprim-sulfamethoxazole) has been commonly described in the South East Asia region and a recent report suggests that the salmonella typhi have reduced response to fluoroquinolones (nalidixic acid-resistant). The optimum treatment protocol for this type of serovar has not been established. This study compared different antimicrobial regimens for the treatment of uncomplicated typhoid fever which was conducted in the medicine ward of Dhaka Medical College Hospital (DMCH) and outdoor setting in private practice in Dhaka metropolitan city, Mymensingh and Sylhet town from January 2017 to December 2017. Bangladeshi adults with uncomplicated typhoid fever were included in this an open-label randomized controlled trial. Ciprofloxacin (20mg/kg of body weight/day for 14 days), azithromycin (20mg/kg/day for 14 days), and Cefixime (16mg/kg/day for 14 days) were compared. Of the 81 enrolled patients, 62 were eligible for analysis (61 S. enterica serovar Typhi, 1 Salmonella enterica serovar paratyphi A). Of the S enterica serovar Typhi isolates, 88.7% (55/62) were MDR and 93.5% (58/62) were nalidixic acid resistant (NAR). The clinical cure rate was 62% (13/21) with ciprofloxacin, 71% (15/21) with Cefixime, and 85% (17/20) with azithromycin (p=0.053). The mean (95% confidence interval [CI]) fever clearance time for patients treated with azithromycin (5.8 days [5.1 to 6.5 days]) was shorter than that for patients treated with cefixime (7.1 days [6.2 to 8.1 days]) and ciprofloxacin (8.2 days [7.2 to 9.2 days]) (p<0.001). All three antibiotics were well tolerated. A 7-day course of azithromycin can be successfully used in uncomplicated typhoid fever due to isolates of MDR S enterica serovar Typhi.

A real-time approach of diagnosing rice leaf disease using deep learning-based faster R-CNN framework

The rice leaves related diseases often pose threats to the sustainable production of rice affecting many farmers around the world. Early diagnosis and appropriate remedy of the rice leaf infection is crucial in facilitating healthy growth of the rice plants to ensure adequate supply and food security to the rapidly increasing population. Therefore, machine-driven disease diagnosis systems could mitigate the limitations of the conventional methods for leaf disease diagnosis techniques that is often time-consuming, inaccurate, and expensive. Nowadays, computer-assisted rice leaf disease diagnosis systems are becoming very popular. However, several limitations ranging from strong image backgrounds, vague symptoms' edge, dissimilarity in the image capturing weather, lack of real field rice leaf image data, variation in symptoms from the same infection, multiple infections producing similar symptoms, and lack of efficient real-time system mar the efficacy of the system and its usage. To mitigate the aforesaid problems, a faster region-based convolutional neural network (Faster R-CNN) was employed for the real-time detection of rice leaf diseases in the present research. The Faster R-CNN algorithm introduces advanced RPN architecture that addresses the object location very precisely to generate candidate regions. The robustness of the Faster R-CNN model is enhanced by training the model with publicly available online and own real-field rice leaf datasets. The proposed deep-learning-based approach was observed to be effective in the automatic diagnosis of three discriminative rice leaf diseases including rice blast, brown spot, and hispa with an accuracy of 98.09%, 98.85%, and 99.17% respectively. Moreover, the model was able to identify a healthy rice leaf with an accuracy of 99.25%. The results obtained herein demonstrated that the Faster R-CNN model offers a high-performing rice leaf infection identification system that could diagnose the most common rice diseases more precisely in real-time.

Knowledge of Stroke and its Risk Factors among Stroke Survivors: A Hospital Based Study

Significant variations observed in stroke incidence, risk factors and sufferings between high & resource poor countries. Considering lack of study in our country perspective, the study was designed to assess the knowledge of stroke and its risk factors among stroke survivors in Bangladeshi population. This hospital based cross-sectional study was conducted at the Department of Medicine and Department of Neurology in Uttara Adhunik Medical College & Hospital (UAMCH), Dhaka, Bangladesh. Patients aged >18 years who were admitted with stroke (Ischemic and hemorrhagic) were included in the study. Before enrollment informed consent was ensured. Total 50 patients were interviewed and assessed. Separate case record form was used during data collection. Final analysis was done by SPSS 22.00 version software. A 'good' knowledge of stroke was defined by correct answer to ≥4 out of 7 questions about location, cause, risk factor, warning sign, treatment, complication and prevention of stroke. Among 50 stroke survivors, mean age was 58.34±12.90 (SD) years. Male-female ratio was 1.08:1. Overall 78% patients had good knowledge of stroke. Brain was correctly identified as center of stroke by 52% stroke survivors and disturbance of blood supply to brain as a cause of stroke was recognized by 12%. Stress was the most common risk factor identified (50%). At least one warning sign was identified by 76% stroke survivors. Seventy-four percent stroke survivors knew that they have to be taken to nearest health facility and if possible, in hospital where neurological care is available. Only 4% knew about the golden hour of taking the stroke patient. On average knowledge about treatment, complication and prevention of stroke was good. Stroke knowledge was not significantly associated with demographic and socio-economic profile of stroke survivors. More than two thirds of the patients had knowledge regarding stroke and its risk factors but no uniform pattern of knowledge is noticed.

The classification of motor imagery response: an accuracy enhancement through the ensemble of random subspace k-NN

Brain-computer interface (BCI) is a viable alternative communication strategy for patients of neurological disorders as it facilitates the translation of human intent into device commands. The performance of BCIs primarily depends on the efficacy of the feature extraction and feature selection techniques, as well as the classification algorithms employed. More often than not, high dimensional feature set contains redundant features that may degrade a given classifier's performance. In the present investigation, an ensemble learning-based classification algorithm, namely random subspace k-nearest neighbour (k-NN) has been proposed to classify the motor imagery (MI) data. The common spatial pattern (CSP) has been applied to extract the features from the MI response, and the effectiveness of random forest (RF)-based feature selection algorithm has also been investigated. In order to evaluate the efficacy of the proposed method, an experimental study has been implemented using four publicly available MI dataset (BCI Competition III dataset 1 (data-1), dataset IIIA (data-2), dataset IVA (data-3) and BCI Competition IV dataset II (data-4)). It was shown that the ensemble-based random subspace k-NN approach achieved the superior classification accuracy (CA) of 99.21%, 93.19%, 93.57% and 90.32% for data-1, data-2, data-3 and data-4, respectively against other models evaluated, namely linear discriminant analysis, support vector machine, random forest, Naïve Bayes and the conventional k-NN. In comparison with other classification approaches reported in the recent studies, the proposed method enhanced the accuracy by 2.09% for data-1, 1.29% for data-2, 4.95% for data-3 and 5.71% for data-4, respectively. Moreover, it is worth highlighting that the RF feature selection technique employed in the present study was able to significantly reduce the feature dimension without compromising the overall CA. The outcome from the present study implies that the proposed method may significantly enhance the accuracy of MI data classification.

Mental Health of the COVID-19 Patients in Bangladesh

The mental health aspect of coronavirus disease-19 (COVID-19) patients in Bangladesh has remained less focused and has not been addressed properly. The objective of the study was to assess the levels of anxiety and depression in COVID-19 patients. We adopted a mixed online and telephone-based survey using Google Forms. Recruitment was performed through a snowball sampling approach. The Google Form was initially circulated in Facebook to identify interested participants. Then, three trained physicians interviewed the online responders over telephone for a period spanning from April 2020 to June 2020. Two well-known questionnaires, the Generalized Anxiety Disorder 7-item (GAD-7) scale and the Patient Health Questionnaire (PHQ-9), were used for the assessment of anxiety and depression, respectively. Here, the severity of anxiety was classified with the standard thresholds: minimal or none (0-4), mild (5-9), moderate (10-14) and severe (>15) for the GAD-7. Depression severity score: 0-4 was considered as none or no depression, 5-9: mild, 10-14: moderate, 15-19: moderately severe, 20-27 was for severe depression. A total of 237 patients were finally analyzed. The mean age ±SD of the patients was 41.59±13.73 years. Most of them were male (73%) and lived in urban areas (90.29%). Half of the patients were unemployed, and 17.7% admitted loss of job due to lockdown. The overall prevalence of anxiety and depression was 55.7% and 87.3%, respectively. The mean GAD-7 score was 5.79±4.95, and the mean PHQ-9 score was 5.64±5.15. Among the depressive patients, 3% had minimal depression, 38.4% had mild depression, 32.1% had moderate depression, 11.8% had moderate depression, and 2.1% had a severe depression. Similarly, 37.1%, 10.5% and 8% had mild, moderate and severe levels of anxiety, respectively. Nearly half of the study population (47.7%) was suffering from both depression and anxiety. Living in urban area was an independent predictor for depression (OR 3.882; CI: 1.249-12.069). Considering the high comorbid burden, the mental health issues of these patients need to be addressed and reinforced to the existing health system on a priority basis.

Morel Lavallée Lesion - A case report and review of literature

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Morel Lavallée Lesion is an elusive diagnosis & can cause a life-threatening state.

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Diagnosis of Morel Lavallée Lesion is clinical, but aided by several modalities.

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There are several treatment options for Morel Lavallée Lesion.

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Morel Lavallée Lesion should be treated when diagnosed.

Introduction

Morel-Lavallée lesion (MLL) is an uncommon entity, by which shearing forces result in a closed degloving lesion. This can result in an infected hematoma and lead to a life-threatening situation.

Presentation of case

We present a case of a 59-year-old patient who presented to our emergency department. This patient had a crushing injury, and later was found to have an infected MLL. The patient was treated with surgical drainage, and 2 split thickness skin grafts. The patient fully healed.

Discussion

We review the current literature regarding MLL and diagnostic tools in order to accurately and rapidly diagnose this often-missed entity. Special emphasis is given to the treatment of MLL, with the current knowledge as reflected in the literature.

Conclusions

It is important for caregivers to know the diagnostic steps and pitfalls of this elusive diagnosis in order to diagnose and treat MLL quickly, before it turns into a life-threatening state for the patient.

Antibacterial, anthelmintic, and analgesic activities of Piper sylvaticum (Roxb.) leaves and in silico molecular docking and PASS prediction studies of its isolated compounds

Background In the present study, we investigated the antibacterial, anthelmintic, and analgesic activities of methanol extract of P. sylvaticum leaves (MEPSL) in experimental models. Then, computational analysis (in silico molecular docking and PASS prediction) was performed to determine the potent phytoconstituents of total six isolated compounds of this plant for antibacterial and anthelmintic activities. Methods Qualitative and quantitative phytochemical studies were carried out by established methods. In vitro antibacterial activity was determined by disc diffusion technique and anthelmintic activity was tested against Tubifex tubifex worm whereas analgesic activity was determined by the acetic acid-induced writhing test in mice. Molecular docking study was performed using Schrödinger Maestro 10.1 and an online tool used for PASS prediction. Results Our phytochemical study revealed the presence of alkaloids, flavonoids, saponins, and also indicated a substantial amount of phenols (65.83 mg), flavonoids (102.56 mg), and condensed tannins (89.32 mg). MEPSL showed good antibacterial activity against both gram-positive and gram-negative bacteria. Our result exhibited that MEPSL has strong anthelmintic action compared to standard levamisole. In addition, the extract also showed a dose-dependent and statistically significant analgesic activity at the doses of 200 and 400 mg/kg, body weight. Docking studies showed that piperine and piperlonguminine have the best scores for the tested enzymes. PASS predicted the antibacterial and anthelmintic activity of both phytoconstituents. Conclusions This study suggests that MEPSL possess significant antibacterial, anthelmintic, and analgesic activities which could be related to the presence of several phytochemicals. The phytoconstituents, i.e. piperine and piperlonguminine were found to be most effective in computational studies.

Breast Cancer with Paraneoplastic Syndrome in a 72 Year Old Male Patient

Breast cancer in male is rare which accounts about 1% of all malignant breast neoplasm cases. Since paraneoplastic syndrome is unusual with male breast cancer, very few reported cases are found. A72- year-old gentleman presented with proximal myopathy in all four limbs was referred to Dr. Sirajul Islam Medical College and Hospital in April 2017. He had generalized wasting with reduced tone and reflexes. Planter responses were normal with intact sensory. There were typical Heliotrope rash bilaterally. In background, he had history of radical mastectomy due to stage IIA ductal carcinoma of left breast 7 years back. Three years later, he was found to have multiple metastases in lung and liver, however, deliberately discontinued chemotherapy after first dose. Currently he is on Tamoxifen. Two months back, he was diagnosed to have brain metastasis. Also his serum sodium level was low with low urine osmolality. Considering his background, we diagnosed him dermatomyositis with peripheal neuropathy & SIADH as paraneoplastic presentation of breast malignancy. Despite of normal CPK and NCV, we treated him with steroid as dermatomyositis can present with normal CPK. His myopathy improved after 2 weeks of steroid treatment. Fluid restriction increased his serum sodium level. The aim of reporting this case is to aware physicians about the aggressive nature of male breast cancer, its orthodox paraneoplastic presentation and to differentiate neuropathy from myopathy so that early treatment can improve the outcome.

Distribution of adeB and NDM-1 genes in multidrug resistant Acinetobacter baumannii isolated from infected wound of patients admitted in a tertiary care hospital in Bangladesh

BACKGROUND

The adeB gene in Acinetobacter baumannii regulates the bacterial internal drug efflux pump that plays a significant role in drug resistance. The aim of our study was to determine the occurrence of adeB gene in multidrug resistant and New Delhi metallo-beta-lactamase-1 (NDM- 1) gene in imipenem resistant Acinetobacter baumannii isolated from wound swab samples in a tertiary care hospital of Bangladesh.

METHODS

A total of 345 wound swab samples were tested for bacterial pathogens. Acinetobacter baumannii was identified by culture and biochemical tests. Antimicrobial susceptibility pattern was determined by the disc diffusion method according to CLSI standards. Extended spectrum beta-lactamases were screened using the double disc synergy technique. Gene encoding AdeB efflux pump and NDM-1 were detected by Polymerase Chain Reaction (PCR).

RESULTS

A total 22 (6.37%) Acinetobacter baumannii were identified from 345 wound swab samples and 20 (91%) of them were multidrug resistant. High resistance rates to some antibiotics were seen namely, cefotaxime (95%), amoxyclavulanic acid (90%) and ceftriaxone (82%). All the identified Acinetobacter baumannii were sensitive to colistin and 82% to imipenem. Two (9%) ESBL producing Acinetobacter baumannii strains were detected. adeB gene was detected in 16 (80%) out of 20 multidrug resistant Acinetobacter baumannii. 4 (18%) of 22 Acinetobacter baumannii were imipenem resistant. NDM-1 gene was detected in 2 (50%) of the imipenem resistant strains of Acinetobacter baumannii.

CONCLUSION

The results of this study provide insight into the role of adeB gene as a potential regulator of drug resistance in Acinetobacter baumanni in Bangladesh. NDM-1 gene also contributes in developing such resistance for Acinetobacter baumannii.

Outcome of Pregnancy Related Acute Kidney Injury Observed in a Tertiary Care Hospital

This prospective case control study was carried out in Mymensingh Medical College Hospital (MMCH) from April 2011 to March 2012. The main objective of the study was to determine the short term maternal outcome of pregnancy related Acute Kidney Injury and to identify aetiological factors and to observe clinical features of pregnancy related Acute Kidney Injury. Total 60 pregnant women with AKI were included in the study as sample and equal (60) number of pregnant women with normal renal function was taken as control. Mean ages (±SD) of study and control group were observed 31.6±6.9 years and 25.5±4.7 years respectively. It was observed that most patients were from rural area with low income group. Most women were multiparous and presented in third trimester and postpartum period. Majority of the study subjects did not receive antenatal care at any stage of pregnancy. Fifty (86.7%) of the study subjects were oligo-anuric, forty-nine (81.7%) were edematous and fifty one (85%) were anaemic. Twenty-five (41.7%) patients presented with abnormal vaginal bleeding. Sepsis (including septic abortion and puerperal sepsis) was responsible for of Pregnancy Related AKI (PR-AKI) in more than two fifths of cases. Haemorrhage (APH & PPH combined) was the next common cause of Pregnancy Related AKI (PR-AKI). Toxemia of Pregnancy was responsible in one fourth of cases. Dialysis (HD & IPD combined) was required for two fifths of the patients. Rest patients were treated conservatively with antibiotics, blood transfusion, maintenance of fluid and electrolytes balance etc. Maternal outcome of Pregnancy related acute kidney injury was considered for the period of patient's hospital staying. 56.6% patients recovered completely, 15.0% patients recovered partially, 6.7% did not recover at the time of hospital discharge; while 21.7% died. So it can be concluded that, pregnancy related acute kidney injury is a critical condition, associated with worse prognosis.

Myopericytoma - a unifying term or a unique entity?

Myopericytoma are uncommon, slow-growing benign perivascular neoplasms that show hemangiopericytoma-like vascular pattern. We report a 52-year-male patient with a painless palpable nodule in the left thumb for the past 9 months. The mass, on the thenar aspect, was 15x12mm in size. X-ray revealed a soft tissue swelling with no bony association. The excised nodule was a non-capsulated, well-circumscribed vascular neoplasm composed of proliferating spindle to ovoid bland cells with eosinophilic cytoplasm. A concentric perivascular arrangement of the cells was seen interspersed by thin-walled, branching, staghorn blood vessels. Nuclear atypia, mitotic figures and necrosis were not observed. Immunohistochemistry revealed diffuse positivity of the tumour cells for smooth muscle actin while staining negative for CD34 and desmin - features suggestive of origin from the perivascular myoid cell. Morphological features of myopericytoma are shared with hemangiopericytoma, glomus tumors, myofibroma and solitary fibrous tumour which form the important differential diagnoses. It is a relatively newly described disease entity recognized by the World Health Organisation classification of tumours.

Effects of perfluorooctane sulfonate on the hematology and histopathology of juvenile tilapia, Oreochromis niloticus

Perfluorooctane sulfonate (PFOS), a persistent organic pollutant, biologically stable in the environment and bio-accumulate in the tissues of aquatic animals as well as wildlife and humans. The toxicity of perfluorooctane sulfonate were tested at 1, 3 and 5mg/L concentrations on the juvenile tilapia, Oreochromis niloticus after 7, 15, 30, 45 and 60 days of exposure. The hematological parameters revealed that with the increase in concentrations and exposure time the total count of the RBC, WBC and hemoglobin content were significantly (p<0.05) decreased compared to the control. The histopathological examinations showed that PFOS may induce some changes in kidney and liver. The present results demonstrate that additional research may be conducted to identify the mechanism of perfluorooctane sulfonate toxicityJahangirnagar University J. Biol. Sci. 4(2): 37-45, 2015 (December)

Reproductive performance of Black Bengal goat under semi-intensive and extensive condition in Rajshahi district of Bangladesh

The present study was carried out to investigate the status of different reproductive parameters of Black Bengal in a rural area of Mukterpur under Charghat Upazilla of Rajshahi district during the period of July to December/2012. A total of 200 Black Bengal goats under both semi-intensive (n=100) and extensive condition (n=100) were selected on the basis of age, weight, body shape and conformation. The average age at puberty was 197.82±12.58 days and age at first conception was 292.96±0.50 days under semi-intensive condition whereas 208.82±12.60 days and 287.65±0.52 days under extensive condition. Age at first kidding was 448.26±25.48 days under semi-intensive condition whereas under extensive condition it was 450.07±22.43 days. Average litter size in the first, second and third parity was 1.06, 1.76 and 1.96, respectively under semi-intensive condition whereas under extensive condition, these were 1.01, 1.76 and 1.96, respectively. The average kidding interval of goats under semi-intensive and extensive conditions were 190.2±20 and 178.23±.50 days, respectively and the difference between these two was statistically significant (p<0.01). Sex ratio of male and female kids born was found to be 56 : 44, 44 : 56 and 55 : 45 in the first, second and third parity, respectively under semi-intensive condition whereas, it was 55 : 45, 48 : 52 and 54 : 56 in the first, second and third parity, respectively under extensive condition. The usual numbers of kids at one time in Black Bengal goats varied from single to quadruplet. Average post partum weight of does was higher under semi-intensive condition than extensive condition which was statistically significant (p<0.05). Age of kid mortality was more in first parity under one month of age but gradually decreased with the age of kids under both semi-intensive condition and extensive condition. The average birth weight of kids was 1.28 ± 0.11 kg and 1.25 ± 0.10 kg under semi-intensive and extensive condition respectively which was statistically significant (p<0.01). Average birth weight of male was higher than female under both conditions. Kid mortality increased from 2 to 21% with the increase of parity. Birth weight of kids was higher in July-October and kid mortality was higher in winter season. The age at puberty was found earlier in summer season than others seasons under both semi-intensive and extensive conditions. Reproductive performances of Black Bengal goat were better in third parity than that of the first and second parity under both conditions.Asian J. Med. Biol. Res. June 2015, 1(1): 22-30

Prevalence of microalbuminuria in relation to glycemic control in type-2 diabetic patients in Mymensingh

Microalbuminuria is a renal marker of generalized vascular endothelial damage and early atherosclerosis. Patients with microalbuminuria are at increased risk of microvascular and macrovascular complications of diabetes mellitus like myocardial infarction, stroke and nephropathy. Poor glycemic control increases the risk of microalbuminuria. This study was conducted to determine the frequency of microalbuminuria in type 2 diabetes and compare the frequency of microalbuminuria in poor and good glycemic control in type 2 diabetes. One Hundred and twenty two type 2 diabetic patients were included in the study. Data on age, gender, duration of diabetes, microalbuminuria and HbA1c were recorded. Urine and blood samples were collected and analyzed for microalbuminuria, blood glucose and HbA1c. All patients of both genders with type 2 diabetes for over 2 years were selected in this study. Patients with other causes of proteinuria were excluded. Out of 120 cases 93(77.5%) were male and 27(22.5%) were female. Mean age of patients was 57.8±14.7 years and average duration of diabetes was 9.2 years. Microalbuminuria was found 76.9% of male and 23.1% of female. Patients with poor glycemic control and good glycemic control have frequency of microalbuminuria of 55% and 54% respectively. Uncontrolled diabetes is strongly associated with prevalence of microalbuminuria. Screening for microalbuminuria and HbA1c test should be done both in newly and already diagnosed type 2 diabetic patients as an early marker of renal dysfunction and glycemic control.

Study on serum glucose level among smear positive pulmonary tuberculosis patients in Bangladesh

This case control study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh in cooperation with the Outpatient Department and Medicine Units of Mymensingh Medical College Hospital, Fulbaria Upazilla Health Complex, Mymensingh and some DOTS centers of BRAC, a non-government organization during the period of July 2006 to June 2007. The aim of the study was to explore the status of serum glucose level in smear positive Bangladeshi pulmonary tuberculosis patients. A total of 120 people of different age groups were included in this study. Subjects were divided into two groups - Group I (Control; n=60) - apparently healthy people selected matching by age, sex and socioeconomic status with the cases and Group II (Case; n=60) - people with smear positive pulmonary tuberculosis. Serum glucose (fasting) was estimated by colorimetric principle. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD of serum glucose (fasting) in Group II (5.91±1.02mmol/L) was significantly higher (p<0.001) than in Group I (4.87±0.57mmol/L). It is evident from the study that serum glucose level significantly increases in smear positive pulmonary tuberculosis patients.

Assessment of anaemia in patients with rheumatoid arthritis

The present cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh from December 2009 to November 2010 to find out the association of iron deficiency, in anaemia with rheumatoid arthritis and to find a sensitive and less invasive marker to differentiate iron deficiency anaemia from the anaemia of chronic disease. A total of 45 patients of rheumatoid arthritis were provisionally included in the study. Of them, 12 patients were excluded as they did not allow for aspirating the bone marrow, leaving 33 patients to complete the study. The mean age of the patients was 42.6 years (22-66 years) with female to male ratio being roughly 3:1. Majority (97%) of the patients presented weakness followed by 78.8% dizziness, 54.5% palpitation, 24.2% pallor, 12.1% breathlessness, another 12.1% smooth tongue and 6.1% nail change. About 79% of the patients were positive for RA test and nearly 70% of patient had moderate anaemia. The mean serum ferritin was significantly reduced in patients with hypochromic with or without microcytic anaemia than that with normocytic normochromic anaemia (p<0.001). While total iron binding capacity was found to be significantly increased in patients with iron deficiency anaemia than that in patients with anaemia of chronic disease (p<0.021). The serum iron level was considerably reduced in the former group than that in the later group (p<0.066). Bone marrow iron grading revealed 48.5% of the patients with iron depleted and 51.5% with iron repleted. Serum ferritin level of patients with iron depleted bone marrow was significantly decreased than that in patients with iron repleted bone marrow (p<0.001). Serum iron level of the former group was also reduced than that of the later group (p<0.133). Total iron binding capacity was significantly raised in patients with iron depleted group than that in patients with iron repleted group (p<0.001). The study finds that anaemia of chronic disease and iron deficiency anaemia frequently coexist in patients with rheumatoid arthritis and serum ferritin and total iron binding capacity are considered good indicator for differentiating iron deficiency anaemia from the anaemia of chronic disease. Serum iron levels will not help for differentiating.

Comparison of salbutamol with normal saline and salbutamol with magnesium sulphate in the treatment of severe acute asthma

This study compared the efficacy and safety of nebulized magnesium sulphate with salbutamol to normal saline with salbutamol as the initial treatment of severe acute asthma patients. The present study was designed as a randomized open controlled clinical trial. The study was conducted Mymensingh Medical College Hospital over a period of 11 months from December 2009 to October 2010. Patients admitted with severe acute asthma having inclusion criteria were the study population. Among 120 study population 60 were in salbutamol with magnesium sulphate group and 60 were in salbutamol with normal saline group. The study finding showed that peak flow at baseline was similar in two groups. At 10 minutes after nebulization, the mean±SD percentage increase in peak flow was greater in magnesium sulphate group (20±4%) than in the normal saline salbutamol group (13±3%). At 20 minutes the percentage increase in peak flow was greater in magnesium sulphate group (35±7%) than in the normal saline salbutamol group (24±6%) p value <0.001. Magnesium sulphate plus salbutamol group reached PEF near to 60% which is not in saline salbutamol group. There was no significant changed in respiratory rate, pulse rate, systolic, diastolic blood pressure and clinical evidence of unwanted adverse effect.

Prevalence of risk factors of chronic kidney disease in adults

Chronic kidney disease (CKD) is an emergent public health burden. Its prevalence varies country to country, even in different professional and social groups in the same country. In Bangladesh there is no reported nationwide survey but there are some reports of survey in disadvantageous and advantageous population. In this study 125 CKD patients (cases) and 125 age and sex matched healthy subjects (control) in Mymensingh Medical College, a tertiary hospital of Bangladesh were compared for the presence of non-modifiable [age, sex, family history of hypertension (HTN), Cardiovascular disease (CVD), family history of kidney disease and Socioeconomic condition] and modifiable [HTN, Diabetes mellitus (DM), smoking habit, and obesity] risk factors. The mean age of control was 43.5 ± 6.3 years and the mean age of CKD cases was 44.7 ± 12.7 years. Out of 125 patients of CKD, males were 96 in number (76.8%) and females were 29 in numbers (23.2%). Most of the patients (52.8%) were in poor socioeconomic status while most of controls were from middle class (68.8%). Most of the participants were in stage-3 CKD [67.2%, creatinine clearance (Ccr):36.74 ± 13.61 ml/min]. Glomerulonephritis was the dominant cause of CKD (67.2%) followed by diabetes (24%), hypertension (4.8%) and others (4%). 72.8% of CKD patients were smokers. Among CKD, 86.4% participants had hypertension and 26.4% had diabetes. The difference of hypertension, diabetes and Body mass index (BMI) between case and control group is statistically significant (p<0.001). No statistically significant difference was found with risk factor like family history of kidney diseases. This emphasizes risk factor identification in general population to early diagnose CKD.