Bangladesh Medical Research Council Bulletin (Vol 46, No 02 2020)

Abstract

Background: Neonatal sepsis is a life-threatening condition with high mortality and morbidity throughout the world.

Objective: This study evaluated the diagnostic role of serum procalcitonin (PCT), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) in the early diagnosis of neonatal sepsis.

Methods: This cross-sectional study was conducted among neonates admitted to the special baby care unit (SCABU) of BIRDEM General Hospital, Dhaka, from November 2018 to April 2019. According to selection criteria, 90 clinically suspected cases of neonatal sepsis were selected and categorised into confirmed, probable, and no sepsis groups based on CRP, white cell count, platelet count, and blood culture results. Serum PCT, IL-6, and tumor necrosis factor (TNF-α) were estimated in all cases by standard laboratory methods.

Results: Serum PCT, IL-6, CRP, and TNF-awere significantly higher in confirmed and probable sepsis groups in comparison to no sepsis group. Among the studied biomarkers, serum PCT was found most sensitive (95% sensitivity), and serum IL-6 was found most specific biomarkers (65.7% specificity) than CRP and TNF-α for the diagnosis of neonatal septicaemia. Though the accuracy of both PCT and IL-6 was found equal (70%), but the positive predictive value (PPV) and negative predictive value (NPV) of serum PCT were higher than IL-6.

Conclusion: Both serum PCT and IL-6 are more sensitive and specific markers than CRP and TNF-α in the diagnosis of neonatal sepsis. Moreover, serum PCT is more useful than IL-6.

Keywords: Neonatal sepsis, Procalcitonin, Interleukin-6(IL-6), Tumor necrosis factor (TNF-α)

Abstract

Background: The worldwide incidence of oral health among the autistic children has been found to be poor for various reasons. Risk of dental caries and gingivitis is expected to be higher in these patients due to improper brushing and flossing because of the difficulties of the trainers and parents encounter when they brush the children’s’ teeth. They tend to pouch food inside the mouth instead of swallowing it due to poor tongue coordination, thereby increasing the susceptibility to caries. Communication and behavioural problems pose the most significant challenges in providing oral care.

Objective: The purpose of this study was to examine the oral health status and dental needs of autistic children in Bangladesh.

Methods: This case control study was carried out among 2-13 years old children with special health-care needs. The study was conducted in the Department of Orthodontics of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from the period of August to December 2017. A total of 130 children having ASD and aged between 2 -13 years were taken as cases and 182 gender-matched healthy children were taken as control. Cases were taken from BSMMU and other two autism centres. Controls were taken from a neighborhood school. Oral lesions were evaluated using standard international diagnostic criteria. Association of food habits and oral hygiene status were assessed among the study subjects. Dental status was evaluated using DMFT/dmft index according to the World Health Organization oral health surveys. Gingival health status were assessed using the Oral hygiene index of Loe and Silness, while the papillary bleeding index were assessed by employing the papillary bleeding index of Miihleman to ascertain the oral hygiene status.

Results: The mean age was found 8.72±3.40 years in the case group and 10.26±1.36 years in control group. Chi square test showed significant associations with the participants’ consumption of having more soft foods, presence of papillary bleeding and presence of decayed teeth with their oral hygiene status.

Conclusion: As data regarding oral health among autistic children are not available presently in Bangladesh. So, it is difficult for comparison of children having disabilities with those of healthy group. For planning and providing effective dental health care services for the children with autistic disorders.

Keywords: Autistic children, Oral hygiene status, Gingivitis, Poor tongue coordination

Abstract

Background: The exercise is a widely promoted way to improve and maintain health, and osteoarthritis (OA) is a major health problem also. The study was conducted to examine the impact of different types of leisure-time physical activity on the OA of the knee.

Objective: The study was aimed to evaluate the association of recreational (habitual) physical activities with the osteoarthritis of the knee in the female.

Methods: The case-control study was carried out on 174 female selected purposively with the age range of 40 – 70 years and above, from September 2016 to August 2017.Among them 87 were the cases with OA of the knee, and the same number of healthy females of the same age group were included as the control. Physical activity was assessed by self-reported regular exercise patterns. A structured interviewer-administered questionnaire was used to collect data.

Results: Age, educational status, occupational status and BMI were not statistically significant (p>0.05) between the two groups. High level of physical activities (walking, running or jogging 20 or more miles per week) were associated with osteoarthritis of the knee, while low level of physical activities (<10miles/per week) and moderate level of physical activities (10-20 miles/per week) had no significant association with the osteoarthritis of the knee.

Conclusion: Based on the findings, the study suggests not to continue a high level of physical activities rather than to continue with moderate and low level of physical activity in accordance to subject’s physical propensity, and endorse this note for the general health promotion.

Keywords: Osteoarthritis, Habitual physical exercise, Physical propensity, High level physical activity

Abstract

Background: Immune mediated destruction of pancreatic beta cell in type-I diabetes is well established but its’ role in young type-2 diabetic patients is still not conclusive. These young diabetic patients pass through several stages where they do not need insulin but found to have serum autoantibody against islets cell and even become dependent on insulin for survival in course of time. This study aims to find the presence of islets cell auto-antibodies (ICA) and autoantibody to glutamic acid decarboxylase-65 (GAD-65) in non-insulin requiring young diabetic patients of Bangladesh.

Objective: To evaluate the presence of ICA and GAD-65 between the non-insulin requiring young type-2 diabetic patients and compare with the non-diabetic control group.

Method: This case control study was carried out at the Department of Immunology, BIRDEM General Hospital, Dhaka for a period of one year from July 2013, A total of 120 non-insulin requiring (≥12 months) young type-2 diabetic patients and 60 age, sex matched non-diabetic were enrolled as control subjects following inclusion and exclusion criteria. ICA and GAD-65 tests were performed by enzyme linked immune-sorbent assay (ELISA) method by using kits from DRG Inc. International, USA.

Results: In this study statistically significant difference found between non insulin requiring young diabetic patients and non diabetic control in respect of positive ICA result (p=0.015). The moderately strong negative association was found between different age of onset of diabetes mellitus and value of ICA level (r=-0.45). Only 20-24 years age group showed statistically significant difference between patient and control (p=0.013). Statistically significant difference was not found in GAD-65 values of non insulin requiring young diabetic patients and non diabetic controls (p=0.441).

Conclusion: This study revealed that there is significant difference present in respect of ICA among non-insulin requiring young diabetic patients and non-diabetic controls. Therefore, autoimmune pathogenesis of beta cell killing by producing ICA against islets cell take place in young type-2 diabetic patients.

Keywords: Islet cell autoantibody, Glutamic acid decarboxylase-65, Latent autoimmune diabetes in youth, Type-2 diabetes

Abstract

Background: The impact of body mass index (BMI) and physical activity on menopausal symptoms is still unclear. The relationship between menopausal symptoms with physical activity and BMI may differ depending on the specific symptom and socio-demographic factors may have impact on the symptoms.

Objectives: It was aimed to determine most common presenting symptoms as per MRS scale, and to assess physical activity status as per IPAQ scale. Also to assess the impact of physical activity and BMI on common menopausal symptoms in addition to socio-demographic characteristics of the respondents in particular.

Methods: This was a descriptive cross-sectional study among menopausal women age between 45-60 years attended at Outpatient Department (OPD) of Obs & Gynae in three randomly selected tertiary care hospital of the country during November 2017 to April 2018. The data were generated as per Menopause Rating Scale (MRS) and by International Physical Activity Questionnaire (IPAQ) and by calculation of Body Mass Index (BMI).

Results: About 70.0% respondents were within 45-54 years of age group, 28.0% respondents were illiterate and 78.0% were housewife. Overweight was to be found almost 30.0% within 50-54 years age group. Respondent’s somato-vegetative menopausal symptoms like hot flashes, heart discomfort and sleeping problems were found mild to moderate among 53.0-67.0% respondents mostly. Psychological and urogenital menopausal symptoms were found mild to moderate among 52-62.0% and 45-53.0% respondents respectively. The irritability and heart discomfort were found significantly associated with age. Moreover, joint and muscular discomfort, hot flushes, sweating and heart discomfort were also found significantly associated with BMI (p<.05).

Conclusion: Findings of the study will help planners and policy makers in developing one stop comprehensive services as appropriate in minimizing symptoms without medications and will also help minimizing burden of symptoms among menopausal women towards a comfortable end stage life line towards menopause specific quality of life (MENQOL).

Keywords: Menopause rating scale, International physical activity questionnaire, Body mass index, ObesityL

Abstract

Background: Ovarian cancer is the ninth most common cancer in women and it ranks fifth as the cause of cancer death in women. Epithelial ovarian cancer (EOC) represents the most lethal malignancy of the female genital tract. EOC is typically diagnosed in advanced FIGO (Federation of International Gynaecology and Obstetrics) stages due to lack of symptoms in the earlier stages. So, the aim of this study was to determine the disease free survival (DFS) of EOC after treatment and also to find out the prognostic factors such as age, FIGO stage, histopathological subtypes and grade for recurrence of disease.

Methods: A retrospective study was conducted in gynaecological oncology department of National Institute of Cancer Research and Hospital (NICRH), Dhaka. Study period was 02 years from January 2017 to December 2018.Histopathologically confirmed epithelial ovarian malignancy after completion of treatment was included in this study. Non-epithelial ovarian malignancy was excluded from this study.

Results: Mean age was 53 yrs (range 25-80 yrs).Final surgical staging (FIGO stage) of disease were as follows stage I; 24 (25.8%), stage II; 18 (19.4%), stage III; 45 (48.4%) and stage IV; 6 (6.5%). Mean follow-up time was 34 months (range 24-60 months). DFS according to FIGO stages were 35 months, 27 months, 25 months and 9 months respectively. DFS based on the complete and incomplete surgical staging were 27 months and 22 months respectively. At univariate analysis, factors significantly associated with decrease DFS and increase recurrence which included age (HR- 1.39 95% CI), stage (HR- 1.22, 95% CI), histopathological type (HR-1.28, 95% CI) and grade of tumor (HR-1.65, 95% CI). At multivariate analysis, FIGO stage (HR-3.9, 95% CI), histopathological type (HR-1.86, 95% CI) and grade (HR-1.11, 95% CI) having an association with decease DFS.

Conclusion: Surgical stage was one of the strongest independent prognostic factors of DFS for EOC. Increasing age, histopathology and grade are also independent predictors of decrease DFS in patient with EOC treated with current standard therapy.

Keywords: Epithelial ovarian cancer, Disease free survival, FIGO stage, Non-epithelial ovarian malignancy

Abstract

Background: Endometrial cancer, previously referred to as carcinoma of the uterus. The incidence of endometrial cancer is raising, due to improved screening causing fewer hysterectomies in ageing population. Several studies are going on to find out the association and effects between DM and DM-related diseases, especially the cancer. Obesity and physical inactivity plays important role as modifiable determinants of insulin resistance, hyperinsulinaemia and diabetes. All these factors are also responsible for endometrial cancer.

Objectives: To find out the association between endometrial carcinoma with obesity and diabetes mellitus

Methods: This was a cross sectional and observational study, conducted among. 50 consecutive patients admitted as known case of endometrial carcinoma diagnosed by fractional curettage and endometrial biopsy and 50 consecutive patients having other common gynaecological problems in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2015 to December 2017.

Results: Out of 50 women having endometrial carcinoma, only 4% (n=2) having healthy BMI, 36% (n=18) were overweight, 60% (n=30) were obese. Among 50 healthy women without endometrial carcinoma showed that 4% (n=2) having underweight, 70% (n=35) having healthy BMI, 14% (n=7) having overweight and only 12% (n=6) were obese. Regarding distribution of diabetes mellitus among study population, 50 women having endometrial carcinoma 26 % (n=13) were diabetic and 74% (n=37) were non diabetic.50 healthy women without endometrial carcinoma showed that 8% (n=4) diabetic and 92% (n=46) were non diabetic. Among total 17% (n=17) diabetic patients, 76.5% (n-13) having endometrial carcinoma and 23.5% (n=4) were healthy having no endometrial carcinoma. Among 83% (n=83) women having no diabetes 55.4% (n=46) were healthy having no endometrial carcinoma and 44.6% (n=37) having endometrial carcinoma. Association between Diabetes mellitus and endometrial carcinoma was statistically significant (p=0.017). Having high BMI (overweight, obese) and diabetics had significant elevated risks of endometrial cancer, compared with non-overweight non-diabetic subjects.

Conclusion:Obesity, history of PCOS, physical inactivity and diabetes are the risk factors of endometrial carcinoma. So, it should be treated promptly these diseases to reduce risk factors. Moreover, strengthen public awareness to address these risk factors at earlier to reduce the cancer burden is recommended.

Keywords: Endometrial carcinoma, obesity, Diabetes, Physical inactivity

Abstract

Background: Cervical spondylosis is the results of disc degeneration with associated osteophytosis. Cervical traction is widely used to treat neck disorders. Rehabilitation treatment like cervical traction along with other measures at home may play an important role to reduce symptoms of the patients with cervical spondylosis.

Objective: A randomised clinical trial was conducted among 125 patients having cervical spondylosis to find out the effects of manual continuous home cervical traction.

Methods: The patients were selected on the basis specific selection criteria. They were subdivided into two groups. In Group-A (manual continuous home cervical traction group), 61 patients were treated with exercise, cervical collar, neck support, manual continuous home cervical traction, NSAID, warm moist compression and instruction in posture. In Group-B (conventional treatment receiving group), 64 patients were treated with exercise, cervical collar, neck support, warm moist compression, NSAID and instruction in posture.

Results: Among the subjects there were 68 (54.4 %) male and 57 (45.6 %) female. The mean age of the subjects was 45.94 ± 11.65 years. There was marked improvement of symptoms of the patients of Group-A in response to treatment for 6 weeks (p < 0.007). It indicates that manual home cervical traction was found effective to reduce the sign and symptoms of cervical spondylosis. There was improvement after treatment in Group-B also (p < 0.01). It indicates that conventional treatment was also found effective. In comparison, there was no significant difference between two groups (p < 0.36, 95% CI= ‐0.56 to 1.51) found after first week. But there was significant improvement in Group-A than Group-B after six weeks of treatment (p < 0.003, 95% CI= -2.40 to -0.51).

Conclusion: It may be concluded that manual continuous home cervical traction is beneficial for the patients with cervical spondylosis.

Keywords: Cervical Spondylosis, Cervical Traction, Home Cervical traction, NSAID

Abstract

Background: Vitamin D deficiency is one of the most common micronutrient deficiency in children worldwide, even in Bangladesh. However, to date, the prevalence of vitamin D deficiency among children of different region of Bangladesh is less reported.

Objective: This study was conducted to assess vitamin D status of urban and rural Bangladeshi children including the risk factors associated with vitamin D deficiency are also evaluated.

Methods: A multi-centre (urban and rural based), cross sectional study was done from July 2016 to June 2017, using serum 25(OH) vitamin D₃as a marker of nutritional vitamin D status. Urban and rural children were taken from Paediatric Outpatient Department, United Hospital Limited. Dhaka and Medical Outpatient Department, Upazila Health Complex, Ghatail, Tangail respectively. Children of 1-10 years age attending OPD with mild undernutrition (<–1 SD z score) and/or clinical features suggestive of vitamin D deficiency were included in the study.

Results:Atotal 150 children were studied with 102 (68.0%) urban and 48 (32.0%) rural children. Hypovitaminosis D (25-OHD <30ng/ml) was found in 75.0% of children. Hypovitaminosis D was found significantly more in urban children (81.0%) compared to rural (62.0%) children (OR=0.382, 95% CI: 0.177-0.822, p value <0.05). Inadequate exposure to sunlight was significantly associated with hypovitaminosis D compared to adequate sun exposure and it was about 2.5 times higher (OR=2.475, 95% CI: 1.139-5.380, p value <0.05). No significant associations of vitamin D deficiency were detected with skin color of children, covering clothes of mother, exclusive breast feeding, limb pain and anthropometric status. Children of higher educated mother (above Secondary School Certificate) (OR=0.412, 95% CI: 0.189-0.900) were more associated with vitamin D deficiency.

Conclusion: Vitamin D deficiency (VDD) is prevalent among Bangladeshi children, urban children being more vulnerable to VDD. Adoption of a screening programme for children of all age group and implementation of preventive strategies for VDD through public health policies are strongly recommended.

Keywords: Vitamin D, Serum 25(OH)D, Sun exposure, Hypovitaminosis D

Abstract

Background: Schwannoma is mostly benign lesion that originates from the Schwannoma cells that cover the myelinated nerve fibers. Schwannoma arising from the tonsil are very rare. In head and neck region the incidence rate of schwannoma is between 25 to 45%. In most of the cases vestibular nerve followed by a parapharyngeal space is involved. It is also known as neurilemmoma.

Objective: To diagnoses and manage the case of a Schwannoma of Tonsil.

Findings: A case of tonsillar schwannoma in a 42 years old males was reported. The patient presented with unilateral enlargement of left tonsil with congested pharyngeal mucosa.

Conclusion: Proper clinical examination with radiological assessment plays a vital role to diagnosis this accurately.

Keywords: Schwannoma, Neurilemmoma, Schwann cell, Tonsil

Dear Editor,

The coronavirus disease 2019 (Covid-19) has been caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) that declared as an global pandemic by the World Health Organization (WHO).^1,2 This ongoing pandemic causes devastation across the world while multiple countries have been facing with another outbreak- Dengue, a known tropical disease.³ Dengue is the most rapidly spreading mosquito-borne viral infection, also considered as a major public health concern. During COVID-19 pandemic, the increasing incidence of dengue become a further threat especially in the dengue-endemic countries of Southeast Asia and Latin America.⁴ The global burden of dengue is dynamic, estimated 50 million real cases per year across approximately 100 countries.⁵ Currently, most of the countries are fighting against COVID-19, therefore, further outbreak of dengue has been posed a number of practical challenges to combat the diseases simultaneously.

As dengue cases have been increased during Covid-19 pandemic, both SARS‑CoV‑2 and dengue viruses are co-existing and co-circulating in the environment. Consequently, patients with SARS‑CoV‑2 and dengue co-infection has been reported recently in several countries like Singapore, Thailand, India, and Bangladesh.^6-9 Hence, it is speculated that the co-infection cases will be increased and found in another countries in the upcoming days when dengue season goes in its peak. Currently, multiple countries in South America like Brazil, Paraguay, Colombia, Argentina, Bolivia are suffering seriously from co-epidemics of dengue and Covid-19.⁴

In: Ahsan CR^* Begum K, Kabir E, Talukder KA. Enterotoxic, Neurotoxic and Cytotoxic Effects Demonstrated by Shiga Toxin Producing (2d) Producing Escherichia coli in Experimental Models. Bangladesh Med Coun Bull 2020; 46: 41-47.

The list of authors and their affiliation should have been Begum K¹, Ahsan CR^1*, Kabir E², Nur-E-Kamal A³, Talukder KA⁴. ¹Department of Microbiology, University of Dhaka, Dhaka, Bangladesh; ²Department of Pathology, Sir Salimullah Medical College, Dhaka, Bangladesh; ³Department of Biology, Medgar Evers College of the City University of New York, Brooklyn, NY, USA; ⁴Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh; instead of Ahsan CR^* Begum K, Kabir E, Talukder KA; Department of Microbiology, Dhaka University, Dhaka, Bangladesh.