A RIPPLE EFFECT OF COVID-19 PANDEMIC ON SHORTAGE OF MEDICINAL PRODUCTS AND ITS IMPACT ON PATIENT CARE

Objective: Shortages of medicinal products are complex global problems. Drug shortages remain a significant public health issue. Global shortages of medical products have a potential effect on patient health and total healthcare costs. Countries worldwide, especially those affected by Coronavirus disease 2019 (COVID-19), is experiencing a rapid increase in drug shortage, which causes several complications for physicians, health care provider, patients, health institutes and health regulatory bodies. Methods: To carry out the study of shortages, several efforts have been taken by the regulators and industries. Prominent amongst these include FDA's research the needs and the reforms made in the regulations about shortages. We also searched for electronic databases (PubMed, Science direct, Web of Science) using the terms (COVID-19 and shortage) or (medicine and COVID-19) for articles in periods of 2019 to 2021. Results: On assessment based on the report, the number of shortage drugs in 2020 is 835; Anesthesia drugs are highest during the COVID-19 outbreak data indicate the number of shortages is 143 in USA. It was found that generic products were mostly in short supply, with antimicrobial agents (63%) topping the list of therapeutic categories of medicines with interrupted supply, followed by oncology medicines (47%) and then anesthetic agents (38%) during COVID-19 pandemic. Conclusion: Many steps have been taken to reduce the impact of a shortage of health care. Agencies like the United States Food and Drug Administration (US FDA) and European Medicines Agency (EMA) has established guidelines and works with manufacturers and other partners to help prevent shortages. This article aims to the analysis the root cause of medicinal product shortages, their effects on the patient outcome, medication error, which occurs due to the substitution safe and effective therapies with alternative treatments, identify possible solutions and policies established to manage medicinal product shortages

Mutation of NPHS1, NPHS2, WT1, LAMB2, COL4A5 and other genes in children with idiopathic steroid resistant nephrotic syndrome

Background: Many children with idiopathic steroid resistant nephrotic syndrome have been reported worldwide due to mutation of NPHS1, NPHS2, WT1 and LAMB2 genes. This study aimed to determine the frequency of mutation of NPHS1, NPHS2, WT1, LAMB2, COL4A5 and other genes and their association with renal histopathological patterns of idiopathic steroid resistant nephrotic syndrome patients. Methods: This cross-sectional study was conducted on 25 patients with idiopathic steroid resistant nephrotic aged 1-17 years in the Department of Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Bangladesh, from July 2017 to June 2018. Next Generation Sequencing and mutation analysis were performed after DNA extraction from patients\u27 venous blood lymphocytes. Histopathological study of renal tissue was done among 17 patients. Results:  A little more than half (56%) of the patients were male. The mean age at the initial attack of nephrotic syndrome was 94.2 months. They mostly had minimal change disease (41%) and IgA nephropathy (12%). One subject had the NPHS2 gene mutation, histopathologically diffuse mesangial proliferative glomerulonephritis, and clinically stage-4 chronic kidney disease. Another subject had the COL4A5 gene mutation and focal segmental glomerulosclerosis.  Both were male and had no familial renal disease, consanguinity, or hematuria. Conclusion: Children with idiopathic steroid resistant nephrotic syndrome showed NPHS2 and COL4A5 gene mutations. Histopathologically, they showed diffuse mesangial proliferative glomerulonephritis and focal segmental glomerulosclerosis

Novel chemical degumming process and its effect on structure and properties of mulberry fibres

366-371A novel chemical degumming (Fibre-N) method has been used to extract fibres from the bark of mulberry plant. Fibres obtained by a new method (Fibre-N) are characterized by the X-ray diffraction, scanning electron microscopy, Fourier transform Infrared spectroscopy, residual gum content, fibre yield, and mechanical property measurement. Fibre-N method exhibits 17.71% lower residual gum content, 37.18% higher breaking strength, 18.36% higher breaking elongation and 10.81% higher fibre yield. Fibre-N process used to extract fibres from mulberry plant is more economical and efficient, which could be used as a promising method for producing textile yarns, nonwovens, and composites

Novel chemical degumming process and its effect on structure and properties of mulberry fibres

A novel chemical degumming (Fibre-N) method has been used to extract fibres from the bark of mulberry plant. Fibres obtained by a new method (Fibre-N) are characterized by the X-ray diffraction, scanning electron microscopy, Fourier transform Infrared spectroscopy, residual gum content, fibre yield, and mechanical property measurement. Fibre-N method exhibits 17.71% lower residual gum content, 37.18% higher breaking strength, 18.36% higher breaking elongation and 10.81% higher fibre yield. Fibre-N process used to extract fibres from mulberry plant is more economical and efficient, which could be used as a promising method for producing textile yarns, nonwovens, and composites.

Assessment of lead augmented vector left (aVL on surface electrocardiogram) for confirming atrioventricular nodal reentrant tachycardia

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) stands as one of the most common forms of paroxysmal supraventricular tachycardia (PSVT), encompassing a wide spectrum of clinical presentations and diagnostic challenges. The aim of this study was to evaluate the assessment of lead aVL (surface ECG) for confirming AVNRT. Methods: This was a prospective observational study and was conducted at the Department of Cardiology and Electrophysiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh during the period from February 2019 to January 2020. Results: In our study 41 patients (66.1%) had AVNRT and 21 patients (33.9%) had AVRT on the final evaluation. Total 33.9% of patients had aVL notch on ECG. Among patients who had AVNRT, 46.3% had an aVL notch and among patients who had AVRT, 9.5% had an aVL notch on ECG. The difference was statistically significant (p=0.004). Among 21 patients who had aVL notch on ECG, 6 (31.6%) male patients had AVNRT, 13 (64.8%) female patients had AVNRT, 1 (50%) male patients had AVRT and 1 (50%) female patient had AVRT. Conclusions: In conclusion, the interpretation of electrocardiographic criteria, including the aVL notch, plays a pivotal role in confirming the diagnosis of AVNRT and guiding therapeutic interventions

Factors Associated with Klebsiella

Although Klebsiella bacteremia in children is perceived to be associated with fatal consequences, data are scarce on those children presenting with diarrhea. We evaluated the factors associated with Klebsiella bacteremia in such children. In this retrospective chart analysis, data of all diarrheal children was retrieved from electronic medical record system (named as SHEBA) of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), from January 1, 2010, to December 31, 2012, who had their blood culture done. This was a study having a case-control design where comparison of clinical and laboratory characteristics was done among children with Klebsiella bacteremia (cases = 30) and those without any bacteraemia (controls = 90). Controls were selected randomly. The cases more often had fatal outcome (p<0.001). In logistic regression analysis, after adjusting for potential confounders such as young age, severe dehydration, severe wasting, abnormal mentation, hypotension, and fast breathing, the cases were independently associated with hospital-acquired infection and positive stool growth (for all, p<0.05). The study highlights the importance of obtaining blood cultures in hospitalized children under five years old with diarrheal illness in the presence of either hospital-acquired infection or positive stool culture to have better outcome

Trends, determinants and inequities of 4+ ANC utilisation in Bangladesh

Background: The objectives of this study are to document the trend on utilisation of four or more (4+) antenatal care (ANC) over the last 22 years period and to explore the determinants and inequity of 4+ ANC utilisation as reported by the last two Bangladesh Demographic and Health surveys (BDHS) (2011 and 2014). Methods: The data related to ANC have been extracted from the BDHS data set which is available online as an open source. STATA 13 software was used for organising and analysing the data. The outcome variable considered for this study was utilisation of 4+ ANC. Trends of 4+ ANC were measured in percentage and predictors for 4+ ANC were measured through bivariate and multivariable analysis. The concentration index was estimated for assessing inequity in 4+ ANC utilisation. Results: Utilisation of 4+ ANC has increased by about 26% between the year 1994 and 2014. Higher level of education, residing in urban region and richest wealth quintile were found to be significant predictors. The utilisation of 4+ ANC has decreased with increasing parity and maternal age. The inequity indices showed consistent inequities in 4+ ANC utilisation, and such inequities were increased between 2011 and 2014. Conclusions: In Bangladesh, the utilisation of any ANC rose steadily between 1994 and 2014, but progress in terms of 4+ ANC utilisation was much slower as the expectation was to achieve the national set target (50%: 4+ ANC utilisation) by 2016. Socio-economic inequities were observed in groups that failed to attend a 4+ ANC visit. Policymakers should pay special attention to increase the 4+ ANC coverage where this study can facilitate to identify the target groups whom need to be intervened on priority basis

Aesthetic implant: A new era of aesthetic dentistry

The dental implant is used to replace the natural tooth system. It requires comprehensive preoperative planning and precise surgical execution. In this case report, a 45 year old male presented with missing upper left maxillary central incisor which was extracted 5 months back. He had discomfort during function and unwillingness to smile. He wanted to replace that edentulous area. The treatment options for replacing the missing tooth were discussed with the patient. Finally, with patient's consent the decision was made to replace that edentulous area with an implant supported porcelain fused to metal prosthesis in an esthetic manner. Recall visits exhibited patient's high-level confidence of smile with optimum satisfaction and successful aesthetic outcome.

Aesthetic implant: A new era of aesthetic dentistry

The dental implant is used to replace the natural tooth system. It requires comprehensive preoperative planning and precise surgical execution. In this case report, a 45 year old male presented with missing upper left maxillary central incisor which was extracted 5 months back. He had discomfort during function and unwillingness to smile. He wanted to replace that edentulous area. The treatment options for replacing the missing tooth were discussed with the patient. Finally, with patient\u27s consent the decision was made to replace that edentulous area with an implant supported porcelain fused to metal prosthesis in an esthetic manner. Recall visits exhibited patient\u27s high-level confidence of smile with optimum satisfaction and successful aesthetic outcome.

Mutation of NPHS1, NPHS2, WT1, LAMB2, COL4A5 and other genes in children with idiopathic steroid resistant nephrotic syndrome

Background: Many children with idiopathic steroid resistant nephrotic syndrome have been reported worldwide due to mutation of NPHS1, NPHS2, WT1 and LAMB2 genes. This study aimed to determine the frequency of mutation of NPHS1, NPHS2, WT1, LAMB2, COL4A5 and other genes and their association with renal histopathological patterns of idiopathic steroid resistant nephrotic syndrome patients. Methods: This cross-sectional study was conducted on 25 patients with idiopathic steroid resistant nephrotic aged 1-17 years in the Department of Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Bangladesh, from July 2017 to June 2018. Next Generation Sequencing and mutation analysis were performed after DNA extraction from patients' venous blood lymphocytes. Histopathological study of renal tissue was done among 17 patients. Results:  A little more than half (56%) of the patients were male. The mean age at the initial attack of nephrotic syndrome was 94.2 months. They mostly had minimal change disease (41%) and IgA nephropathy (12%). One subject had the NPHS2 gene mutation, histopathologically diffuse mesangial proliferative glomerulonephritis, and clinically stage-4 chronic kidney disease. Another subject had the COL4A5 gene mutation and focal segmental glomerulosclerosis.  Both were male and had no familial renal disease, consanguinity, or hematuria. Conclusion: Children with idiopathic steroid resistant nephrotic syndrome showed NPHS2 and COL4A5 gene mutations. Histopathologically, they showed diffuse mesangial proliferative glomerulonephritis and focal segmental glomerulosclerosis