Bangladesh Medical Research Council Bulletin (Vol. 50, No. 03, 2024)

Abstract

Background: Post-stroke depression (PSD) is one of the common emotional disorders associated with increased morbidity, mortality and strongest predictors for poor quality of life among stroke survivors.

Aims: To find out the frequency and risk factors for PSD.

Methods: A cross-sectional analytical study conducted from July 2020 to June 2021 comparing stroke patients with and without depression, whoever was attending for follow up of three to twelve months’ post-stroke duration. The cases were divided into two groups: depression and non-depression according to DSM-V criteria for major depressive disorder. Disability was measured using modified Rankin scale (score 0 complete recovery, 5 worst). Logistic regression was performed to identify risk factors for depression.

Results: A total of 258 stroke cases were recruited and 95 (36.8%) had depression. Mean (SD) age of depressed and non-depressed cases were 57.97(12.64) and 58.1(15.1) years respectively. Logistic regression indicated that ischemic stroke [OR 2.03, 95% CI (1.00-4.11), p= 0.049], disability [OR 4.69, 95% CI (1.09 - 20.16), p = 0.038] and left cerebral hemisphere lesion [OR 4.86, 95% CI (1.19-15.95), p= 0.011] were the important risk factors for post stroke depression.

Conclusion: In this study, we observed that nearly one-third stroke survivors had depression. Ischemic stroke type, having disability and left cerebral hemisphere lesion had strongest associations for the development of this depression. Future studies should explore the relationship for targeted prevention and treatment strategies.

Keywords: Post-stroke depression, risk factors, stroke

Abstract

Background: A lightning strike is an electric discharge between atmosphere and an object. It can produce severe injuries and deaths. Worldwide, mortality from lightning is estimated at between 0.2 and 1.7 deaths per 1000000 population, affecting mainly the young and people who work outdoors.

Objectives: The study was designed to find out the epidemiology of lightning related deaths and injuries in Bangladesh in 2018.

Methods: The cross sectional descriptive study or content analysis was carried out in Mymensingh Medical College, Bangladesh from November 2019 to April 2020. The contents of reports on lightning events occurred in 2018, published in three top circulated daily national newspapers were analyzed with SPSS version 22.0.

Results: A total of 247 lightning events were reported in 2018. A total of 379 persons were affected by lightning strikes. Mean age of the affected persons was 33.74 years with a standard deviation of 16.13 years. Majority (317, 83.6%) were male and the remaining 62 (16.4%) were female. Majority (111, 29.3%) of the affected persons were farmer. Most of the event (120, 48.6%) occurred in the month of May followed by in April (50, 20.2%) and September (28, 11.3%). Majority of the lightning (74, 30.0%) stroke in the field, while 45 (18.2%) stroke in river, pond, lake or in the haor areas. Maximum lightning events 73 (29.6%) occurred in the evening; followed by 56 (22.7%) in the morning and 23 (9.3%) at night. Out of 379 affected persons, 296 (78.1%) died and 83 (21.9%) were injured but survived. Lightning related mortality was 1.8 deaths per 1000000 population in Bangladesh in 2018.

Conclusion: Lightning related mortality in Bangladesh in 2018 was 1.8 deaths per 1000000 population which was much more higher than 0.9 deaths per 1000000 population in 2010. The incidence of thunderstorms are increasing in Bangladesh and often farmers working in the field and people on the road are affected. Policy makers should take necessary steps to decrease the events of lightning and to minimize the mortality and morbidity due to lightning strikes. People should be aware of danger of lightning and stay safe while lightning strikes.

Keywords: Epidemiology, Lightning, Injuries, Deaths, Bangladesh.

Abstract

Background:Stroke is a leading cause of death globally and many stroke survivors lead their lives with multiple disabilities. Rehabilitation is a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment. Stroke rehabilitation is a continuum, starting within days of onset and ending only when it no longer produces any positive effects.

Objective: To evaluate the impact of the rehabilitation team approach on disability among stroke patients

Methods: This was a quasi experimental study which was conducted in the Physical Medicine and Rehabilitation Department of Bangladesh Medical University (BMU), Dhaka, Bangladesh from November, 2021 to October, 2022. Where 136 subjects were selected and divided in two groups: Group-A (received Rehabilitation Team Approach) and Group-B (received Conventional Rehabilitation Approach) by lottery. Respondents were assessed at 6th weeks, 12th weeks, and 26th weeks. Outcomes were measured by FIM (Functional Independence Measure) scores.

Results: Among 136 patients, 68 patients in group A and 68 patients in group B had completed 26th week follow up. The mean age of the patients in group A and B were 57.25 (± 7.22) and 57.09 (± 6.38) years respectively. Majority of the patients were male (72.06 % & 76.47 % in group A & B respectively). Among the study people Main cause of disability was ischemic 88(64.71%) and hemorrhagic 48(35.29%) stroke. At baseline and after 6th week of treatment, there were no significant statistical differences between the two groups regarding FIM scores. In 12th week, FIM significantly increased in group A (108.17 ± 9.52) compared to group B (103.79 ± 7.37) respectively with a p-value 0.0032 which persisted till 26th week 115.62 ±5.07 & 110.22 ± 4.97 with a p-value <0.0001 in group A & B respectively.

Conclusion: In this study found out that rehabilitation team approach significantly reduces disability of the stroke patients.

Keywords:Rehabilitation Team Approach, Conventional Team Approach, FIM, Stroke rehabilitation.

Abstract

Background:The COVID-19 pandemic poses an urgent need to understand the role of host immunity in viral infections. Peripheral blood lymphocytes play an important role in the immune system. The disrupted immune response can lead to alterations of lymphocyte counts among COVID-19 patients.

Objectives: The study aimed to quantify and compare the peripheral blood lymphocytes, including CD3+ T cells, CD4+ T cells, CD8+ T cells, B cells and Natural killer cells in COVID-19 patients according to clinical severity.

Methods:The cross-sectional study was conducted from March 2020 to January 2021 in the Department of Microbiology and Immunology, Bangladesh Medical University. A total of 103 RT-PCR confirmed COVID-19 patients and 20 healthy subjects were enrolled. COVID-19 patients were clinically categorized into asymptomatic (n=18), mild-moderate (n=38) and severe-critical (n=47) groups. Peripheral venous blood samples were collected from study groups and immunophenotyping was done by flow cytometry

Results: Compared to the healthy group, COVID-19 patients had significantly decreased percentages of total peripheral lymphocytes and T cells (P < .0001 and P= .002, respectively). The percentage of B cells increased (P=.001) while NK cells remained statistically unchanged in COVID-19 patients. In accordance with clinical severity, the severe-critical group had a decrease in total lymphocytes and T cells than the asymptomatic and mild-to-moderate groups (P<.001). Furthermore, CD4+ and CD8+ T cell counts were decreased in severe-critical COVID-19 patients compared to asymptomatic and mild-moderate patients (P<.001).

Conclusion: Patients with severe COVID-19 showed a significant decrease in total lymphocytes, including T cells, CD4+ T cells and CD8+ T cells. Therefore, lymphocyte immunophenotyping could be an important laboratory approach in monitoring COVID-19 patients.

Keywords:COVID-19, Peripheral blood lymphocyte, Flow cytometry, Lymphocyte immunophenotyping.

Abstract

Acute viral myositis is a rare condition that may occur even during the recovery phase of an illness. We report a case of a 72-year-old female who presented with proximal muscle weakness and myalgia three weeks after an episode of fever. A thorough clinical, laboratory, and electrophysiological evaluation was done. The initial creatinine phosphokinase (CPK) was very high. The nerve conduction study (NCS) was normal, and needle electormyogram (EMG) showed some features of denervation with myopathic motor unit action protential (MUAPs). Histopathological findings were also suggestive of inflammatory myopathy. Both anti-cytomegalovirus IgM and IgG were positive. However, the patient improved rapidly over a short period with normalization of CPK without any corticosteroid or immunosuppressive treatment. Based on the above features and the self-limiting nature of the disease, the patient was diagnosed as a case of Cytomegalo virus (CMV) induced myositis. Viral myositis is a self-limiting myopathy that mimics polymyositis as both having similar clinical and laboratory features. Though it is not common, early diagnosis of viral myositis, if possible can reduce the hazard of long-term use of immunosuppressive medications.

Keywords: Cytomegalovirus, creatine kinase, polymyositis, viral myositis