Bangladesh Medical Research Council Bulletin (Vol. 48, No. 03, 2022)

Abstract

Background: Thalassemia is an inherited blood disorder that affects hemoglobin’s structure and functions. Among several forms of this life-threatening disorder, HbE/β and β-thalassemia are most common in Bangladesh and worldwide as well. But the molecular and clinical data are not adequate regarding the underlying cause of this genetic disorder in Bangladesh. So, we aimed to identify the genetic mutations within β-globin gene (HBB) and to investigate the correlation of the mutations with HBB mRNA structure, gene transcription and hematological status among the patients with blood transfusion dependent HbE/β and β-thalassemia in Bangladesh.

Methods: A total of 40 blood samples were collected from the patients with blood transfusion dependent HbE/β and β-thalassemia prior to taking their consent. Detection of mutations within HBB gene was carried out by polymerase chain reaction followed by Sanger DNA sequencing method. Identification and characterization of mutations along with their effects on HBB gene were analyzed by various bioinformatics approaches. In addition, complete blood count (CBC), and hemoglobin electrophoresis were done for hematological analysis.

Results: c.92+5G>C, c.79G>A and c.9T>C genetic mutations were identified within the HBB gene, where c.92+5G>C was the most common mutation among the study patients. Mutations along with hematological status and putative transcription factor binding sites revealed that the severity of the disease depends upon the mutation type and its location in the HBB gene sequence. In addition, mRNA structure analysis showed that the identified mutations contribute to its structural diversity by altering folding mechanism that ultimately affects the stability and function of the HBB protein among the patients with blood transfusion dependent HbE/β and β-thalassemia

Conclusion: The study showed the underlying cause of HbE/β and β-thalassemia in genetic level by identifying rare and common mutations within HBB gene and their effects on with HBB gene transcription and mRNA structure. We hope study will contribute in designing effective molecular medicine and other therapeutics for the patients with HbE/β and β-thalassemia to improve their health condition.

Keywords: HbE/β-thalassemia, β-thalassemia, Mutations, Transcription factors, mRNA structure. .

Abstract

Background: Cervical cancer develops from well-defined precursor lesions in a variable period of time. Detecting in early or pre invasive stages, cervical cancer is preventable and curable, so detection of preinvasive lesions is very important.

Objective: The aim of our study was to correlate of Pap smear and colposcopy in relation to histopathological findings in detection of preinvasive lesion of cervix.

Methods: This was a cross-sectional study of 110 women to attend in department of Gynecological Oncology OPD of Bangabandhu Sheikh Mujib Medical University from July 2016 to June 2017. Inclusion criteria were age of 30 to 60 years, who had unhealthy cervix, intermenstrual or post coital bleeding and excessive vaginal discharge. Exclusion criteria were any cervical growth, bleeding at the time of examination, pregnant women.

Results: In present study sensitivity of Pap smear for detecting lesions above LSIL was 11(10.0%), specificity 68.38%, PPV was 94.44%, negative predictive value 71.86%. The incidence of preinvasive lesions (LSIL and HSIL) was 33.64% with LSIL 21(19.09%) and HSIL 16(14.55%) and of carcinoma were 10(9.09%).

Conclusion: With a comprehensive approach to make awareness and doing proper screening by Paps smear, colposcopy and colposcopy directed biopsy; cervical cancer can be eliminated as a public health problem within a generation.

Keywords: Pap smear; Colposcopy; Precancerous lesions; Histopathology; HSIL; LSIL.

Abstract

Background: The current Pandemic situation has the potential to impact mental health unfavourably. As a by and large new infection, much still needs to be had some significant awareness of Coronavirus. Following openness to the SARS-CoV-2 infection contamination, the vast majority of the people stay asymptomatic or foster gentle indications. Coronavirus cases can make complexities that will require hospitalization.

Objective: Coronavirus patients revealed conditions like intense respiratory pain disorder, cardiovascular breakdown, liver diseases, renal impairment, shock, and multiorgan disappointment. During the current Coronavirus pandemic, general clinical issues have pulled in more highlight. Diverged from that, the psychological wellness outcomes of Coronavirus pandemic have gotten less thought.

Methods: This study will follow a cross-sectional study aimed to determine the prevalence of depression, anxiety, and stress during the initial stage of the COVID-19 pandemic among the Bangladeshi population.

Results: Self-reported information on socio-demographics, illness and mental health status was obtained predominantly. Mental health status was assessed using the Depression, Anxiety and Stress Scale (DASS-21). A total of 420 individuals participated in this study who were relatively young and highly educated. The study finding suggests that COVID-19 pandemic may increase the risk of depression, anxiety, and stress in Bangladesh. The prevalence of depression, anxiety, and stress were 46.7% (95% Confidence Interval, CI:42.1% - 51.8%), 39.1(95% CI:34.3% – 43.9%), and 34.8% (95% CI:30.2 – 39.5%), respectively. Females and individuals with physical illness are at higher risk of developing adverse psychological consequences. Gossiping with family members is protective against depression (OR: 0.5, 95% CI:0.3 – 0.7). Watching television reduces stress (OR:0.6, 95% CI:0.4-0.9). Necessary measures should be considered to improve psychological well-being during the COVID-19 pandemic.

Conclusion: To find out the mental health status of the population during COVID-19 pandemic in Bangladesh, this study finding may form a basis for the development of a mental health support strategy in Bangladesh.

Keywords: COVID-19, mental health, depression, anxiety, stress, pandemic.

Abstract

Background: The emergence of multidrug-resistant Enterobacter species as a worrying resistant pathogen seriously threatened human health. The rising rate of resistance to commonly used antibiotics limit the choice hence it is urgent to evaluate the antimicrobial activity of older drug like Fosfomycin

Objective: The study aimed to seek the frequency of fosfomycin resistance in the clinical isolates of Enterobacter species and to detect the fosfomycin resistance gene along with antibiotic resistance pattern.

Methods: This cross-sectional study was conducted in the Department of Microbiology of a tertiary care hospital in Bangladesh from July 2018 to June 2019. Enterobacter spp. was isolated from a total of 350 samples by a standard microbiological method. Antibiotic susceptibility was performed by the disk diffusion technique. Antibiotic susceptibility and minimum inhibitory concentration (MIC) of fosfomycin were determined by the agar dilution method. Fosfomycin resistance gene fosA, fosA3, fosA4, fosA5, fosB, fosB2, fosC, fosC2 and fosX among fosfomycin resistant Enterobacter spp detected by polymerase chain reaction (PCR) using specific primer. Sequencing of fosA and fosA… was performed by capillary method, and the nucleotide sequence of fosA… has been deposited to GenBank.

Results: Out of 28 Enterobacter spp. 7 (25%) fosfomycin resistant Enterobacter spp. were detected by agar dilution method. Out of 7 fosfomycin-resistant strains, 4 (57.14%) were isolated from urine samples. Fifteen (53.57%) isolates of Enterobacter spp. were multidrug-resistant detected by disc diffusion technique. All of the fosfomycin-resistant isolates were MDR. A significant rise in the MIC was found between 256µg/ml - ≥4096µg/ml to fosfomycin. PCR revealed that 100% of fosfomycin resistant isolates are positive for fosA, 71.43% and 28.57% were positive for fosA… and fosB‚ respectively. Sequencing of fosA… gene established the FosA family fosfomycin resistance glutathione transferase gene.

Conclusion: The results of this study showed a high proportion of fosfomycin resistance among multidrug-resistant Enterobacter spp. irrespective of fosfomycin usage in Bangladesh. FosA family fosfomycin resistance glutathione transferase gene is emerging in Bangladesh.

Keywords: Fosfomycin resistance gene, Multidrug resistance, Polymerase chain reaction, Sequencing, Enterobacter spp.

Abstract

Distorted terminal portion of QRS complex on initial electrocardiogram in ST segment elevation myocardial infarction is a strong predictor of in hospital adverse outcome This observational prospective study was carried out in the department of cardiology, BSMMU, Dhaka from July 2014 to June 2015 to analyse admission ECG in patients of STEMI based on terminal portion of QRS complex and find out inhospital death, heart failure, cardiogenic shock and recurrent myocardial infarction, with GRACE scoring assessment. Total 60 patients with STEMI (age 54.33±10.37, 55M/5/F) were included in this study after analysing the selection criteria. We defined two ECG groups according to absence of distortion of terminal QRS (Group-I) and presence of distorted terminal QRS (Group-II) in two or more adjacent leads. Group-II further divided into pattern-A – J point originating at ≥50% of height of R wave in leads with qR configuration and pattern B- S wave is absent in leads with RS configuration. Global Registry of Acute Coronary Events (GRACE) risk score was evaluated and compared in between two groups. Out of 60 patients of STEMI, 30 patients had distortion of QRS complex. There were 7 deaths, 16 heart failure, 3 cardigenic shock and no recurrent myocardial infarction. Hospital mortality and heart failure were found to be significantly higher in distorted QRS group (1 vs. 6 patients p=0.04; 4 vs. 12 patients p=0.02; respectively), cardiogenic shock of both groups did not show significant difference (0 vs. 3 patients p=0.075). Multiple logistic regression analysis using hospital mortality as dependable variable and all studied risk factors were independent variables, QRS distortion on admission ECG and Killip class were only variable found to be statistically significant (OR=7.25, p value < 0.05 ; OR=16.25, p value < 0.05 respectively). GRACE risk score was significantly high in distorted QRS group and low in without QRS distorted group (6 vs 15 patients p=0.014; 6 vs 16 patients p=0.007; respectively). Intermediate GRACE score did not show any statistically significant difference between two groups (p=0.77). Careful analysis of ECG which is simple, cheap, universally available bed side investigation may offer important prognostic information in patients with STEMI and would help in deciding which patients should go urgent myocardial revascularization rocedure. Assessment of GRACE risk scoring is strongly encourage in everyday clinical practice as it provides reliable identification of STEMI patients who are at high risk of death.

Keywords: STEMI, Distorted QRS, Death, Heart failure, Cardiogenic shock, GRACE risk score

Abstract

Background: Pharmacovigilance is concerned with public health and adverse drug reactions. The essence of pharmacovigilance is the reporting of adverse drug reactions (ADRs). All health care professionals should have knowledge about pharmacovigilance.

Objective: To assess knowledge of unani and ayurveda practitioners regarding pharmacovigilance.

Methods: A cross sectional study was conducted among 190 selected Unani and Ayurveda practitioners who graduated from Govt-Unani and Ayurvedic medical college. Purposive sampling method was applied for sampling. A semi-structured questionnaire was developed and the respondents were interviewed face to face maintaining confidentiality and privacy. Study places were Govt-Unani and Ayurvedic Medical College of Dhaka and Sylhet and Private medical chambers of Unani and Ayurveda practitioners.

Results: This study revealed that out of 190 respondents 60% belonged to age group of 20-34 years and 3.7% were within the age group greater than 54 years and mean age were 34.55±7.42 years. 64.7% of the respondents were Unani practitioners and 35.3% were Ayurvedic practitioners. Regarding concept of pharmacovigilance, 22.6% of the respondents had good knowledge whereas 22.1% of the respondents had good knowledge about ADR and drug safety. Out of total 190 respondents 34.7% had good knowledge regarding pharmacovigilance, 35.8% of respondents had fair knowledge and 29.5% had poor knowledge regarding pharmacovigilance.

Conclusion: This study revealed that majority of Unani and Ayurveda practitioners had fair knowledge regarding pharmacovigilance. Education and training programs are necessary to improve knowledge of Unani and Ayurveda practitioners.

Keywords: Pharmacovigilance, ADR, Knowledge, Unani and Ayurveda Practitioners.

Abstract

Background: Literacy and stigma of suicide have been poorly assessed across the groups in Bangladesh even though they affect help-seeking behavior and have an enduring effect on suicide prevention.

Objective: We aimed to determine the status of literacy and stigma of suicide along with associated factors among medical students of Bangladesh.

Methods: This study was conducted from January to June 2022 among 172 undergraduate medical students in Bangladesh by Google form. Literacy and stigma were assessed by the Bangla literacy of suicide scale (LOSS-B), and the Bangla stigma of suicide scale (SOSS-B).

Results: The mean age of the participants was 22.81±1.8 (range 19-28) years, 64% were females, and 95% were unmarried. The LOSS-B score ranged from 0-10 with a mean of 4.72±1.97. The literacy was significantly higher in married students, students with chronic physical illness and psychiatric disorder, lifetime suicidal thoughts, and suicidal thoughts in the past year while stigma was significantly lower among females, with mental disorders, with a family history of suicide attempts, and students with suicidal thoughts in a lifetime and past year.

Conclusion: The study determines the level of suicide literacy and stigma towards suicide among medical students of Bangladesh. Having history of previous mental health services consumption of mental health services and past suicidal behavior revealed a better level that indicates the effectiveness of mass media campaigns for raising awareness and reducing stigma.

Keywords: Suicide literacy, stigma, suicide in Bangladesh, medical students, stigma reduction.

Abstract

Prader Willi Syndrome (PWS) is one of the most common genetic condition of childhood morbid obesity. Absence of expression of the paternally active genes on the long arm of chromosome 15 is responsible for this syndrome. A 4-year-old girl, presented with excessive weight gain since early infancy. She has developmental delay, mental retardation and Her physical features were suggestive of Prader-Willi syndrome. MS PCR detected deletion of the specific chromosomal region 15q11.2-q13 in the paternal allele which is causative of Prader-Willi syndrome. The syndrome has no cure but multidisciplinary approaches are available to improve associated problems. We confirm the case of Prader Willi Syndrome by genetic analysis, which is important for those who present with obesity and mental retardation.

Keywords: Prader-Willi syndrome, genome-wide copy number variation analysis, high resolution chromosome gene imprinting

Abstract

Background: Co-existence of a hydatidiform mole with a normal fetus is extremely rare and is considered as a high risk pregnancy.

Objective: It was an observational study conducted during July 2020 to march 2021.

The case: A 23 year old primigravida, referred with a diagnosis of 27 weeks pregnancy with gestational choriocarcinoma. She was a booked patient. USG report at 9 weeks with a single gestational sac and single fetal pole. Her complains were lower abdominal pain and brownish vaginal discharge. Serum Beta HCG was 3,23,280 IU/L. USG and fetal MRI report were single graved fetus, no anomaly detected and a large hyper echogenic soft tissue mass (10*7cm) interposed with multiple tiny cystic spaces near to placenta. Diagnosis was 28 weeks pregnancy with partial mole and high rising b HCG level. Thoroughly evaluated the patient to exclude distal metastasis. Proper counseling, the pregnancy was continued as per the patient’s desire. The pregnancy was closely monitored with serial serum bHCG and USG. Spontaneously labour pain start at 36 weeks pregnancy and delivered a live baby per vaginally at 36 weeks with near normal Apgar score. The placenta with molar tissue was sent for histopathological examination. The histopathologically confirmed partial mole with normal placenta. Beta HCG was 20,000 ml/L at 7 days and normal at 8 weeks after delivery. Close surveillance for 6 months. After 6 month follow-up, both mother and development of her baby are alright.

Conclusion: The diagnosis, management and monitoring of this condition will remain challenging because of its rarity. Though the general trend is to terminate pregnancy with coexistent mole in anticipation of complications, under close surveillance, optimal outcomes can be achieved.

Keywords: Molar pregnancy, co-exist normal viable fetus, successful pregnancy.