A 12-year-old boy presented with jaundice, abdominal distension and leg edema

This article has no abstract. The first 100 words appear below: A 12-year-old immunized boy, 3rd issue of consanguineous parents, presented with jaundice for the last 4 months and gradual abdominal distension for last 2 months. Mother also mentioned the swelling of both ankles for the same duration. He had anorexia, nausea and generalized weakness. There was no history of previous jaundice, blood transfusion, surgical procedure, history of taking offending drugs, no family history of liver disease, deterioration of school performance or neuropsychiatric manifestations, bleeding manifestations, behavioral abnormality, altered consciousness or convulsion

Are Boys at Risk of Low Immune Response to Recombinant Hepatitis B Virus Vaccine in Steroid Sensitive Nephrotic Syndrome?

Introduction: This study was conducted to evaluate the immune response following vaccination with different doses and to compare the antigen specific antibody response to Hepatitis B Vaccine (HBVac) in Steroid Sensitive Nephrotic Syndrome (SSNS) patients between boys and girls.Materials and Methods: This prospective study was conducted in 30 SSNS children at Bangladesh Institute of Child Health, Dhaka, Bangladesh from July 2012 to June 2013.Thirty patients who had all features of Minimal Change Nephrotic Syndrome (MCNS) according to International Study for Kidney Diseases for Children (ISKDC) and received oral prednisolone every alternate day and were HBsAg negative were enrolled in the study. The patients were randomly assigned to one of the two treatment group to receive either 0.5 ml (10μg) or double dose 1ml (20μg) of HB vaccine in a 0-1-2month schedule. After excluding hepatitis B virus infection, the vaccine was administered at a standard dose in group-A (0.5 ml or 10 microgram) and at a double dose (1 ml or 20 microgram) in group-B. After one month of the last dose, the seroprotection rate was measured and compared among sexes.Results: The mean age of the participants in group-A was 5.81 ± 1.73 years with a boy to girl ratio of 9:6 and the mean age of the subjects in group-B was 5.65 ± 1.68 years with a boy to girl ratio of 8:7. The mean vaccine titer was 25.60 ±19.97 mIU/ml in group-A and 617.47 ±292.11 mIU/mlin group-B, with a significant difference (p<0.05) between the two groups. Irrespective of the dose, the mean vaccine titer was higher in girls (37.33 ± 19.45 mIU/ml) compared to boys (16.22 ± 14.81mIU/ml) and the difference was statistically significant in group-A. It was also observed that the mean vaccine titer was significantly higher in girls (743.00±252.34mIU/ml) compared to boys (394.88±246.63 mIU/ml) in group-B (p<0.05,t-test).Conclusions: The results of our study showed a reduced response to HB Vaccine boys with SSNS in comparison to girls. As the study size was small, single center study and time limited follow-up, we cannot draw any valid conclusions.Keywords: Immune deficiency; Sex differences; Steroid Sensitive Nephrotic Syndrome; Seroconversion

The effectiveness of intrapartum cardiotocography with fetal outcome-a hospital-based study

Background: The determination of the fetal condition during labour is important to minimize fetal mortality, morbidity and neurological sequelae of fetal hypoxia. The study aims to evaluate the effectiveness of intrapartum cardiotocography (CTG) in detecting fetal outcomes. Methods: This cross-sectional observational study was conducted at the department of obstetrics and gynecology in the centre for women and child health (CWCH), Ashulia, Dhaka from November 2020 to August 2022. The study was carried out with a total of 63 pregnant women (n=63) who had delivered their child either by lower uterine caesarian section (LUCS) or normal vaginal delivery (NVD) during the study period. Result: Among the participants, almost half participants (47.6%) were aged between 25-29 years. Intrapartum CTG was reactive in around half (54%) of the participants, while non-reactive in 46% of the participants. During the study period, intrapartum CTG was reactive in 34 patients. Of them, only 19 patients had an NVD, while 15 patients despite normal intrapartum CTG also underwent LUCS due to various reasons such as having meconium-stained liquor or slightly stained liquor, non-progressing labour or prolonged labour, premature rupture of the membrane (PROM), fear of NVD etc. During the study period, all twenty-nine patients having intrapartum non-reactive CTG underwent LUCS. During the study period, intrapartum CTG was non-reactive in 29 cases. However, after delivery, the baby’s APGAR score was ≥7 for the 20 neonates of those 29 non-reactive CTG cases. On the other hand, intrapartum CTG was reactive in 34 of the participants. Among them, 3 neonates were delivered through NVD. However, meconium-stained liquor was found and the baby’s APGAR score was <7, which required NICU admission. In total, thirteen neonates (13, 20.6%) had required admission to the neonatal intensive care unit (NICU). Conclusions: CTG is one of the reliable methods of monitoring the fetus. Non-reactive CTG record with a high probability indicates the likelihood of the presence of perinatal asphyxia. Instant and adequate decisions regarding obstetric intervention and optimal procedures should be taken if fetal distress is suspected.

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

The synthesis of small molecule tools to study biological processes

This thesis consists of three separate chapters with individual projects: 1. Chapter 1: Developing a Chemical Biological Approach to Study E3 Ligase Activity: This is the main project of this thesis; this project aims to develop a novel chemical approach to study the formation of PPIs (Protein-Protein Interactions) in cells. The PPI system that is of interest is the ubiquitin proteasome system (UPS), with the aim to develop a set of chemical tools to study the biological activity of E3 ligases that have been recently discovered as potential drug targets. 2. Chapter 2: Understanding the Mechanism of PTC-209, a Potential Protein Translation Inhibitor (completed at the University of Toronto): The project aims are to better understand mechanism of PTC-209, as currently the known mechanism of PTC-209 is not strongly supported. Utilising the aminothiazole central core that is present in PTC-209 as a building block and varying the fragments to help identify what causes the activity seen in literature. 3. Chapter 3: Synthesis of a Lysine Covalent Ibrutinib Derivative (completed at the University of Toronto): This project aims to find an alternative solution to effectively inhibit BTK for treatment of B cell tumours. With the aim to alter ibrutinib’s scaffold to overcome the current ibrutinib design that results in patient relapse and is explained by the mutation of the targeted residue

SUPPLY-SIDE EFFECT OF HEALTH CARE FACILITIES ON PRODUCTIVITY AMONG THE FEMALE WORKER IN THE READYMADE GERMENT SECTOR

This study was conducted in 4 selected garment factories within Dhaka city. The objectives of this study were to find out health care access (Supply-side effect) in the garments factory for the women workers and their relation to the productivity. A total of 300 women garment workers were included in this study. Most (60.0%) of the respondents were adolescents, unmarried and having only primary level education (5 years of school education). Their average take home monthly salary was 1791.7 taka which was spent mostly on food. They passed a tight work schedule from 6 AM to 11.30 PM without any rest. Hundred percent of female workers had no previous idea about garments nor had any formal training, but they produced on an average 1016 garment pieces a day. They did not get any vaccine, health education or health related knowledge from the garments factory. There was no provision of health care centre or doctor, treatment for fire burn (other than gas), medicine and support in chronic, severe illness for themselves or their family members. More than half (63.0%) of the respondents mentioned about loss of time due to illness. There was a strong correlation (r=0.858) between sickness and production loss, between hour loss and production loss (r=0.9283), between production loss and percentage loss (r=0.871). Though there was loss due to illness, no health access or facility for women workers in the garments factory was available. To overcome the situation and improve the productivity, owners have to provide health access and women workers have to come forward for their rights. Ibrahim Med. Coll. J. 2008; 2(1): 4-

Solitary rectal ulcer syndrome in a teenage patient, an unrecognized cause of rectal bleeding: A case report

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Social impact and healthcare- seeking behavior for urinary incontinence among perimenopausal women attending gynae out patient department in BSMMU

Background: Urinary incontinence (UI) is a highly prevalent and burdensome condition among women.However,fewer than half of women with symptoms consult with a physician about incontinence, and determinant of treatment seeking are not well understood.Objectives: The aim of this study was to determine the prevalence, awareness and determinants of urinary incontinence (UI) among women attending GOPD in BSMMU and the sociodemographic factors involved in their health care-seeking behaviour.Methods: Cross-sectional study was carried out in Gynaeout patient department of Bangabandhu Sheikh Mujib Medical University with a sample of 800 women aged 45 yrs and above.Results: A total of 1000 women were recruited for the study by purposive sampling,among them 800 agreed to participate and completed the questionnaire. Of these, 165 (20.6%) were found to have UL Overall, the reason for not seeking medical attention was mainly embarrassment (40.6%) at having to speak with doctor. Of the total study sample, 566 subjects (70.6%) believed that UI was abnormal and worth reporting to a doctor. Coping mechanisms among incontinent women included frequent washing (58.3%) and wearing a protective perineal pad (42.4%), changing underwear frequently (41.3%), decreasing fluid intake (19.8%) and stopping all work (4.9%). Sufferers were most troubled by their inability to pray (64%) maintain marital relationship (47%), limitation of their social activities (20%), difficulty in doing housework (14%) and inconven­ience during shopping (13%). Most (56%) found it most embarrassing to discuss UI with their husbands. The majority of women (51.9%) believed child birth to be the major cause ofUI, followed by ageing (49.5%), menopause (34.2%) and paralysis (25.3%). Most of the subjects (62.3%) believe that UI can cause infection, some (20.5%) believe that it can cause skin allergy and very few think that it can cause cancer or other disorders.Conclusions: Our findings indicate that although UI is relatively common ,it is undereported by the women because of social and cultural attitudes. This findings suggest that strategies to promote care-seeking for incontinence must be developed and employed in the community

Social impact and healthcare- seeking behavior for urinary incontinence among perimenopausal women attending gynae out patient department in BSMMU

Background: Urinary incontinence (UI) is a highly prevalent and burdensome condition among women.However,fewer than half of women with symptoms consult with a physician about incontinence, and determinant of treatment seeking are not well understood. Objectives: The aim of this study was to determine the prevalence, awareness and determinants of urinary incontinence (UI) among women attending GOPD in BSMMU and the sociodemographic factors involved in their health care-seeking behaviour. Methods: Cross-sectional study was carried out in Gynaeout patient department of Bangabandhu Sheikh Mujib Medical University with a sample of 800 women aged 45 yrs and above. Results: A total of 1000 women were recruited for the study by purposive sampling,among them 800 agreed to participate and completed the questionnaire. Of these, 165 (20.6%) were found to have UL Overall, the reason for not seeking medical attention was mainly embarrassment (40.6%) at having to speak with doctor. Of the total study sample, 566 subjects (70.6%) believed that UI was abnormal and worth reporting to a doctor. Coping mechanisms among incontinent women included frequent washing (58.3%) and wearing a protective perineal pad (42.4%), changing underwear frequently (41.3%), decreasing fluid intake (19.8%) and stopping all work (4.9%). Sufferers were most troubled by their inability to pray (64%) maintain marital relationship (47%), limitation of their social activities (20%), difficulty in doing housework (14%) and inconven­ience during shopping (13%). Most (56%) found it most embarrassing to discuss UI with their husbands. The majority of women (51.9%) believed child birth to be the major cause ofUI, followed by ageing (49.5%), menopause (34.2%) and paralysis (25.3%). Most of the subjects (62.3%) believe that UI can cause infection, some (20.5%) believe that it can cause skin allergy and very few think that it can cause cancer or other disorders. Conclusions: Our findings indicate that although UI is relatively common ,it is undereported by the women because of social and cultural attitudes. This findings suggest that strategies to promote care-seeking for incontinence must be developed and employed in the community