Pattern and risk factors of acute poisoning in a tertiary hospital of Central Bangladesh

Objective: Acute poisoning is a common cause of hospital admission in Bangladesh. But, risk factors and characteristics of victims of different modes of poisoning have not been evaluated for possible intervention strategies. So, in this study we aimed to describe the pattern of acute poisoning in central Bangladesh as well as identifying risk factors for various mode of poisoning. Methods: A prospective observational study was undertaken in Dhaka Medical College Hospital in 2015. Consenting adult acute poisoning victims were included as study subjects. A pretested structured case record form was used to systematically record the cases. The poisoning cases were defined by clinical toxidrome (sympathomimetic, antimuscarinic, opioids, cholinergic, sedative, etc) during acute presentation with suspected poisoning and groups accordingly. SPSS 20 was used for data analysis and statistical tests including mean ± standard division (SD), percentage, t test and chi-square were used accordingly. Results: Total poisoning cases were 1155. Suicidal (62.25%, n = 719), commuter poisoning (24.16%, n = 279) and accidental poisoning (12.38%, n = 143) were main types of poisoning. Risk factors of suicidal poisoning were young females of 11 to 30 years, married, housewives and students (P < 0.0001). Stressful relationship was the commonest reason of suicidal poisoning. Pesticides and sedatives were frequently chosen for easy availability. Commuter poisoning was common in males and urban areas (P < 0.0001). Accidental poisoning was more in males and rural areas (P < 0.0001) and snake envenomation was the main cause. Conclusion: Poisoning burden is high in central Bangladesh. Identified risk factors will help develop poisoning prevention strategies

Seroepidemiological surveillance of Burkholderia pseudomallei in Bangladesh

AbstractMelioidosis (Burkholderia pseudomallei infection) has yet to be demonstrated systematically in Bangladesh. A prospective, cross-sectional serological survey was conducted in 2010 at six Bangladeshi hospitals. Age, gender, occupation and residential address were recorded. Of 1244 patients, 359 (28.9%) were positive for B. pseudomallei by indirect haemagglutination assay. Farmers had an increased risk of seropositivity (risk ratio=1.4, 95% CI 1.0–1.8; p=0.03). There was no clear geographic clustering of seropositives. Melioidosis should be considered as a possible cause of febrile illness in Bangladesh. Further studies are needed to establish the incidence of clinical disease and distribution of environmental risk

Construction of copy number variation landscape and characterization of associated genes in a Bangladeshi cohort of neurodevelopmental disorders

Introduction: Copy number variations (CNVs) play a critical role in the pathogenesis of neurodevelopmental disorders (NDD) among children. In this study, we aim to identify clinically relevant CNVs, genes and their phenotypic characteristics in an ethnically underrepresented homogenous population of Bangladesh. Methods: We have conducted chromosomal microarray analysis (CMA) for 212 NDD patients with male to female ratio of 2.2:1.0 to identify rare CNVs. To identify candidate genes within the rare CNVs, gene constraint metrics [i.e., “Critical-Exon Genes (CEGs)”] were applied to the population data. Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) was followed in a subset of 95 NDD patients to assess the severity of autism and all statistical tests were performed using the R package. Results: Of all the samples assayed, 12.26% (26/212) and 57.08% (121/212) patients carried pathogenic and variant of uncertain significance (VOUS) CNVs, respectively. While 2.83% (6/212) patients’ pathogenic CNVs were found to be located in the subtelomeric regions. Further burden test identified females are significant carriers of pathogenic CNVs compared to males (OR = 4.2; p = 0.0007). We have observed an increased number of Loss of heterozygosity (LOH) within cases with 23.85% (26/109) consanguineous parents. Our analyses on imprinting genes show, 36 LOH variants disrupting 69 unique imprinted genes and classified these variants as VOUS. ADOS-2 subset shows severe social communication deficit (p = 0.014) and overall ASD symptoms severity (p = 0.026) among the patients carrying duplication CNV compared to the CNV negative group. Candidate gene analysis identified 153 unique CEGs in pathogenic CNVs and 31 in VOUS. Of the unique genes, 18 genes were found to be in smaller (<1 MB) focal CNVs in our NDD cohort and we identified PSMC3 gene as a strong candidate gene for Autism Spectrum Disorder (ASD). Moreover, we hypothesized that KMT2B gene duplication might be associated with intellectual disability. Conclusion: Our results show the utility of CMA for precise genetic diagnosis and its integration into the diagnosis, therapy and management of NDD patients

Perceptions about Telemedicine among Populations with Chronic Diseases amid COVID-19: Data from a Cross-Sectional Survey

Chronic diseases, including non-communicable diseases (NCDs), have arisen as a severe threat to health and socio-economic growth. Telemedicine can provide both the highest level of patient satisfaction and the lowest risk of infection during a pandemic. The factors associated with its usage and patient adherence are not visible in Bangladesh's resource-constrained settings. Therefore, this study aimed to identify perceptions about telemedicine among populations with chronic diseases amid the COVID-19 pandemic. A closed-ended self-reported questionnaire was created, and the questionnaire was written, reviewed, and finalized by a public health investigator, a psychiatrist, and an epidemiologist. The data for this study were collected from individuals using simple random sampling and snowball sampling techniques. Ethics approval was granted, and written/verbal consent was taken before interviews. Most of the participants showed a positive attitude towards telemedicine. People aged 35-54 years old and a higher level of education were less frequently associated with willingness to receive telemedicine services for current chronic disease (WRTCCD) than their counterparts. People living in urban areas and lower-income participants were more strongly associated with WRTCCD. Additionally, people who did not lose their earnings due to the pandemic were less strongly associated with WRTCCD. However, the main strength of this research is that it is a broad exploration of patient interest in several general forms of telehealth. In Bangladesh, there are many opportunities for telemedicine to be integrated into the existing healthcare system, if appropriate training and education are provided for healthcare professionals

Correction: Cardiovascular Risk Factors and Clinical Outcomes among Patients Hospitalized with COVID-19: Findings from the World Heart Federation COVID-19 Study.

This article details a correction to: Prabhakaran D, Singh K, Kondal D, Raspail L, Mohan B, Kato T, et al. Cardiovascular Risk Factors and Clinical Outcomes among Patients Hospitalized with COVID-19: Findings from the World Heart Federation COVID-19 Study. Global Heart. 2022; 17(1): 40. DOI: http://doi.org/10.5334/gh.1128

VIEW POINT ANTIVENOM FOR SNAKE BITE: CRITICAL SUPPLY IN HEALTH CARE SETTINGS

Poisonous snake bite is common in Bangladesh, especially on the countryside. Often fatality occurs in these cases due to lack of anti-snake venom supply in rural areas. Health professionals are sometimes found wanting in skills and knowledge in dealing with such cases. Critical care support is essential in every case of snake bite which, unfortunately, is underdeveloped in our country. We are in urgent need of locally produced anti-snake venom to ensure availability of this life-saving drug in all parts of the country

Patterns of Self Poisoning by Household Substances ............................................................................IJMTFM (2011) 1(2):59-64

Background: Poisoning is an important public health problem in developing countries like Bangladesh; self poisoning with organophosphorous compound (OPC) used in agriculture is particularly common. However, tertiary level hospitals in urban settings, self-poisoning with different household substances is also frequent, especially in teenagers. This study aims to identify the common household substances used for self harm and describe their clinical profile. Methods: A prospective study was performed in five adult medicine units of Dhaka Medical College Hospital over a period of six months from January 2008 to June 2008. Data were collected purposefully in a standard case record forms. Results: One hundred and twenty eight patients with a definite history of self poisoning were enrolled. Majority of patients came from urban areas (77.4%); mean age was 20 years and 48.1% were unmarried. Most patients (102, 76.7%) were female. A suicidal intention was mentioned in 88.7% of cases and family disharmony (70.7%) was the main reported reason. Most of the patients (119, 89.4%) were educated with at least Primary school. The most commonly used compounds were Savlon (Chlorhexidine 0.05%, Cetrimide 0.5%) in 50.4% of cases and Harpic(Sodium alkyle benzene sulphonate &amp; sodium alkene sulphonate) in 30.8% of poisoning cases. 92.5% of patients sought treatment in a public hospital. All patients received supportive and symptomatic treatment, commonly with intravenous fluids and omeprazole. Recovery was usually fast; 92.9% improved within two days. All patients survived and no complications were noted. Conclusion: Though poisoning due to household substances is usually mild, prompt recognition and early treatment is important. An effort should be made to define preventive measures that can be implemented in order to reduce this common form of self poisoning

A 32-YEAR-OLD OBESE MALE WITH PROLONGED INCREASED TRANSAMINASE LEVEL ASSOCIATED WITH NASH AFTER HBV HEPATITIS

Nonalcoholic steatohepatitis (NASH) is an underdiagnosed liver disease and is the main cause of persistent elevated serum liver enzymes among the general population. Here, we report the case of a 32-year-old obese man who was diagnosed as a case of chronic hepatitis caused by HBV infection. He was treated with Lamivudine for two years. Though his HBV DNA load became negative, he had persistently elevated ALT and AST for two years. Then a liver biopsy was planned for greater diagnostic and prognostic certainty, as the patient was obese, and aspartate transaminase to alanine transaminase ratio was greater than one. The histopathology showed steatosis, ballooning degeneration, microinflammation and fibrosis compatible with non-alcoholic steatohepatitis. We present the case as we think that clinicians should be aware of the possibility, that hepatitis B viral hepatitis with prolonged elevated serum liver enzymes might be associated with non-alcoholic steatohepatitis

Clinico-Epidemiological study of poisoning in a tertiary care hospital in Bangladesh

Objective: The scale of the problem of poisoning is enormous hence clinico epidemiological spectrum of all poisoning cases need to explore to generate the management tool. Methods: This prospective study was done at two medicine units (Unit 5 and 10) of Dhaka Medical College Hospital from July to December 2010 where all poisoning cases were seen. A total of 2890 patients were admitted out of which 600 were taken into the study. Results: Among the poisoning cases 29% were pesticide, 27% travel related poisoning, and 20% benzodiazepine. 70% of poisoning occurred below 30 years of age and male: female ratio was 3:2. Incidence of poisoning was highest among students (31%) and housewives (25%). Majority of the patients were from urban area (76%) and most common intention was suicidal (66%). Familial disharmony was the prime cause (63%) behind poisoning. 42% cases got admitted between 5-8 hours of poisoning and more than 80% patients were admitted in the hospital directly without getting any first aid anywhere. Sixty-eight percent had Glasgow coma scale (GCS) score above 10 during admission. Cardinal clinical features of poisoning were nausea/vomiting (63%), drowsiness (56%), miosis (31%). Seventy percent patients were treated with only general and supportive treatment and specific antidotes were used in 30% cases. Case fatality for pesticide, benzodiazepine/anti-psychotic, rodenticide and snake bite was 6.9%, 2.2%, 8.3% and 3.3% respectively. Conclusion: To assess the magnitude of problem, awareness of the public for prevention, immediate first aid measures and quick hospital admission is crucial component of poisoning