Status of Serum Magnesium, Serum Zinc and C-reactive Protein in Hospitalized Patients with Chronic Kidney Disease in Mymensingh Locality

Chronic Kidney Disease (CKD) is an important public health issue, with a leading cause of death and disability around the world. This cross-sectional study was conducted from January 2021 to December 2021 in the department of Biochemistry in Mymensingh Medical College in cooperation with the Department of Nephrology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The study was carried out to evaluate the status of serum magnesium, zinc and CRP in patients with CKD not on dialysis for monitoring the disease progression. For this purpose, 110 subjects were included, where 55 Hospitalized CKD patients were considered as Group I and 55 normal healthy individuals as Group II. Study subjects were selected on the basis of inclusion and exclusion criteria by purposive and convenient sampling method. Serum magnesium and zinc were determined by colorimetric method while CRP was measured by CRP-Latex Test (Slide Agglutination Test) from each sample. SPSS windows package, version 21.0 was used to perform the statistical analysis. Statistical significance of difference between Group I and Group II were evaluated by using student's unpaired 't'-test and the significance was defined as p<0.05. Correlation was done by using Pearson's correlation coefficient test. Mean age of Group I was 52.65±4.93 and Group II was 51.15±6.32 years. P-value was 0.165 which is statistically insignificant. The mean ±SD of BMI was 24.46±1.84 Kg/m² for Group I and 24.50±1.05 Kg/m² for Group II. P-value was 0.886 which is statistically insignificant. Among the study groups the mean serum magnesium were 2.25±0.17 and 1.95±0.05mg/dl, zinc were 88.64±9.21 and 102.11±12.93μg/dl, CRP were 24.00±16.73 and <6.0±0.00mg/L in Group I and Group II respectively. Analysis showed that, the mean serum magnesium and CRP were significantly increased while serum zinc was significantly decreased in CKD patients in comparison to that of healthy individual. There was negative correlation between serum zinc and CRP. This study was done within the context of the facilities available to us.

Status of Serum Calcium in Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) remains a major public health problem with relatively high prevalence rates worldwide (5-13%). COPD is a major cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. The purpose of the study was to explore the alteration of serum calcium in patients with COPD. This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh from January 2021 to December 2021. Data was collected from Medicine Department of Mymensingh Medical College Hospital, Mymensingh. A total number of 120 subjects participated in this study. Out of them, 60 apparently normal healthy individuals were selected as Group I and another 60 diagnosed COPD patients were selected as Group II. Serum calcium was measured by colorimetric method using the test kit. The results were calculated and analyzed by using statistical package for social science (SPSS), windows package version 21.0. Data were expressed in mean ±SD and statistical significance was done by Student's unpaired 't' test. In this study, the mean ±SD values of serum calcium were 9.21±1.06mg/dl and 8.26±0.95mg/dl in Group I and Group II respectively. The results were highly significant (p<0.001). The result suggested that there was significant relation between COPD and alteration of serum calcium. So, by this study we recommended that routine evaluation of serum calcium is important for prevention of exacerbations, reduction of morbidity and mortality in patients with COPD.

Status of C-reactive protein, Serum Albumin and Serum Zinc in Hospital Admitted Patients with Chronic Kidney Disease

Chronic Kidney Disease (CKD) is one of the most concerned non-communicable diseases now a day. Multiple complications arise and different biochemical parameters change in this disease. This cross-sectional study was conducted from January to December, 2021 in the Department of Biochemistry, Mymensingh Medical College with the help of the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh. The motive of this study was to explore the status of C-reactive protein (CRP), serum albumin and serum zinc in patients with CKD for monitoring the disease progression. In this study, 110 subjects were included, where 55 Hospital admitted CKD patients act as Group I and 55 normal healthy individuals act as Group II. The subjects were selected on the basis of inclusion and exclusion criteria by purposive and convenient sampling method. In this study, CRP levels, serum albumin and serum zinc were measured. All values were expressed as Mean±SD. All statistical analysis was done by using SPSS (statistical package for social science) windows package version 21.0. Statistical significance of difference between Group I and Group II were evaluated by using Student's unpaired 't'-test and the significance was defined as p<0.05. Correlation was done by using Pearson's correlation coefficient test. Mean age of Group I was 52.65±4.93 and Group II was 51.15±6.32. P value was 0.165 which is statistically insignificant. The mean±SD of BMI was 24.46±1.84 for Group I and 24.50±1.05 for Group II. P value was 0.886 which is statistically insignificant. The mean±SD values of CRP were 24.00±16.73mg/L and <6.0±0.00mg/L in Group I and Group II respectively. So, we found significant (p<0.05) increase in CRP levels. The mean±SD values of serum albumin were 3.62±0.26g/dl and 4.16±0.69g/dl in Group I and Group II respectively. We found highly significant (p<0.001) decrease in serum albumin. Among the study groups the mean serum zinc was 88.64±9.21μg/dl and 102.11±12.93μg/dl in Group I and Group II respectively. The mean serum zinc was highly significantly (<0.001) decreased. There was negative correlation between CRP and serum albumin, CRP and serum zinc. There was positive correlation between serum albumin and serum zinc. Analyzing the findings of present study, significant increase in CRP levels, significant decrease in serum albumin and serum zinc were observed in CKD patients.

Assessment of Dialysis Adequacy Using Small Solute Clearance Indices among Twice versus Thrice Weekly Maintenance Hemodialysis Patients in a Tertiary Care Hospital of Bangladesh

This observational study was carried out in the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from January 2020 to December 2020. A total of 179 patients were included in this study according to inclusion and exclusion criteria. Informed written consent was taken from each patient. All patients were underwent detail history taking, thorough physical examination and relevant investigations. Data collection was conducted through a structured questionnaire. Collected data were analyzed using the statistical software SPSS 23.0. Mean age ±SD of the study patients was 47.06±14.1 with a majority in age group 41-50 years. Male predominance was observed with a male: female ratio of 2.19:1 and 68.7% male patients. Level of pre-dialysis, post-dialysis urea in the study population was 123.77±26.86mg/dl, 50.27±15.70mg/dl respectively and mean ±SD of Urea Reduction Ratio (URR) in hemodialysis (target >65.0%) was 67.2±1.9. Most of the 8 hours (two times) per week hemolysis patients could not achieve the target value of dialysis adequacy parameters. On the other hand, maximum people in 12 hours (three times) per week hemodialysis group achieved the target value of dialysis adequacy parameters. It is important to calculate Kt/V or URR and individualize the dialysis doses for each patient.

Status of Serum Magnesium and Uric Acid in Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) remains a major public health problem with relatively high prevalence rates worldwide (5.0-13.0%). COPD is a major cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. The purpose of the study was to explore the relationship of biochemical alterations of serum magnesium and uric acid with frequent exacerbations, hypoxia, increase hospital stay, morbidity and mortality in patients with COPD. This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh from January 2021 to December 2021. Data was collected from Medicine Department of Mymensingh Medical College Hospital, Bangladesh. A total number of 120 subjects participated in this study. Out of them, 60 apparently normal healthy individuals were selected as Group I and another 60 diagnosed COPD patients were selected as Group II. The results were calculated and analyzed by using statistical package for social science (SPSS), windows package version 21.0. Serum magnesium was measured by photoelectric colorimetric method using the test kit and serum uric acid was measured by enzymatic colorimetric method using the test kit. Data were expressed in mean±SD and statistical significance of different parameter was done by Pearson's correlation co-efficient test. The mean±SD values of serum magnesium were 2.15±0.29mg/dl and 1.54±0.30mg/dl in Group I and Group II respectively. Result was statistically highly significant (p<0.001). The mean±SD values of serum uric acid were 5.43±2.05mg/dl and 6.86±1.61mg/dl in Group I and Group II respectively. Result was statistically highly significant (p<0.001). Pearson's correlation coefficient test showed that there was significant (p=0.001) negative correlation (r= -0.415) found between serum magnesium and serum uric acid in study group. In this study, the result suggested that there was significant relation between COPD exacerbations and alteration of these biochemical parameters. So, by this study we recommended that routine evaluation of these parameters is important for prevention of exacerbations, reduction of morbidity and mortality in patients with COPD.

Study of Serum Zinc Level in Patients with Type 2 Diabetes Mellitus

A major global public health concern is the prevalence of diabetes mellitus, especially in developing countries like Bangladesh. While still battling communicable diseases, Bangladesh is already inundated with non-communicable diseases. Type 2 diabetes has been found in almost 90.0% of all instances of diabetes. The main risk factors for type 2 diabetes are an excessively caloric diet, advanced age, sedentary behavior and obesity. Along with preexisting risk factors, many micro-nutrients have been related to a rise in the incidence of diabetes. The study's objective was to measure and contrast the zinc levels in serum between individuals with type 2 diabetes mellitus and healthy controls. This cross-sectional study was conducted from July 2018 to June 2019 at the Mymensingh Medical College, Mymensingh, Bangladesh. Based on inclusion and exclusion criteria, the subjects were chosen using a purposeful (non-random) sample method. In total, 100 people participated in this study. They were divided into two groups: 50 individuals who had been diagnosed with type 2 diabetes mellitus were chosen as cases and 50 individuals who appeared to be in generally excellent health were chosen as controls. For the analytical aims of this investigation, serum zinc levels were examined. All values were expressed as the mean SD. The statistical analyses were carried out using the Windows program statistics package for social science (SPSS). The statistical significance of the difference between the case and control groups was evaluated using the Student's unpaired 't' test. A thorough research revealed that type 2 diabetes mellitus patients had significantly lower mean serum zinc levels than healthy controls (case group was 110.96±13.60 and control group 130.18±9.95μg/dl). Cross-sectional research was used in this study. The current study's findings showed that type 2 diabetes mellitus patients had dramatically changed serum zinc levels. The study's hypothesis was verified as a result.

Status of Serum Calcium and Magnesium in Hospital Admitted Chronic Kidney Disease Patients in Mymensingh Locality of Bangladesh

The study was designed to evaluate the serum calcium and magnesium levels in hospitalized patients with Chronic Kidney Disease (CKD). This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College (MMC), Bangladesh with the help of the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from the period of January 2021 to December 2021. The subjects were selected on the basis of inclusion and exclusion criteria by purposive and convenient sampling method. A total of 110 subjects were included in this study. Among them, 55 were diagnosed CKD patients denoted as Group I and 55 were normal healthy individuals denoted as Group II. The subjects were briefed and written consents were taken. Under aseptic precaution 5.0ml of venous blood was collected from median cubital vein. Analyses were carried out in the Department of Biochemistry, Mymensingh Medical College and serum calcium and magnesium levels were measured. All values were expressed as Mean±SD. All statistical analysis was done by using SPSS (statistical package for social science) windows package version 21.0. Statistical significance of difference between Group I and Group II were evaluated by using Student's unpaired 't' test and the significance was defined as p<0.05. Correlation was done by using Pearson's correlation coefficient test. The mean±SD values of serum calcium were 8.15±0.54mg/dl and 9.80±0.50mg/dl and serum magnesium were 2.25±0.17mg/dl and 1.95±0.50mg/dl in Group I and Group II respectively. We found mean serum calcium was highly significantly (<0.001) decreased and serum magnesium was highly significantly increased (<0.001) in CKD patients in comparison to that of healthy individual.

Relationship of Serum Creatinine Level in Heart Failure Patients in Bangladesh

Heart failure means that the heart is unable to pump blood around the body properly. It usually happens because the heart has become too weak or stuff. In collaboration with department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh this cross-sectional study from January to December 2018 was performed in the department of Biochemistry in Mymensingh Medical College, Mymensingh, Bangladesh. The aim of this study was to explore the relationship of serum creatinine in patients with heart failure (HF) for management purpose. In this study 120 subjects were included, where 60 patients of diagnosed HF acts as case group and 60 individuals were normal healthy acts as control group. Serum creatinine was determined by colorimetric method from each sample. Statistical analysis was performed by SPSS windows package, version 21. Among the study groups the mean serum creatinine levels were 2.20±0.87mg/dl and 0.92±0.26mg/dl in case and control group respectively. Analysis showed that the mean serum creatinine level was highly significantly (p<0.001) increased in HF patients in comparison to that of control group.

The role of trust and habit in the adoption of mHealth by older adults in Hong Kong: a healthcare technology service acceptance (HTSA) model

BACKGROUND

Evidence from the literature suggests that mobile health (mHealth) services can potentially improve healthcare outcomes among older adults. Hence, the government of Hong Kong has recently taken several community and information technology (IT) services initiatives to train older adults on how to enhance their abilities and interest in using mHealth technology. Although mHealth services have been widely implemented globally, their adoption and use by older adults are very low, including those in Hong Kong. This study aims to understand key factors influencing mHealth use intention among the older Chinese population in Hong Kong.

METHODS

We extended the Unified Theory of Acceptance and Use of Technology (UTAUT2) as the basis of our conceptual framework. We applied Partial Least Squares path modeling method to conduct the Structural Equation Model (SEM) technique that allows measuring the theoretical validity of any conceptual framework. Convenience and snowball sampling methods were used to recruit participants aged 65 or above. In total, 201 valid responses were used for testing the theoretical validity of the proposed conceptual framework.

RESULTS

The primary finding shows that the widely used UTAUT2 model falls short in explaining mHealth service acceptance behavior in the Chinese older population in Hong Kong. We further propose a simplified model, the Healthcare Technology Service Acceptance (HTSA) model, to understand the formation of mHealth service acceptance behavior. The findings show that trust is an important component of technology service acceptance intention behavior that was missing in the UTAUT2 model. The results also show that several antecedent factors (i.e., social influence, government policy, and service quality) are critical in forming technology trust beliefs.

CONCLUSIONS

The study shows that the HTSA model can better explain mHealth acceptance behavior than the UTAUT2 model. This study advances knowledge in the mHealth technology adoption domain by proposing a simplified new version of the UTAUT2 model for understanding healthcare technology service acceptance and use intention among older adults. The findings of the study provide valuable information to the Hong Kong government and healthcare organizations for wider adoption of mHealth services, especially in older adults.

Changes in Serum Uric Acid Level in Acute Myocardial Infarction Patients

Myocardial infarction (MI) is one of the dangerous manifestations of coronary artery disease and one of the commonest causes of mortality. This cross-sectional study was carried out in the department of Biochemistry, Mymensingh Medical College in collaboration with the department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during the period of January 2018 to December 2018. A total of 120 subjects were included in this study. Among them 60 were diagnosed AMI patients denoted as case group and 60 were apparently normal healthy individuals denoted as control group. Biochemical values were expressed as Mean±SD (Standard deviation). Statistical analysis was done by using SPSS (Statistical package for social science) version 21.0 windows package. Serum uric acid determined by enzymatic colorimetric method using the test kit. Among the study groups the mean±SD values of uric acid were 6.61±2.62 and 5.38±1.16mg/dl in case and control group respectively. The analysis showed that, serum uric acid was statistically increased in case group compared with control group. The level of significance was 0.001. Statistical significance of difference between two groups were evaluated by using Student's unpaired 't' test.

Antecedents of Perceived Service Quality of Online Education During a Pandemic: Configuration Analysis Based on Fuzzy-Set Qualitative Comparative Analysis

BACKGROUND

During COVID-19 lockdown worldwide, classroom education continues remotely through online. The question remains, comparing with the face-to-face education, does online education has a similar satisfaction level among the students? There are only a few studies that examine the perceived service quality of online education.

OBJECTIVE

The study aims to analyze the factors of perceived service quality of online education during a pandemic.

RESEARCH DESIGN

A structured questionnaire elicits information from 147 students from different study backgrounds of various universities worldwide. The fuzzy-set qualitative comparative analysis (fsQCA) is used for data analysis and model design. Research constructs evaluation for reliability and internal consistency are subsequently performed. A snowball random sampling method is applied for data collection.

RESULTS

Findings from the fsQCA analysis identify four core factors that underpin student satisfaction through positive perceived service quality of online education. Alternative paths are determined based on gender, students' current education status, and their loyalty toward online education. We also introduce two topologies of perceived quality regarding online education and student satisfaction.

ORIGINALITY

Because of the primary nature of the data, this is firsthand experience gathered from different universities around the world who have willingly or unwillingly experienced online learning during the pandemic. The fsQCA technique for examining perceived service quality of online education.

CONCLUSIONS

The findings contain a number of contributions, illustrating different topologies of the student from different backgrounds and their intention, satisfaction and loyalty towards e-learning, and identifying causal factors that influence willingness to recommend online education.

An empirical study of factors influencing e-health services adoption among public in Saudi Arabia

Until now most of the studies concerning eHealth in Saudi Arabia are about the exploration of the national benefits from eHealth and the technical and infrastructural challenges in implementing eHealth rather than finding the factors influencing the users in adopting eHealth services. Further, the eHealth adoption rate in Saudi Arabia is low despite the scope of potential growth for the eHealth market. In this study, the authors added Trust, Privacy and System Quality factors to Technology Acceptance Model by considering the research context to examine the factors influencing eHealth services adoption. The proposed model was empirically tested based on the data collected, through survey questionnaire from 314 responses in Saudi Arabia. Structural Equation Modelling was followed to analysis and validates the proposed model based on partial least squares method using SmartPLS. Based on the findings, Perceived Usefulness in addition to Privacy significantly affect eHealth adoption. Moreover, Perceived Ease of Use factor has indirect effect on people perception toward eHealth services. Furthermore, the results show that System Quality and Trust are not influencing factors. This study is important for the healthcare policymakers for getting direction for future studies to avail the maximum benefits of eHealth in Saudi Arabia.

Low Cardiac Output Syndrome: Incidence after Mitral Valve Replacement with or without Preservation of Mitral Valve Apparatus

Standard mitral valve replacement in patients with chronic mitral valve regurgitation and mitral valve stenosis consistently results in a decrease in early postoperative left ventricular ejection performance. Some studies showed that preservation of mitral valve leaflet and subvalvular apparatus can reduce postoperative left ventricular dysfunction. On the basis of the concept, this randomized clinical trial comparing mitral valve replacement with preservation of mitral subvalvular apparatus and conventional mitral valve replacement performed in National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, in the period of July 2010 to December 2011. We included 60 patients of mitral regurgitation and mitral stenosis, among them 30 patients underwent mitral valve replacement with preservation of mitral subvalvular apparatus (Group A) and 30 patients underwent conventional mitral valve replacement (Group B). There was no significant difference between two groups in terms of peri-operative variables. But there was significant higher incidence of Low cardiac output (LOS) syndrome [36.7% vs. 6.9% (p<0.05)] and congestive heart failure in Group B than Group A. The duration of ICU stay was also significantly higher in conventional mitral valve replacement group [113.23±11.30 hours vs. 96.23±20.02 (p=0.001)]. Additionally, there was significantly less fall of left ventricular ejection fraction in preservation of mitral subvalvular apparatus group [preop 65.27±5.45, at discharge 54.31±3.78, after 3 months 58.28±5.20 (p<0.0001)] than conventional group [preop 66.43±4.58, at discharge 46.43±3.87, after 3 months 46.55±3.63 (p<0.0001)]. In this study left ventricular ejection fraction was used as measure of left ventricular function. We postulate that, this relative preservation of left ventricular ejection fraction was likely the result of preservation of mitral subvalvular apparatus.

Blood Uric Acid Prediction With Machine Learning: Model Development and Performance Comparison

Background

Uric acid is associated with noncommunicable diseases such as cardiovascular diseases, chronic kidney disease, coronary artery disease, stroke, diabetes, metabolic syndrome, vascular dementia, and hypertension. Therefore, uric acid is considered to be a risk factor for the development of noncommunicable diseases. Most studies on uric acid have been performed in developed countries, and the application of machine-learning approaches in uric acid prediction in developing countries is rare. Different machine-learning algorithms will work differently on different types of data in various diseases; therefore, a different investigation is needed for different types of data to identify the most accurate algorithms. Specifically, no study has yet focused on the urban corporate population in Bangladesh, despite the high risk of developing noncommunicable diseases for this population.

Objective

The aim of this study was to develop a model for predicting blood uric acid values based on basic health checkup test results, dietary information, and sociodemographic characteristics using machine-learning algorithms. The prediction of health checkup test measurements can be very helpful to reduce health management costs.

Methods

Various machine-learning approaches were used in this study because clinical input data are not completely independent and exhibit complex interactions. Conventional statistical models have limitations to consider these complex interactions, whereas machine learning can consider all possible interactions among input data. We used boosted decision tree regression, decision forest regression, Bayesian linear regression, and linear regression to predict personalized blood uric acid based on basic health checkup test results, dietary information, and sociodemographic characteristics. We evaluated the performance of these five widely used machine-learning models using data collected from 271 employees in the Grameen Bank complex of Dhaka, Bangladesh.

Results

The mean uric acid level was 6.63 mg/dL, indicating a borderline result for the majority of the sample (normal range <7.0 mg/dL). Therefore, these individuals should be monitoring their uric acid regularly. The boosted decision tree regression model showed the best performance among the models tested based on the root mean squared error of 0.03, which is also better than that of any previously reported model.

Conclusions

A uric acid prediction model was developed based on personal characteristics, dietary information, and some basic health checkup measurements. This model will be useful for improving awareness among high-risk individuals and populations, which can help to save medical costs. A future study could include additional features (eg, work stress, daily physical activity, alcohol intake, eating red meat) in improving prediction.

Mobile health interventions in developing countries: A systematic review

This study reviews the quality of evidence reported in mobile health intervention literature in the context of developing countries. A systematic search of renowned databases was conducted to find studies related to mobile health applications published between a period of 2013 and 2018. After a methodological screening, a total of 31 studies were included for data extraction and synthesis. The mobile health Evidence Reporting and Assessment checklist developed by the World Health Organization was then used to evaluate the rigor and completeness in evidence reporting. We report several important and interesting findings. First, there is a very low level of familiarity with the mobile health Evidence Reporting and Assessment checklist among the researchers and mobile health intervention designers from developing countries. Second, most studies do not adequately meet the essential criteria of evidence reporting mentioned in the mobile health Evidence Reporting and Assessment checklist. Third, there is a dearth of application of design science-based methods and theory-based frameworks in developing mobile health interventions. Fourth, most of the mobile health interventions are not ready for interoperability and to be integrated into the existing health information systems. Based on these findings, we recommend for robust and inclusive study plans to deliver highly evidence-based reports by mobile health intervention studies that are conducted in the context of developing countries.

Association between Serum Albumin Status with Heart Failure (HF) Patients in Bangladesh

In collaboration with the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh this cross sectional study was performed in the Department of Biochemistry, Mymensingh Medical College from January 2018 to December 2018. The aim of the study was to explore the relationship of serum albumin in patients' with heart failure (HF) as a resource to monitor the possibility of management of these patients. A total of 120 subjects were included in this study. Among them 60 patients in case group were diagnosed HF patients and as control group 60 individuals were normal healthy. Serum albumin was determined by colorimetric method from each sample. Statistical analysis was performed by SPSS windows package, version 21. Among the study groups the mean serum albumin levels were 3.25±0.59 and 4.14±0.38 in case and control group respectively. Analysis showed that the mean serum albumin level was highly significantly (p<0.001) decreased in HF patients in comparison to that of control group.

Adoption intention and usage behavior of mHealth services in Bangladesh and China

Purpose

The purpose of this paper was to explore the comparative influential factors affecting the behavioral intention and actual usage of mHealth services in two distinct national environments, i.e. China and Bangladesh, in relation to the international expansion of mHealth services.

Design/methodology/approach

In this study, widely accepted Unified Theory of Acceptance and Use of Technology (UTAUT) with two additional variables, i.e. Perceived Reliability and Price Value have been selected as a theoretical framework. Primary data were collected from existing mHealth users among generation Y in both China and Bangladesh. A total of 296 and 250 questionnaires were deemed as usable for data analysis for Bangladesh and China, respectively.

Findings

Performance expectancy and social influence had significant impact on the adoption intention of mHealth services for both countries. Effort expectancy and price value were insignificant factors for Bangladesh, whereas facilitating condition and perceived reliability were insignificant for China.

Practical implications

The insights from this study could benefit mHealth services providers and those policymakers who seek to enter the Chinese and the Bangladeshi healthcare market. The dimensions identified in the study are based on a full assessment of mHealth usages experiences. Global service providers can use the dimensions identified by the paper to better assess their service performance on an international level.

Originality/value

The paper is unique in that it is one of the first cross-country examinations of influential factors affecting the adoption of mHealth services in two different countries. This study confirms the applicability of extended UTAUT model in the context of mHealth services among the generation Y in developing countries such as China and Bangladesh.

Serum Amino-Terminal Pro-B Type Natriuretic Peptide (NT-pro BNP) Status among Heart Failure (HF) Patients in Bangladesh

This cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to December 2018. The aim of the study was to explore the relationship of serum NT-pro BNP in heart failure (HF) patients as a means to monitor the possibility of management of these patients. A total of 120 subjects were included in this study. Among them 60 were diagnosed HF patients denoted as case group and 60 were normal healthy individuals denoted as control group. Serum NT-pro BNP concentration was measured by Fluorescence Immunoassay (FIA) from each sample. Statistical analysis was performed by SPSS windows package, version 21. Among the study group the mean serum NT-pro BNP levels were 4931.93±7229.36 and 999.47±49.99 pg/ml in case and control group respectively. Analysis showed that the mean serum NT-pro BNP level was highly significant (p<0.001) increased in heart failure patients comparison to that of control group.

Relationship of Cardiac Troponin (CTn-I) with Heart Failure Patients in Bangladesh

This cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to December 2018 to explore the relationship of serum Troponin I in heart failure (HF) patients as a means to monitor the possibility of management of these patients. A total of 120 subjects were included in this study. Among them 60 were diagnosed HF patients denoted as case group and 60 were normal healthy individuals denoted as control group. Serum Troponin I concentration was measured by Fluorescence Immunoassay (FIA) from each sample. Statistical analysis was performed by SPSS windows package, version 21. Among the study groups the mean serum Troponin I levels were 2.78±7.26 and 0.96±0.05 in case and control group respectively. Analysis showed that the mean serum Troponin I level was significantly (p<0.05) increased in heart failure patients comparison to that of control group.

Serum Calcium Level in Preeclamptic Patients of Bangladesh

Preeclampsia is one of the most frequent complication of pregnancy which manifested by hypertension during pregnancy for the first time after 20th weeks of gestation with proteinuria. The aim of the study was to estimate the changes in serum calcium level in preeclamptic patients when compared with normal pregnant women. The case control study was carried out in the Department of Biochemistry, Mymensingh Medical College, Mymensingh, Bangladesh in collaboration with the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2016 to June 2017. A total of 100 subjects were included. Among them 50 were subjects of preeclamptic patients as case and another 50 were apparently healthy normal pregnant women as control. The study revealed that serum calcium level was lower in preeclamptic women (case) as compared to healthy control subjects. The mean values of serum calcium levels were 7.63±0.42 and 8.12±0.94mg/dl in case and control group respectively. The difference in mean serum calcium were highly significant (p<0.001) when compared between case and control.

Women Using Mobile Phones for Health Communication Are More Likely to Use Prenatal and Postnatal Services in Bangladesh: Cross-Sectional Study

Background

The public health system in Bangladesh has been struggling to provide coverage and utilization of basic maternal health care services in pursuit of achieving maternal and child mortality-related goals. Interestingly, the rapid popularization of mobile technology in the country is transforming the landscape of health care access and delivery. However, little is known regarding the use of mobile phones from the perspective of maternal health care service utilization.

Objective

In this study, we aimed to investigate the prevalence and sociodemographic pattern of mobile phone use for health services among women and relationship between the use of mobile phone use and the uptake of essential maternal health services (MHSs).

Methods

Cross-sectional data from the Bangladesh Demographic and Health Survey on 4494 mothers aged between 15 and 39 years were used in the analysis. Using mobile phones to get health services or advice was hypothesized to have a positive association with the uptake of basic MHSs (antenatal care, ANC, facility delivery services, postnatal care) and postnatal care for the newborn. Data were analyzed using bivariate and multivariable techniques.

Results

More than a quarter (1276/4494, 28.4%; 95% CI 26.8-30.3) of the women aged 15-39 years reported using mobile phones to get health services with significant sociodemographic variations in the use of mobile phones. Analysis of the specific purposes revealed that, in most cases, mobile phones were used to contact service providers and consult with the same about what to do, whereas a smaller proportion reported using mobile phone for the purposes of arranging money and transportation. Multivariable analysis showed that compared with respondents who reported not using mobile phones for health care services, those who used them had higher odds of making 3+ ANC visits and delivering at a health facility. The odds were slightly higher for rural residents than for those in the urban areas.

Conclusions

The findings of this study conclude that women who use mobile phones are more likely to use ANC and professional delivery services than those who do not. More in-depth studies are necessary to understand the mechanism through which mobile phone-based services enhance the uptake of maternal health care.

Do It Better: Cross Mattress for Chest Drain Insertion Site Security Offers Quality Outcome in Chest Trauma Patients Required Tube Thoracostomy

We examined the hypothesis that the cross mattress for chest drain insertion site security is better than that of polypropylene horizontal mattress in chest trauma patient required tube thoracostomy at the Department of Casualty Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2016 to June 2016. Accordingly we prospectively studied 50 consecutive patients who needed chest tube insertion. In 25 consecutive cases chest drain insertion site was secured with polypropylene horizontal mattress technique (Control- Group A) and another 25 consecutive patients had a cross-mattress with non-absorbable suture materials (Experimental- Group B). All chest tubes were inserted into the triangle of safety to following the BTS guideline. A baseline x-ray chest was compared with post-procedure chest x-ray. Male preponderance and young adults were comprised in both the groups; mean age in Group A and Group B was 38.7±15.5 and 37.3±14.1 respectively. Haemo-pneumothorax was the most common cause of tube thoracostomy among the trauma victims. This study shows that, polypropylene horizontal mattress results in increased chest tube site infection 52% in Control Group vs. 12% in Experimental Group (p=0.002). Although there was similar incidence of blood loss between the groups, the length of Hospital stay was significantly higher in Control Group. We conclude that cross mattress for chest drain insertion site security showed a better clinical outcome, less wound complications and less hospitalization.

Relationship between HbA1c and Lipid Profile Seen in Bangladeshi Type 2 Diabetes Mellitus Patients Attending BIRDEM Hospital: A Cross-Sectional Study

Diabetes mellitus is one of the leading non-communicable diseases all over the world including Bangladesh. Diabetes is characterized by chronic hyperglycemia and disturbances of carbohydrate, lipid and protein metabolism. Glycated hemoglobin (HbA1c) level of ≥6.5% has been included as a criterion for diagnosis of diabetes. Impaired lipid profile is commonly present in type 2 diabetes. Aim of the study was to investigate the association between serum lipid profile and blood glucose. And hypothesizing that early detection of lipid abnormalities and treatment can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular calamity in patients with type 2 diabetes mellitus (T2DM). This observational cross sectional study was carried out in the department of Biochemistry, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital, Dhaka, Bangladesh from January 2016 to June 2016. A total 105 patients with T2DM of age within the range of 30-45 years were selected for the purpose. Fasting blood glucose (FBG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and glycated haemoglobin (HbA1c) levels were evaluated. Test of significance was calculated by unpaired Student's 't' test. Correlation studies (Pearson's correlation) were performed between glycated haemoglobin (HbA1c) and serum lipid profile. Significance was set at p<0.05. Significantly higher mean serum levels of TC, TG and LDL-C and significantly lower mean serum levels of HDL-C were noted in patients with diabetes. Significant correlations were observed between HbA1c value and serum levels of TC, TG and HDL-C (p<0.05) but no significant correlation of HbA1c value with LDL-C in-diabetes patient. The study concluded that HbA1c value correlate well with lipid profile in-diabetes patients. So, HbA1c can be used as a predictor of dyslipidemia in type 2 diabetes.

Patient Acceptance of e-Health Services in Saudi Arabia: An Integrative Perspective

Background: e-Health has been expansively considered as a technological intervention for fundamental enhancement in the healthcare sector to mitigate the enormous demand and supply of healthcare in both developed and developing nations. In 2000, the Saudi government established a committee for health reform to develop an information technology strategic plan for healthcare and for deploying e-health applications within the country. The objective of e-health systems was to provide better healthcare to patients and to increase the efficiency of healthcare organizations. Despite numerous e-health interventions to provide healthcare services, very little is studied about the adoption process of e-health from users' viewpoints in Saudi Arabia. This study minimizes this knowledge gap by studying the factors affecting the adoption and acceptance of e-health in the context of Saudi Arabia. Materials and Methods: This study has combined the Technology Acceptance Model and Theory of Planned Behavior frameworks to evaluate the factors influencing the patient acceptance of e-health services in Saudi Arabia. Data were collected from patients at various private and public hospitals in Saudi Arabia. The partial least square technique based on structural equation modeling was applied to analyze the survey data. Results: The study shows the significant influence of perceived usefulness and perceived ease of use on the attitude. Furthermore, attitude and subjective norm (p < 0.05) significantly influence patient behavioral intention (BI) to use e-health services. However, perceived behavioral control (p > 0.05) had no significant influence on patient BI to use e-health services. Conclusions: The findings of this study might be useful to policymakers, the government, and healthcare service providers in Saudi Arabia and other developing countries.

Big Data Based m-Health Application to Prevent Health Hazards: A Design Science Framework

BACKGROUND

Every year about three million Muslims visit the Holy City of Makkah in Saudi Arabia to perform the Hajj. Because of the large number of people present during this period, pilgrims can be subjected to many health hazards. An adequate system to minimize these health hazards is needed to support the pilgrims who attend the Hajj. This study justifies the need for developing a large data-based m-Health application to identify the health hazards encountered during the Hajj.

MATERIALS AND METHODS

In developing a big data-based m-Health application, this study follows the framework suggested by Hevner. The design of the science framework allows the development of a technological solution (i.e., design artifact) of the problem through a series of actions. The design involves rigorous knowledge of the environmental factors, including knowledge of the construction and evaluation of technological solutions, that are important and relevant to an existing problem.

RESULTS

Based on the design science framework, the process of artifact development can be classified into Artifact Design, Artifact Implementation, and Artifact Evaluation. This paper presents the Artifact Design step for the design of the big data-based m-Health application, which has an Environmental Relevance Cycle, a Knowledge-based rigor Cycle, and an Artifice development and design cycle. The big data-based m-Health application is a prototype and must be evaluated using the evaluation-and-feedback loop process until the optimum artifact is completely built and integrated into the system.

CONCLUSION

Development of a big data-based m-Health application using a design science framework can support the effective and comprehensive plan of the government of Saudi Arabia for preventing and managing Hajj-related health issues. Our proposed model for developing and designing a big data-based m-Health application could provide direction for developing the most advanced solution for dealing with the Hajj-related health issues in the future.

Disparities in the use of mobile phone for seeking childbirth services among women in the urban areas: Bangladesh Urban Health Survey

BACKGROUND

In Bangladesh, similar to its other South Asian counterparts, shortage of health workers along with inadequate infrastructure constitute some of the major obstacles for the equitable provision of reproductive healthcare services, particularly among the marginalized and underserved neighbourhoods. However, given the rapidly expanding broadband communication and mobile phone market in the country, the application of eHealth and mHealth technologies offer a window of opportunities to minimise the impact of socioeconomic barriers and promote the utilization of maternal healthcare services thereby. In the present study we aimed to investigate 1) the prevalence of usage of mobile phones for seeking childbirth services, 2) neighbourhood and socioeconomic disparities in the use, and 3) association between using mobile phones and the uptake of postnatal care among mothers and neonates.

METHODS

Data for the present study came from Bangladesh Urban Health Survey 2013. Study subjects were 9014 married women aged between 15 and 49 years.

RESULTS

The overall rate of use of mobile phone was highest in City Corporation non-Slum areas (16.2%) and lowest in City Corporation Slum areas (7.4%). The odds of using mobile for seeking childbirth services were significantly higher among those who were living in non-slum areas, and lower among those who never attended school and lived in poorer households. Results also indicated that women in the slum areas who used mobile phone for childbirth service seeking, were 4.3 times [OR = 4.250;95% CI = 1.856-9.734] more likely to receive postnatal care for themselves, and those from outside the city-corporation areas were 2.7 times [OR = 2.707;95% CI = 1.712-4.279] more likely to receive postnatal care for the newborn.

CONCLUSION

Neighbourhood, educational and economic factors were significantly associated with the mobile phone utilization status among urban women. Promoting access to better education and sustainable income earning should be regarded as an integral part to the expansion of mHealth for maternal healthcare seeking behaviour.

Association between Metabolic Syndrome and Acute Myocardial Infarction (AMI)

To evaluate the biochemical parameters of metabolic syndrome in case of acute myocardial infarction (AMI) patients this case control study was carried out in the department of Biochemistry, Mymensingh Medical College in collaboration with Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2012 to June 2013. To assess of serum total cholesterol, triacylglycerol, HDL-cholesterol, LDL-cholesterol, to estimate of serum glucose and to establish the association of age, sex, BMI, waist circumference, waist hip ratio and blood pressure of myocardial infarction patients. A total of 120 subjects were included in the study. Among them 60 were subjects of AMI cases and another 60 subjects of non AMI patients as controls. Serum total cholesterol, serum triacylglycerol, serum LDL-Cholesterol & serum HDL-Cholesterol were estimated in each sample. All values were expressed as Mean±SD. Statistical significance of difference between case and control were evaluated by using student's unpaired 't' test. All statistical analysis was done by using SPSS windows package. Past history of diabetes Mellitus and hypertension were more common in cases compared to those in control (p<0.001) which was statistically highly significant. There was no significant difference in the history of smoking between case and control. Statistical mean values of serum triacylglycerol, serum FBS, serum total cholesterol were highly significant in AMI patients in comparison to control (p<0.001). Statistical mean value of HDL-C was significantly decreased in AMI patients in contrast to control (p<0.001). In this study systolic blood pressure and diastolic blood pressure were significantly increased in AMI patients in comparison to control (p<0.05). Waist circumference was highly significant in AMI patients in comparison to control (p<0.001). Analyzing the findings of the present study there were significant alteration in lipid profile, blood pressure, fasting blood sugar & WC. These findings reaffirm the clinical importance of the metabolic syndrome as a significant risk factor for AMI. So it may be recommended that estimation of these parameters may help pivotal for better management of AMI.

Challenges in HbA1C Level as a Diagnostic Tool of Diabetes and Pre-Diabetes in Middle-Aged Population: The Bangladesh Study

Worldwide prevalence of diabetes is found to be the human health at an alarming rate. However, large numbers of patient remain undiagnosed. Oral glucose tolerance test (OGTT) still is regarded as gold standard in diagnosis of blood glucose abnormality. Although the less number of bodies are considering measurement of HbA1C as an alternate tool to identify risk group. This study was undertaken to evaluate the role of measurement of HbA1C in the diagnosis of diabetes and pre-diabetes in middle-aged Bangladeshi subjects and carried out in the department of Biochemistry, BIRDEM from July 2013 to June 2014. A total 177 subjects of age within the range of 30-45 years were selected for the purpose and classified into healthy control (n=62) pre-diabetes (n=69) and diabetes (n=46) groups based on the values of OGTT. Middle aged Bangladeshi subjects attending Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital, the HbA1C values were 5.0-5.6% in control group, 5.6-6.2% in pre-diabetes and 8.1-9.7% in diabetes group (95% CI). The optimal cut-off value of HbA1C related to pre-diabetes diagnosed by OGTT was 5.6%, which showed the sensitivity 47.8%, specificity 74.2%, positive predictive value 67.3% and negative predictive value 58.5%. Variants of hemoglobin especially Hemoglobin E (HbE) is prevalent in South East Asia including Bangladesh. The presence of genetic variants of hemoglobin can profoundly affect the accuracy of HbA1C measurements. So measurement of HbA1C may not be used as an alternate tool of OGTT to identify people of diabetes and pre-diabetes in certain situation.

Serum Copper Status among Acute Myocardial Infarction Male Patients in Bangladesh

This case control study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2015 to December 2015. The aim of the study was to explore the serum copper status among acute myocardial infarction (AMI) patients as a means to monitor the possibility of management of these patients. A total of 120 subjects were included in this study. Among them 60 were diagnosed AMI patients denoted as case group and 60 were normal healthy individuals denoted as control group. Serum copper determined by colorimetric method from each sample. Statistical analysis was performed by SPSS windows package, version 20. Among the study groups the mean serum copper levels were 150.30±26.16 and 103.65±9.38 in case and control group respectively. Analysis showed that the mean serum copper level was significantly (p<0.01) increased in AMI patients in comparison to that of control group.

Early Outcome of Primary Repair in Colonic Injury

The management of the colon injury remains controversial in spite of a number of divergent reports during the past decade. Previously surgeons were reluctant to do primary anastomosis but now-a-days they are doing primary repair with good results. The present study is designed to see the early outcomes of primary repair in colonic injury. This prospective observational study performed at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2013 to June 2013 with allocation of 50 patients with colonic injury who underwent laparotomy with primary repair of that injury in the department of Casualty Surgery. A primary repair was performed after freshening the edges or by resection and primary anastomosis with 3.0 round-body Vicryl by single layer extra mucosal interrupted suture. Data processed using software SPSS version 16.0. For all analytical results a p value <0.05 was considered significant. In this study the commonest site of injury were transvers colon and sigmoid colon 38.0% in each. Out of 50 respondents, 5(10.0%) developed burst abdomen, 1(2.0%) developed entero-cutaneous fistula with none had paralytic ileus or septicaemia or pelvic collection. No mortality observed. This study showed that the increasing in colon injury scale (CIS) score culminate into increasing rate of postoperative complication & post operative complications were more at left colon (24%). On basis of our findings, we recommend the primary repair is a safe and effective surgical technique for addressing the large gut injury. Unnecessary proximal diversions should be avoided. According to our experience, we believe that the policy of primary repair of colon injuries can be applied more liberally in majority of patients with high success rate.

An empirical study of mHealth adoption in a developing country: the moderating effect of gender concern

BACKGROUND

mHealth has become a valuable tool for providing health care services in developing countries. Despite the potential benefits of mHealth, its adoption remains a very challenge in developing countries like Bangladesh. The aim of this study is to investigate the factors that affect the adoption of mHealth services in Bangladesh using Extended Technology Acceptance Model (TAM).

METHODS

Data were collected from over 250 respondents in Dhaka, Bangladesh. The data were analyzed using the Partial Least Squares (PLS) method, a statistical analysis technique based on the Structural Equation Modeling (SEM).

RESULTS

The study found that perceived ease of use, perceived usefulness and subjective norm (p < 0.05) had significant positive impact on the intention to adopt mHealth services. Surprisingly, the effects of personal innovativeness in IT (p > 0.05) on mHealth adoption were insignificant. This study also revealed that gender was strongly associated with the adoption and use of mHealth in developing countries.

CONCLUSIONS

The findings of this study can be used by government, policy makers, and mobile phone Company to maximize the acceptance of mHealth services in Bangladesh. The paper concludes with a discussion of research results and draws several implications for future research.

Left Atrial Myxoma in a Late Case of Lung Carcinoma

Concomitant occurrence of lung carcinoma and an atrial myxoma is rare. We are reporting such a case, a 55 year old male, farmer, smoker for 30 years was under evaluation for his recent episode of stroke with hemiparesis during which an echocardiography showed presence of a left atrial myxoma and chest x-ray showed a lesion in the midzone of right lung. Fine needle aspiration cytology (FNAC) from enlarged right supraclavicular lymphnode revealed metastatic adenocarcinoma. Patient was referred to a tertiary cancer care hospital thereafter.

Genetic Diversity and Phylogenetic Analysis of South-East Asian Duck Populations Based on the mtDNA D-loop Sequences

The maternally inherited mitochondrial DNA (mtDNA) D–loop region is widely used for exploring genetic relationships and for investigating the origin of various animal species. Currently, domestic ducks play an important role in animal protein supply. In this study, partial mtDNA D–loop sequences were obtained from 145 samples belonging to six South-East Asian duck populations and commercial duck population. All these populations were closely related to the mallard duck (Anas platyrhynchos), as indicated by their mean overall genetic distance. Sixteen nucleotide substitutions were identified in sequence analyses allowing the distinction of 28 haplotypes. Around 42.76% of the duck sequences were classified as Hap_02, which completely matched with Anas platyrhynchos duck species. The neighbor-joining phylogenetic tree also revealed that South-East Asian duck populations were closely related to Anas platyrhynchos. Network profiles were also traced using the 28 haplotypes. Overall, results showed that those duck populations D-loop haplotypes were shared between several duck breeds from Korea and Bangladesh sub continental regions. Therefore, these results confirmed that South-East Asian domestic duck populations have been domesticated from Anas platyrhynchos duck as the maternal origins.

Cost and Time Effectiveness Analysis of a Telemedicine Service in Bangladesh

Telemedicine has great potential to overcome geographical barriers to providing access to equal health care services, particularly for people living in remote and rural areas in developing countries like Bangladesh. A number of telemedicine systems have been implemented in Bangladesh. However, no significant studies have been conducted to determine either their cost effectiveness or efficiency in reducing travel time required by patients. In addition, very few studies have analyzed the attitude and level of satisfaction of telemedicine service recipients in Bangladesh. The aim of this study was to analyze the cost and time effectiveness of a telemedicine service, implemented through locally developed PC based diagnostic equipment and software in Bangladesh, compared to conventional means of providing those services. The study revealed that the introduced telemedicine service reduced cost and travel time on average by 56% and 94% respectively compared to its counterpart conventional approach. The study also revealed that majority of users were highly satisfied with the newly introduced telemedicine service. Therefore, the introduced telemedicine service can be considered as a low cost and time efficient health service solution to improve health care facilities in the remote rural areas in Bangladesh.

Serum Calcium Status among Pregnancies Complicated By Pre-Eclampsia in Bangladesh

This case control cross sectional study was carried out in the department of biochemistry, Mymensingh medical college in collaboration with the outpatient department, family planning model clinic and antenatal obstetric ward of Mymensingh medical college hospital, Mymensingh during the period of July 2003 to June 2004. The aim of the study was to explore the status of serum calcium among pregnancies complicated by pre-eclampsia in Bangladesh as a means to monitor the possibility of management of these patients. A total of 82 subjects were selected and were grouped as Group I (32 healthy women with uncomplicated pregnancy as control subjects) and Group II (50 pregnant women with pre-eclampsia as cases). Serum calcium was estimated by colorimetric method from each sample. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD (Standard Deviation) of Group I and Group II serum calcium were 8.71±1.00 and 10.78±1.44 mg/dl respectively. By comparing Group I with Group II highly significant difference were found in case of serum calcium (P<0.001). It is evident from the study that serum calcium level significantly increases among pregnancies complicated by pre-eclampsia in Bangladesh.

Cultural Influence on Adoption and Use of e-Health: Evidence in Bangladesh

BACKGROUND

E-health is an important initiative among the public and private hospitals in Bangladesh in the last few years. The factors influencing e-health adoption have been a well-investigated research area in both developed and developing countries. However, there have been only a few studies exploring the role of cultural factors in the adoption and use of e-health, particularly in developing countries. In this study, we investigated the influence of culture on the adoption of e-health in Bangladesh.

MATERIALS AND METHODS

This study developed a more adequate research framework by integrating Hofstede's cultural dimension model and the Technology Acceptance Model (TAM). A structured questionnaire was used to collect data from respondents in different private and public hospitals in Bangladesh. The partial least squares method, a statistical analysis technique based on the Structural Equation Model, was used to analyze the collected data.

RESULTS

The study found that cultural dimensions such as Power Distance, Masculinity, and Restraint had significant impacts on Intention to Use e-Health, whereas Uncertainty Avoidance, Collectivism, and Pragmatism had no significant impact on Intention to Use e-Health in Bangladesh. The results also revealed that Perceived Usefulness was a significant indicator of e-health adoption decisions, whereas Perceived Ease of Use was an insignificant predictor of e-health adoption.

CONCLUSIONS

The findings of this study may assist governments, organizations, and policy makers to understand the key factors affecting e-health adoption and to develop strategies and policies to enhance e-health services in Bangladesh.

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.

An evaluation of serum magnesium status in pre-eclampsia compared to the normal pregnancy

Pre-eclampsia is a disease which causes significant maternal and fetal morbidity and mortality, especially in the developing countries. Despite numerous studies, the etiology of pre-eclampsia has not yet been fully elucidated. Although several evidences indicate that various elements such as serum Magnesium, Calcium etc. might play an important role in pre-eclampsia. The present study prospectively determines and evaluate whether maternal serum levels of magnesium has any association with pre-eclampsia or not. It was a cross sectional study carried out in the Department of Biochemistry, Mymensingh Medical College from July 2009 to June 2010. A total of 108 subjects were selected with the duration of pregnancy from 28th week of gestation to term of which 42 were normal pregnant women (as control) and 66 were pre-eclamptic (34 with mild and 32 with severe preeclampsia) admitted in the Obstetrics and Gynaecology department of Mymensingh medical college hospital. Serum Magnesium level was determined in the laboratory by colorimetric method using recommended commercial kit. Student's unpaired t-test was used to see the statistical significance of the difference between the mean values of the estimated parameters. The mean serum levels of Magnesium in normal pregnant group was 1.91±0.08mg/dl, mild pre-eclamptic group was 1.8±0.11mg/dl,and in severe pre-eclamptic group was 1.75±0.10mg/dl. The mean serum Magnesium of women with mild pre-eclampsia as well as severe pre-eclampsia was significantly (p<0.001) decreased in comparison to that of the control. A significant (p<0.05) decrease in serum magnesium was also found in subject with severe pre-eclamptic compared to that of the mild pre-eclamptic. So, these results indicate that reduction in serum levels of magnesium during pregnancy might be a possible contributor in the etiology of pre-eclampsia and supplementation of this element as diet or drugs may be of value to prevent pre-eclampsia.

Serum iron status among visceral leishmaniasis patients

This case control cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh in cooperation with the Department of Microbiology, Medicine units of Mymensingh Medical College Hospital and Fulbaria & Muktagacha Upazilla Health Complexes, Mymensingh during the period of July 2006 - June 2007. The aim of the study was to explore the status of serum iron among visceral leishmaniasis patients in Bangladesh as a means to monitor the possibility of management of these patients. A total of 120 people of different age groups were included in this study. Subjects were divided into two groups - Group I (Control) consisting of 60 apparently healthy persons matched by age, sex and socioeconomic status with the cases and Group II (Case) consisting of 60 "ICT for Kala-azar" positive VL patients. Serum iron was estimated by colorimetric method with ferrozine from each sample. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD (Standard Deviation) of Group I and Group II serum iron were 100.67±20.83 and 76.76±8.64μgm/dl respectively. By comparing Group I with Group II highly significant difference were found in case of serum iron (P<0.001). It is evident from the study that serum iron level significantly decreases among visceral leishmaniasis patients in Bangladesh.

Intermittent prophylaxis of recurrent febrile seizures with clobazam versus diazepam

Febrile seizures are the most common type of seizure among children that can be prevented by using prophylactic drugs like Clobazam and Diazepam. The present prospective study was conducted in the Department of Pediatrics, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh over a period of 1 year from July 2012 to June 2013 to compare the effectiveness of intermittent Clobazam versus Diazepam therapy in preventing the recurrence of febrile seizures and assessed adverse effects of each drug. A total of 65 patients (32 children administered Clobazam and rest 33 children received Diazepam) of simple and complex febrile seizures aged 6 months to 5 years of both sexes were the study population. Data were collected by interview of the patients, clinical examination and laboratory investigations using the research instrument. Data were analyzed by using Chi-square (χ2) Test, Student's 't' Test and Fisher's Exact Test. For all analytical tests, the level of significance was set at 0.05 and p<0.05 was considered significant. The proportion of patients was higher between age 12-36 months and male was predominant in the both Clobazam and Diazepam groups. Over 31% of patients in Clobazam group who experienced episode of fever within 3 months, 40.6% within 6 months and 9.4% within 9 months compared to 36.4% in Diazepam group within 3 months, 45.5% within 6 months & 12.1% within 9 months after discharge from the hospital. Three (9.4%) patients in Clobazam group and 7(21.3%) in Diazepam group who experienced febrile convulsion during the follow up period. From the data adverse effects within 3 and 6 months experienced by the patient's drowsiness, sedation and ataxia were higher in Diazepam group than those in Clobazam group. However, within 9 months lethargy and irritability were somewhat higher in Clobazam group than those in Diazepam group. The mean duration of hospitalization was significantly higher in Diazepam group compared to Clobazam group (6.0±1.0 vs. 4.6±0.08 days, P<0.001). Seven (21.2%) out of 33 children with febrile seizures in Diazepam group had a history of recurrent seizures, whereas 3(9.4%) of 32 children in the Clobazam group. The risks of recurrent febrile seizure in the Diazepam group was 2.6 times greater compared to those in the Clobazam group (P=0.186). The result indicates that Clobazam is safe, efficacious, requires less frequent dosing and has less adverse effects such as drowsiness, sedation, ataxia and irritability as compared to Diazepam. So, Clobazam may be an alternative to Diazepam given intermittently for prevention of recurrent febrile seizures.

Phylogenetic Analysis of a Privately-owned Korean Native Chicken Population Using mtDNA D-loop Variations

The use of Korean native chicken is increasing, and the discovery of new genetic resources is very important from both economic and genetic conservation points of view. In this study, mtDNA D-loop sequences from 272 privately-owned Korean native chickens from a Hyunin farm were investigated. Seventeen nucleotide substitutions were identified from the sequence analysis and they were classified as 6 haplotypes. Previously investigated haplotypes in five Korean native chicken populations have been compared with the Hyunin chicken population. The results indicated that two haplotypes, H10 and H15, in the Hyunin chicken population were not previously identified in other Korean native chicken populations, representing 33.09% (90/272) and 1.1% (3/272) of the Hyunin population, respectively. On the other hand, four other haplotypes were identical to those of a previous study of Korean native chicken populations. This result is indicative of conservation strategies of Hyunin chicken populations for expanding the genetic diversity in the Korean native chicken population.

Discrimination of korean native chicken lines using fifteen selected microsatellite markers

In order to evaluate the genetic diversity and discrimination among five Korean native chicken lines, a total of 86 individuals were genotyped using 150 microsatellite (MS) markers, and 15 highly polymorphic MS markers were selected. Based on the highest value of the number of alleles, the expected heterozygosity (He) and polymorphic information content (PIC) for the selected markers ranged from 6 to 12, 0.466 to 0.852, 0.709 to 0.882 and 0.648 to 0.865, respectively. Using these markers, the calculated genetic distance (Fst), the heterozygote deficit among chicken lines (Fit) and the heterozygote deficit within chicken line (Fis) values ranged from 0.0309 to 0.2473, 0.0013 to 0.4513 and -0.1002 to 0.271, respectively. The expected probability of identity values in random individuals (PI), random half-sib (PI half-sibs ) and random sibs (PI sibs ) were estimated at 7.98×10(-29), 2.88×10(-20) and 1.25×10(-08), respectively, indicating that these markers can be used for traceability systems in Korean native chickens. The unrooted phylogenetic neighbor-joining (NJ) tree was constructed using 15 MS markers that clearly differentiated among the five native chicken lines. Also, the structure was estimated by the individual clustering with the K value of 5. The selected 15 MS markers were found to be useful for the conservation, breeding plan, and traceability system in Korean native chickens.

Investigation of MC1R SNPs and Their Relationships with Plumage Colors in Korean Native Chicken

The melanocortin 1 receptor (MC1R) gene is related to the plumage color variations in chicken. Initially, the MC1R gene from 30 individuals was sequenced and nine polymorphisms were obtained. Of these, three and six single nucleotide polymorphisms (SNPs) were confirmed as synonymous and nonsynonymous mutations, respectively. Among these, three selected SNPs were genotyped using the restriction fragment length polymorphism (RFLP) method in 150 individuals from five chicken breeds, which identified the plumage color responding alleles. The neighbor-joining phylogenetic tree using MC1R gene sequences indicated three well-differentiated different plumage pigmentations (eumelanin, pheomelanin and albino). Also, the genotype analyses indicated that the TT, AA and GG genotypes corresponded to the eumelanin, pheomelanin and albino plumage pigmentations at nucleotide positions 69, 376 and 427, respectively. In contrast, high allele frequencies with T, A and G alleles corresponded to black, red/yellow and white plumage color in 69, 376 and 427 nucleotide positions, respectively. Also, amino acids changes at position Asn23Asn, Val126Ile and Thr143Ala were observed in melanin synthesis with identified possible alleles, respectively. In addition, high haplotype frequencies in TGA, CGG and CAA haplotypes were well discriminated based on the plumage pigmentation in chicken breeds. The results obtained in this study can be used for designing proper breeding and conservation strategies for the Korean native chicken breeds, as well as for the developing breed identification markers in chicken.

Serum albumin and creatinine clearance rate among smear positive pulmonary tuberculosis patients in Bangladesh

This case control study was carried out in the Department of Biochemistry, Mymensingh Medical College 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 albumin & creatinine clearance levels in smear positive Bangladeshi pulmonary tuberculosis patients as a means to monitor the possibility of management of these patients as these levels decrease significantly. Serum albumin level was investigated in TB patients for monitoring the nutritional status of TB patients and also for the adjustment of serum calcium level. Creatinine clearance rate was investigated in TB patients for monitoring the impairment of renal function and nutritional depletion in 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 albumin was estimated by colorimetric principle. Serum creatinine was also estimated by colorimetric principle & creatinine clearance rate was estimated from serum creatinine by Cockcroft- Gault equation. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD of serum albumin in Group II (3.74±0.44gm/dl) was significantly lower (p<0.001) than that in Group I (4.85±0.31gm/dl). Mean±SD of creatinine clearance rate in Group II (35.36±8.29ml/min) was also significantly lower than that in Group I (84.16±20.20ml/min). It is evident from the study that serum albumin & creatinine clearance rate levels significantly decrease in smear positive Bangladeshi pulmonary tuberculosis patients.

Serum magnesium status among acute myocardial infarction patients in Bangladesh

This case control cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with Cardiology Department of Mymensingh Medical College Hospital, Mymensingh during the period of July 2004 to June 2005. The aim of the study was to explore the status of serum magnesium among acute myocardial infarction (AMI) patients as a means to monitor the possibility of management of these patients. A total of 100 subjects were selected and were grouped as Group I (50 healthy control subjects) and Group II (50 subjects of AMI Cases). Serum magnesium was estimated by colorimetric method from each sample. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD (Standard Deviation) of Group I and Group II serum magnesium were 2.16±0.25 and 1.71±0.17mg/dl respectively. By comparing Group I with Group II highly significant difference were found in case of serum magnesium (p<0.001). It is evident from the study that serum magnesium level significantly decreases among acute myocardial infarction patients in Bangladesh.

Evaluation of TH agglutinin titres of Widal test in the diagnosis of typhoid fever

This prospective study was evaluated the role of TH agglutinins and reevaluate the diagnostic value of Widal test in the diagnosis of typhoid fever by identifying the S. typhi specific antibody. The study was carried out in the department of Microbiology, Mymensingh Medical College, Mymensingh between July 2010 and June 2011, including 200 individuals of different ages and sexes. Widal test and blood culture were performed for each of the cases and controls. Among 150 blood samples from the suspected cases, 23(15.3%) were culture positive for S. typhi and 67(44.7%) had high titres of ≥1:160 for 'O' or 'H' or both agglutinins. Out of 23 culture positive cases, 3(13%) had TO ≥:160, 5(21.7%) had significant TH ≥1:160. Based on the above findings, it was concluded that judicious interpretation of Widal test play an essential role in diagnosis of typhoid fever, especially in the resource poor countries like Bangladesh.

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.

Body iron status among acute myocardial infarction patients

This case control cross sectional study was carried out in the department of Biochemistry, Mymensingh Medical College in collaboration with Cardiology department of Mymensingh Medical College Hospital, Mymensingh during the period of July 2004 to June 2005. The aim of the study was to explore the status of body iron among acute myocardial infarction (AMI) patients in Bangladesh as a means to monitor the possibility of management of these patients. A total of 100 subjects were selected and were grouped as Group I (50 healthy Control subjects) and Group II (50 subjects of AMI Cases). Serum iron, total iron binding capacity (TIBC) & transferrin saturation were estimated from each sample. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD of Group I serum iron, TIBC & transferrin saturation were 71.84±9.10, 336.66±35.39 & 21.73±4.88 respectively and of Group II serum iron, TIBC & transferrin saturation were 137.55±18.22, 267.99±34.97 & 52.40±11.74 respectively. By comparing Group I with Group II highly significant difference were found in case of serum iron (p<0.001), TIBC (p<0.001) and transferrin saturation (p<0.001). It is evident from the study that body iron (serum iron, TIBC & transferrin saturation) level significantly increases among acute myocardial infarction patients in Bangladesh.

Serum calcium 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 calcium 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 calcium was estimated by colorimetric principle. Serum calcium was adjusted by serum albumin concentration. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD of adjusted serum calcium in Group II (2.41±0.15mmol/L) was significantly higher (p<0.001) than that in Group I (1.85±0.11mmol/L). It is evident from the study that serum calcium level significantly increases in smear positive Bangladeshi pulmonary tuberculosis patients.