bluuebunny/crossref_metadata_2025 huggingface dataset:
ТРУДОВЕ НАВЧАННЯ УЧНІВ З ОСОБЛИВИМИ ОСВІТНІМИ ПОТРЕБАМИ У ДИСТАНЦІЙНОМУ ФОРМАТІ: ПОРАДИ ТА РЕКОМЕНДАЦІЇ
Authors: Чеботарьова Олена , Абакумова Ірина
Published: August 2023

У статті розкривається актуальність організації дистанційного навчання учнів старшого шкільного віку з особливими освітніми потребами в умовах воєнного стану в країні. Розглянуто способи організації дистанційного навчання школярів з порушеннями інтелектуального розвитку в умовах воєнного стану в країні.

Висвітлено основні аспекти, які слід враховувати у процесі трудового навчання у дистанційному форматі.

Розглянуто особливості дистанційного формату трудового навчання учнів з особливими освітніми потребами. Висвітлено методичні поради та рекомендації щодо дистанційного навчання школярів з порушеннями інтелектуального розвитку. Представлено практичні рекомендації з організації проектно-технологічного навчання учнів старшої ланки школи в сучасних умовах кризових викликів: уроки кулінарії, міні проекти з розділу «Технологія побутової діяльності та самообслуговування», тематичні вироби до календарних свят тощо.

Охарактеризовано проблеми організації, навчально-методичного забезпечення навчання дітей з порушеннями інтелектуального розвитку, необхідність створення ефективної системи психолого-педагогічного супроводу дітей та їхніх родин в умовах кризових викликів; наявність певних психофізичних обмежень у дітей з порушенням інтелектуального розвитку.

Акцентується увага на важливості злагодженої роботи усіх фахівців закладу, що передбачає залучення педагогів, батьків, створення умов для постійного удосконалення освітнього процесу.

В результаті дослідження обґрунтовано необхідність дотримання у процесі трудового навчання організаційно-педагогічних умов та представлених нормативно-правових та навчально-методичних рекомендацій, технологій та прийомів ефективної взаємодії усіх учасників процесу.

Представлено перспективи подальшого дослідження з окресленої проблематики.
Chronic kidney disease and anemia: updated management issues
Authors: Kafle Mukunda Prasad
Published: August 2023

Anemia is common in patients with chronic kidney diseases (CKD). It is a common complication of advanced CKD. Its prevalence in CKD stage 5 populations is over 50%. The hormone “erythropoetin” (EPO) secreted by the kidneys is essential in the maintenance of adequate hemoglobin in human body. Scientific Presentation BJM Vol. 34 No. 2(1) Suppliment 2023 177 Apart from failure of EPO secretion, many other factors including chronic inflammation, uremic bone marrow suppression, hyperparathyroidism, poor absorption of substrates from the uremic gastrointestinal tract etc. contribute to development of anemia in patients living with advanced kidney failure and dialysis. Iron deficiency state due to absolute or relative iron deficiency is common in CKD population. Furthermore, nutritional anemia is common in general population in our part of the world. Majority of this is also a result of iron deficiency. Replenishing iron stores in the body is the first strategy in the management of this condition. Besides the use of iron, deficiencies of other substrates like vitamin B12 should also be taken into account while managing anemia in CKD. Ferric citrate can be used as an hematinic and phosphate binder as well. Blood transfusion was invariable treatment strategy in the remote past. Though oral and parenteral iron and other hematinics are routinely used in the management of CKD, various erythropoesis stimulating agents (ESAs) used as injectable solutions lead the current therapeutic strategy in the treatment of anemia in patients with end stage renal disease (ESRD) and renal replacement therapies. More recently newer agents, the prolylhydroxylase inhibitors (PHI) like roxadustat which act as hypoxic ischemic factor (HIF) stabilizers have been more appealing to the patients and the clinicians. In contrast to the parenteral administration of ESAs, these new agents can be administered orally. While anemia is common, ideal treatment for anemia in CKD is still unsolved riddle and demands further research.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 177-178
Communication: A Basic Skill of Medical Practice
Authors: Mathur Girish
Published: August 2023

The doctor-patient relationship is central to the practice of medicine and is essential for the delivery of high-quality healthcare in the diagnosis and treatment of disease. There is utmost need for effective communication in medical practice. Communication is the key that unlocks a number of benefits. It leads to increased patient satisfaction, better understanding of the treatment, improved compliance, and overall better health. Therefore, clearer communication better understanding, and thus, better outcomes in the patients’ and attendants’ satisfaction. The need for communication with patients should be emphasized as it helps patients feel at ease, reduces their anxiety and builds their confidence, makes patients/clients feel valued, and reduces the chances of medical errors. Some of the key barriers to effective communication are such as personal barriers: negative attitude by doctors towards communication and giving it a low priority due to their concern primarily to treat illness rather than focus on patients’ other needs which may be psychological or related to social wellbeing. Human failings, such as tiredness and stress: A lack of inclination to communicate with patients. This can be due to lack of time, uncomfortable topics, lack of confidence and concerns relating to confidentiality. Inconsistency in providing information and giving conflicting information by different healthcare providers. Organizational barriers, lack of time, pressure of work being subjected to interruptions. If the complains are justified it is important that you apologize and ask the relatives what they would like to be done about it. Any problem that the family feels or experience should be actively identified and appropriate action should be taken to resolve them. If their demanding behavior continues, set the limit and you can tell them that you cannot do better than what is being done. If the relatives insist on continuing to disagree about the patient’s management, it may be necessary to call some senior doctor to try to explain and convince them. Imparting bad news is an emotional experience for the doctor as well as the patient and requires additional targeted strategies. When you speak to the patient they get the chance to clarify their doubts. Medical schools/ Colleges must be encouraged to provide the best possible communication skills training as part of the core undergraduate curriculum. This training should have set objectives and clear methods of assessment. More communication skills training programs should be developed at post graduate level. Doctors should use the appraisal process as a vehicle for discussing the success of communication skills training.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 178
Changing Concepts in Treatment of ST-Segment Elevation Myocardial
Authors: Khalequzzaman Md
Published: August 2023

ST-Segment Elevation Myocardial (STEMI) is a lifethreatening condition that requires emergent, complex, well-coordinated treatment. Although the primary goal of treatment is simple to describe, reperfusion as quickly as possible- the management process is complicated and is affected by multiple factors including location, patient and practitioners’ characteristics. Indeed, treatment of acute STEMI has progressed considerably over the past 100 years, from the early stages of bed rest and development of thrombolytics and myocardial reperfusion, to today’s current strategy with a variety of mechanical and pharmacologic modalities. But the debate continues regarding optimal antithrombotic/anticoagulant and interventional strategies employed. Given the scientific and technological advantages, treatment strategies can be catered to better suit the patient and their presentation. Fibrinolytic therapy did save the lives compared to placebo, but at best restored Thrombolysis in Myocardial Infarction (TIMI) 3 Flow in 55-70% cases with increased incidence of recurrent ischaemia and infarction and intracranial haemorrhage. From Primary Angioplasty in Myocardial Infarction (PAMI) to 23 RCTs of Thrombolysis in Myocardial Infarction (TIMI) Vs Lysis showed that there is significant reduction in death (7.0% Vs 9.3%), Re-infarction (2.5% Vs 6.8%), haemorrhagic stroke (0.1% Vs 1.0%) and total stroke (1.0%) in Percutaneous Coronary Intervention (PCI) group. STEMI success has plateaued because of suboptimal salvage of myocardium and high rates of non-culprit lesion related events and reperfusion injury. Promising approaches should be further explored like hypothermia, stem cell and super-saturated oxygen therapy and PiCSO to enhance myocardial recovery and reduce infarct size.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 182
Cancer pain: way to overcome
Authors: Chowdhury Mostofa Kamal
Published: August 2023

Cancers are among the leading causes of morbidity and mortality worldwide. Cancer itself or cancer treatment often causes pain which can affectthe quality of life. Cancer pain management is an essential part of cancer treatment and palliative care. Cancer patients may require pain management at any stage of their disease, not only at the end. Expert opinion and statistics from country experiences from numerous low-income countries, where treatment coverage is typically inadequate or non-existent, indicate that around 80% of cancer patients feel moderate or severe pain that lasts on average 90 days. As a result, cancer pain is a major source of avoidable unnecessary suffering. Cancer pain management plans often involve pharmacological and nonpharmacological therapies and psycho-social and spiritual support. Palliative care and pain management are critical components of Universal Health Care. The medical use of narcotic drugs is essential for the treatment of pain and suffering. Therefore appropriate provisions must be made to assure their availability for such purposes. Some obstacles exist that limit the appropriate management of cancer-related discomfort. Communication difficulties, lack of pain management training and education, ethnic/cultural/ religious disparities, opiophobia among health professionals and the general public, and restricted availability to opioids are the primary barriers to successful cancer pain treatment. To combat cancer pain and reduce the suffering of these incurable people, education and training of health professionals on cancer pain management, provision of suitable holistic supports, opioids should be made accessible and available, and general awareness development are some examples. All government and nongovernment players must come forward and work together to win this battle.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 187
HCV Management: Recent Updates
Authors: Rahman Salimur
Published: August 2023

Background: Hepatitis C virus (HCV) has been a major public health threatboth worldwide and in Bangladesh due to itsconsiderable disease burden, morbidities, and death. An individualized, cost-effective, standard treatment regimen can help combat and eliminate HCV once and for all.
Methods: This is an executive summary of the latest EASL (European Association for the Study of the Liver) recommendationsbased on existing literature, and clinical expertise from a panel of specialists chosen by the EASL Governing Board. Additionally, author’s clinical experience is undertaken for considering country level context. Results: HCV infection requires personalized treatment, based on factors such as genotype, liver fibrosis stage, and comorbidities. Direct-acting antiviral (DAA) regimens have replaced interferon, and are recommended as the first-line treatment for all patients with chronic HCV infection, irrespective of genotype. It is recommended to initiate treatment as soon as possible to prevent the progression of liver disease, and associated complications. For patients with decompensated cirrhosis, liver transplantation should be considered as a treatment option after weighing risk-benefit. Additionally, the management of special populations such as children, pregnant women, lactating mother, HCVpatients co-infected with HIV, HBV or SARS-CoV-2, patients with renal impairment, haemoglobin-opathies or bleeding disorders require special attention. Monitoring patients during and after treatment is recommended to ensure sustained virologic response (SVR), to detect any potential complication, and to check potential HCV reinfection.
Conclusion: The EASL recommendations provide a comprehensive overview on personalized treatment of HCV, and monitoring for optimal patient outcomes, ushering high hopes for HCV elimination in the future.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188
Management of Fatty Liver: What Evidence Says?
Authors: Mahtab Mamun Al
Published: August 2023

Fatty liver is a global pandemic and Bangladesh is no exception. Specially high prevalence of diabetes, improved socio-economic condition is contributing to the growing trend of fatty liver in Bangladesh. Currently there is no definite pharmacologic therapy for fatty liver although some drugs are showing promise and as of now life style modification remains the only option. Bangladesh has a rich heritage of traditional medicine with coexistence of Hekimi or Muslim and Ayurveda or Hindu traditional medicines within the political boundary of today’s Bangladesh. However today’s unfortunate reality remains that in Bangladesh, we have not been able to retain our glory. It is now one of our principal research focuses to revive our traditional herbal medicine. We have already demonstrated the beneficial effects of Glycyrrhiza Glabra (joshtimodhu) in end stage hepatocellular carcinoma. Currently we are focusing on non-alcoholic fatty liver disease. We are exploring the prospects of Kalmegh (Andrographispaniculata), Milk thistle (Silybummarianum), Arjun (Terminaliaarjuna) and Moringa (Moringaoleifera). We are collaborating with a galaxy of public-private universities in our humble effort to revive our glory. Our initial experience with Kalomegh in fatty liver is encouraging.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188
Immune-Mediated Thrombocytopenia in adults: Treatment Updates
Authors: Khan Md Rafiquzzaman
Published: August 2023

Immune Thrombocytopenia (ITP) is an acquired low platelet count resulting from immune-mediated platelet destruction and/ or impaired platelet production. Primary ITP is idiopathic and secondary ITP is associated with another conditions. The incidence is 1 to 6 per 100,000 adults. ITPmay present without symptom or present with bleeding. Bleeding manifestations are minor (skin/mucous membrane), critical (e.g. intracranial, intraocular, retroperitoneal, intramuscular bleeding etc) and severe (fall in hemoglobin of 2 g/dL or requires transfusion of e”2 units of red cells).ITP is diagnosed on the basis of isolated thrombocytopenia without anemia or leukopenia. There are no reliable laboratory tests to confirm the diagnosis. The aim of treatment of ITP is to provide a safe platelet count to prevent bleeding, rather than to normalize the platelet count. Treatment options of ITP are the Firstline therapies, second-line therapies and therapies. First-line therapy are for patients with severe bleeding and platelet count <30x10^9/L, which includes platelet transfusion, glucocorticoids (e.g. methylprednisolone, 1 g IV, daily for 3 doses; or dexamethasone, 40 mg orally or IV, daily for four days), IVIG and IV globulin. Second-line therapy is indicated for patients with thrombocytopenia associated with significant bleeding or for severe, persistent or recurrent thrombocytopenia (e.g., platelet count <20x10^9/L) following glucocorticoid-based treatments. Secondline therapies include splenectomy, rituximab, thrombopoietin receptor agonist or immunosuppressive therapy. Other therapies include danazol, vincristine, procarbazine, etoposide etc, or combination therapy. Indications of treatment are (1).Severe bleeding and platelet count <30x10^9/L. (2). Newly diagnosed ITP and any clinically important bleeding (3) Newly diagnosed ITP and platelet count <20x10^9/L, even in absence of bleeding (4) Patients with platelet counts >30x10^9/L having risk of bleeding, other hemostatic defects or require surgery.Spontaneous remission occurs in up to 10% of adults with ITP.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 189-190
Modern Insulin, Device, and Technology: Tips For Clinicians
Authors: Hasan ABM Kamrul
Published: August 2023

Insulin has been a lifesaving treatment for people with diabetes since its discovery in 1921. However, the way insulin is delivered evolved over time. Modern insulin, devices, and technology have transformed the management of diabetes and improved the quality of life for millions of people worldwide.Modern insulins are designed to match the needs of people with diabetes better. Traditional insulins, such as regular and NPH insulin, have a delayed onset and peak, making it difficult to manage blood sugar levels. Newer insulins, such as rapid-acting insulin analogs like aspart, glulisine, and lispro, have a faster onset and shorter duration of action, allowing for greater dosing and timing flexibility. Long-acting insulin analogs, like glargine and detemir, provide more consistent blood sugar control and less hypoglycemia risk.Insulin delivery devices have also advanced significantly. The most common device is the insulin pen, which looks like a large pen and uses disposable insulin cartridges. The pen has replaced traditional syringes and vials for many people with diabetes, offering greater convenience and ease of use. Insulin pumps are also becoming more popular, especially among people with type 1 diabetes. A pump delivers insulin through a catheter inserted under the skin, which can be programmed to provide a continuous infusion of insulin or a bolus dose before meals.Technological advancements have also revolutionized diabetes management. Continuous glucose monitoring (CGM) systems use a small sensor inserted under the skin to measure glucose levels every few minutes, providing real-time data to help people make more informed decisions about insulin dosing and food choices. Some CGM systems also offer alerts for high and low blood sugar levels, making it easier to avoid dangerous fluctuations. Automated insulin delivery systems, also known as closed-loop systems or artificial pancreas systems, use CGM data to automatically adjust insulin delivery, reducing the burden of constant monitoring and decision-making for people with diabetes.In summary, modern insulin, devices, and technology have greatly improved the management of diabetes, allowing for better blood sugar control and a better quality of life for people with diabetes. As technology continues to advance, the future of diabetes management looks promising.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 191
Difficulties in Treating Dermatophytes: A Way To Overcome
Authors: Khan Zulfiqur Hossain
Published: August 2023

Superficial dermatophytosisis currently caused by dermatophytes belonging to three genera, namely Trichophyton, Microspurum and Epidermophyton. In recent years, superficialmycosis have becomeincreasingly resistant to current antifungal treatment. Multiple incidences of chronic infections, reinfections and treatment failure have been reported. The epidemiological shift from T, rubrumtoT. mentagrophytes/ T. interdigitalis are the dominant pathogen in recent tenea patients. Limitation of available approved antifungals for dermatophytosis treatment and difficulties or unavailability of culture and sensitivity test for fungus also contribute to difficulties in treatment outcome.The change in the clinical scenario with increasing frequency of treatment failure gives rise to innumerate treatment options based on individual experience from case by case. We focus on treatmentschedule given in standard textbooks and the current modifications that have evolved to treat the dermatophytosis.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 193
Biologics in Rheumatoid Arthritis: When & Why?
Authors: Islam Md Nazrul
Published: August 2023

Among the autoimmune rheumatic diseases RA is common. Not only articular extra-articular manifestations are common including involvement of skin, ocular, haematological, pulmonary and renal systems. A heightened cardiovascular risk also exists which closely follows disease activity stresses to obtain remission or low disease activity. Therapeutic landscape of RA treatment most significantly shiftedwith the introduction of biological disease modifying anti-rheumatic drugs (bDMARDs). There are five classes of bDMARDs currently available, each with a different molecular target and subtle differences in their efficacy and safety profile. Patient with poor prognostic factors and failed to csDMARDs are the candidate of anti-TNF agents and or other biologics. Clinicians should screen for latent infections with hepatitis B and C serology, chest radiograph plus interferon gamma release assay or tuberculin skin test. In the indicated cases, HIV serology should be requested as well. To reduce infection risk, guidelines specify that patients on bDMARDs should continue with national vaccination schedules including influenza and pneumococcal immunisations as well as the HPV vaccine for cervical cancer. Live attenuated vaccines (like, live herpes zoster vaccine, yellow fever, measles, mumps, rubella), are contraindicated in patients taking a bDMARD. The contraindications of anti-TNF agent’s initiations are serious or untreated infections including TB, current malignancy, multiple sclerosis, severe heart failure and hypersensitivity. In case of tocilizumab contraindications are serious or untreated infections, hypersensitivity and diverticulitisand for rituximab reactivation of hepatitis B.Coadministration of one class of bDMARD with another from a different class is not recommended due to an increased risk of infection. A DAS28 reduction of <1.2 should be considered as improvement at 3 and 6 monthvisits. A close monitoring is advocated for the adverse effects of biologic agents. TNF inhibitors may be continued during pregnancy. Rituximab, abatacept and IL-6 inhibitors are not safe in first trimester.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 193-194
Osteoporosis: Recent Advances
Authors: Shahin Md Abu
Published: August 2023

Osteoporosis is characterized by low bone mass, microarchitectural disruption, and skeletal fragility, resulting in decreased bone strength and an increased risk of fracture. Decreased bone strength is related to many factors in addition to bone mineral density (BMD), including rates of bone turnover, bone geometry, and microarchitecture.Osteoporosis has no clinical manifestations until there is a fracture. Complications of fractures include pain, deformity, disability, and loss of height. A clinical diagnosis of osteoporosis may be made in the presence of a fragility fracture, particularly at the spine, hip, wrist, humerus, rib, and pelvis, without measurement of BMD.In the absence of a fragility fracture, BMD assessment by dual-energy x-ray absorptiometry (DXA) is the standard test to diagnose osteoporosis, according to the classification of the World Health Organization. A DXA T-score d”-2.5 is consistent with osteoporosis, whereas a T-score between -1 and -2.5 isosteopenia.All postmenopausal women with osteoporosis should have a history, physical examination, and basic laboratory evaluation. Initial laboratory studies should include a complete blood count (CBC), biochemistry profile, and 25- hydroxyvitamin D (25[OH]D).The need for additional laboratory evaluation depends upon the initial evaluation and Z-score. Women who have abnormalities on initial laboratory testing, suspicious findings on history and physical examination suggesting a secondary cause of osteoporosis, or Zscores d”-2 may require additional evaluation for these secondary causes.Lifestyle measures should be adopted universally to reduce bone loss in postmenopausal women. Lifestyle measures include adequate calcium and vitamin D, exercise, smoking cessation, counseling on fall prevention, and avoidance of heavy alcohol use. In general, 1200 mg of elemental calcium daily, total diet plus supplement, and 800 international units of vitamin D daily are advised. Many patients require vitamin D supplementation as it is difficult to achieve goals with diet alone. Postmenopausal women with established osteoporosis (T-score d”-2.5) or fragility fracture be treated with a pharmacologic agent. For the treatment of high-risk postmenopausal women with T-scores between -1.0 and -2.5, better to start pharmacologic therapy. Most women, for the initial treatmentoral bisphosphonates is good choice.For severe osteoporosis, some experts prefer initial treatment with an anabolic agent, whereas other experts prefer initial treatment with bisphosphonates. Teriparatide and abaloparatide are good anabolic agent. Romosozumab is an alternative.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 194
Treatment of Tuberculosis in special situations
Authors: Hossain Mohammad Delwar , Mahmud Asif Mujtaba , Hossain Md Ali , Shakur Khan Mohammad Abdus , Bennoor Kazi Saifuddin , Wahid Md Ferdous
Published: August 2023

Treatment of Tuberculosis in special situations implies overcoming special challenges in patients with diabetes, pregnant women, people aged over 65 years, and those with chronic kidney or liver disease.Rifampicin is a potent hepatic enzyme inducer, may lower plasma levels of sulphonyl urea and can increase the hypoglycemic effect of metformin. Since insulin is not metabolized, no pharmacokinetic interactions with anti-TB drugs occur. Gastrointestinal upset and hepatitis are reported as the most frequent adverse events in older people. In patients >80 years,pyrazinamide may be omitted. In TB patients with chronic kidney disease (CKD), an inappropriate dosage of anti-TB drugs can result in unsuccessful treatment or side effects. Current guidelines for first-line anti-TB drugs therefore recommend that dosages of ethambutol (EMB) and pyrazinamide (PZA) be adjusted according to patient renal function and body weight, although no change in dosage is necessary for patients with mild renal insufficiency . However, it remains unknown how the renal function-based dosage adjustments recommended by the guidelines affect efficacy outcomes for TB patients with CKD. In chronic liver disease (CLD) patients, The Child–Turcotte–Pugh (CTP) score can be used as a guide for designing appropriate regimens. In stable CLD (CTP d”7), a treatment regimen including isoniazid, rifampicin, and ethambutol is recommended, a 2-month intensive phase with the three drugs, followed by isoniazid and rifampicin continuation phase for 7 months partially liver-sparing regimen consisting of Ethambutol, Rifampicin, and a quinolone for 9 months is advisable in case of more severe CLD (CTP 8–10).If CLD is very advanced (CTP £11), a total liver-sparing regimen consisting of Ethambutol and a quinolone (Levofloxacin or Moxifloxacin) for 12 months.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 196-197
Chronic Obstructive Pulmonary Disease – Recent Updates
Authors: Chakrabortty Rajashish
Published: August 2023

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death and disability globally as well as in Bangladesh. Continuing research is essential to combat the threat posed by rising prevalence of COPD. Here we present recent updates in the field of COPD research. The revised definition of COPD emphasizes COPD as a heterogeneous disease affecting the bronchi, bronchioles, alveoli and pulmonary vasculature. The traditional view of COPD as a smoker’s disease with a late onset has been replaced by the new concept of COPD etiotypes, which recognizes the contribution of developmental, genetic, environmental, infective and idiopathic contributions to COPD. Vaping has also been proposed as a risk factor for COPD. Two precursors to COPD – pre-COPD and PRISm – have also been proposed to highlight the opportunity of early detection and management. Clinical classification of COPD has been updated to the simplified ABE approach. New recommendations for treatment prioritize the initial use of a fixed dose LABA+LAMA combination. A more judicious use of ICS in COPD patients is recommended, in those with specific indications (exacerbation-prone, high eosinophil counts, or concomitant asthma). In this population, single-inhaler triple-therapy of LABALAMA- ICS has replaced previous recommendations of LABA-ICS. A strong emphasis has been placed on appropriate, individualized choice of inhaler device and training on technique for each patient. Interventional pulmonology and minimally invasive surgery also have a growing role in management of selected patients. Small airways disease is a key cause of morbidity in COPD. Newer diagnostic techniques, such as impulse oscillometry, and novel drug formulations (extra-fine particles, cosuspension forms, soft mist inhalers) are under study. The monoclonal antibody dupilumab has also shown promise in reducing COPD exacerbation. Finally, COPD is a multisystem disease and any management plan must include steps to identify and treat associated co-morbidities.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 197
Evaluation of the Efficacy and Tolerability of a Fixed Dose Combination of Amlodipine And Indapamide in Patients Older Than 55 Years
Authors: Islam Quazi Tarikul , Haque KMHS Sirajuul , Moula Kaniz , Ahasan Ham Nazmul , Patwary Md Ismail , Azad Khan Abul Kalam , Rahman Mujibur , Hossain Md Zakir , Miah M Titu , Azad Abul Kalam
Published: August 2023

Background: There is very limited real-life data on hypertension management in Bangladeshi population. Considering this fact, this study evaluated the effectiveness of treatment with an indapamide/amlodipine single-pill combination (SPC) in Bangladeshi patients over the age of 55 years, in an OPD setting with uncontrolledsystolic hypertension in real-life clinical practice.
Methods: This was a 3-month, multicenter, observational, open-label study conducted in 3 divisional cities of Bangladesh among patients with grade I or II hypertensions who were either uncontrolled on previous antihypertensive treatment or treatment-naïve. The effectiveness of indapamide/amlodipine SPC was assessed by the change in office systolic blood pressure (SBP) and the rate of target SBP (< 140 mmHg)achievement at 2 weeks, 1 month and 3 months, in four age groups: 55–59 years, 60–69 years, 70–79 years, and80 years or older.
Results: The COMBINE study recruited 213 patients, of whom 185 took indapamide/amlodipine 1.5/5 mg SPC forafull three-month course of therapy.Mean age was 62.4±7.4 years, 76 men [41.1%] and 109 women [58.9%]. The absolute decrease of SBP during 3 months of taking indapamide/amlodipine single-pill combination (SPC) was 27.7 mm Hg, DBP - 10.2 mm Hg.After 3 months of treatment significant SBPdecreases from baseline were observed in each age group:”29.9 mmHg (from 156.7 to 126.8),”25.1 mmHg (from 152.7 to 127.6),”26.1 mmHg (from 152.8 to 126.7),and “ 24.5 mmHg (from 151.8 to 127.3)in the 55–59, 60–69, 70–79, and 80 years and older age groups, respectively.
Conclusion: This COMBINE study results showed that indapamide/amlodipine SPC was associated with significant and rapid reductions in BP even in a different age range of Bangladeshi patients in routine clinical practice. This study result is consistent with already achieved data of this SPC globally.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 200
Neonatal Seizures and Neurodevelopmental Outcome
Authors: Waheed MA
Published: August 2023

Background: Neonatal period is the most vulnerable time for the occurrence of seizures. There are various etiological factors of neonatal seizures and increasing evidence suggests that neonatal seizures are associated with adverse neurodevelopment outcomes. The aim of the study is to determine of causes of neonatal seizures with outcome during management and long-term post-natal outcome.
Methods: This prospective study conducted in Rangpur Mother and Children Hospital from 1st July to 2017 to 30th June 2022. Term newborn babies admitted in NICU with convulsion were the samples. A prepared and pretested “Protocol” containing Part-A and Part-B was used - Part-A in neonatal intensive care unit and Part-B in the attached Disability Research Center.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 200-201
Russell’s Viper Bite and Its Immediate Outcome In Bangladesh
Authors: Rahman Abu Shahin Mohammed Mahbubur , Haque MZ , Rahman Mk , Amin Mr , Faiz MA
Published: August 2023

Background: Russell’s viper (Daboia russelii) is found in Asia, throughout Indian subcontinent, much of South East Asia, Southern China and Taiwan. Russell’s viper was seemed to be rare in Bangladesh. Anecdotes suggest that Russell’s viper (Daboia russelii) was an important cause of mortality in the 1920s, but no case of envenoming by this species has since been reported in Bangladesh. Russell’s viper bite has been reported and it is the one of the common snake bite at Rajshahi region which has great morbidity and mortality as well.
Methods: This is a prospective observational study was conducted in the Medicine department of Rajshahi Medical College Hospital. We treated total 171 patients from 2013 to December 2022. Russell’s viper envenomation confirmed either by brought dead or live snake specimen, photograph, bedside 20MWBCT and other symptoms.
Results: In the management of RV bite patient in the Rajshahi Medical College Hospital, we found that most of the patients are delayed in getting hospitalization after bite due to visit to traditional healer. In our study 96% were male, and 4% were female, mostly farmer and 90% bite site in the lower limb during work in the paddy field. The clinical presentation was pain and local swelling (100%), blood oozing from local site (77%), bruising (44%), haematuria (25%), hypotension (30%), oliguria and few with DIC. In lab findings, coagulopathy (24%), raised CPK (60%), 67% Patients had AKI (raised creatinine and RBC in urine), among them 50% needed dialysis. Few patients also develop multiorgan failure. All patients received polyvalent Anti-venomsupplied by GOB (Incepta Bangladesh Ltd.) which works against cobra, krait, Russell’s viper bite. Despite maximum available support at RMCH, around 30% patient died.
Conclusion: It’s high mortality indicates that this polyvalent antivenom might not be working properly. We may need to increase the initial dose or we need to provide monovalent antivenom specific to RV in Bangladesh and early treatment at Upazila Health Complex to reduce the rate of death due to Russell’s viper bite.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 204
The Role of Plasma D-dimer As An Initial Diagnostic Biomarker of Cerebral Venous Sinus Thrombosis In A Tertiary Level Hospital, Bangladesh – Case Control Study
Authors: Rahman Aminur , Ahmed Muhammad Jamil , Russel Abul Hasnat , Huq Mohammed Nazmul , Ali Zahed
Published: August 2023

Background: Cerebral venous sinus thrombosis (CVST) are an uncommon cause of stroke and is often more difficult to diagnose than usual causes of stroke.A number of studies have confirmed the usefulness of Ddimer level in CVST. The aim of the current study to evaluate the correlation of plasma D-dimer levels in diagnosis of CVST.
Methods: This case-control study was conducted on 50 stroke patients and 50 healthy individuals as the control group who will attend in the Department of Neurology of Sir Salimullah Medical College & Mitford Hospital, Dhaka Bangladesh during one year (2021-2022) with new onset headache and presentations suggestive of CSVT will be included in the study. Every medical or surgical condition which causes an increase in D-dimer level was considered as exclusion criteria.
Results: Among patient group, 28(56%) patients were females, while 22(44%) patients were males, and the mean of age was 37.7±11.8 years. Headache was the most frequent presentation that observed in 90% of the patients. The patient with focal neurological signs, papilloedema and seizures came next in 52%, 44% and 30% respectively. The average duration of the symptoms was 6.9 ±3.2 days. Overall, the mean plasma level of D-dimer in CVST patients and controls were 526.7± 97.34 ng/mL and 332.3± 53.71 ng/mL respectively (Table: 3). Independent t-test revealed a significant difference (t= 2.167, p= 0.029). According to cut-off value of the assay (400 ng/mL) there were 44 CVST patients (88%) who were positive for the test compared with 7 (14%) among controls (p< 0.001). Stratification of the study population according to male revealed a wide gap between patient and control males (541.7± 114.9 ng/mL and 320.2±71.13 ng/mL respectively) with a significant difference (p= 0.017) (Table: 4). However, in females, this gap was narrower (530.4± 100.9 ng/mL in females with CVST and 349.7±92.5 ng/ mL in healthy females) but still significant (p= 0.032). The test revealed that the area under the curve (AUC) was 0.879, 95%CI=0.807-0.95, p<0.001. The sensitivity and specificity of the test at cut off value of 400ng/ mL were 0.88 and 0.86 respectively, indicating a very good discrimination value. The positive and negative predictive values of D-dimer in diagnosis of CVST were 86.27 % and 87.76% respectively.
Conclusion: Our study suggests that measurement of D-dimer can be a reliable tool for diagnosis of CVST, especially in patients with acute and subacute disease.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 202-203
Humoral immune response against SARS COV-2 infection in hospitalized COVID-19 patients and healthcare workers
Authors: Matin Md Abdul
Published: August 2023

Background: COVID-19 is a worldwide pandemic causing huge burden on healthcare facilities. Most of the cases were asymptomatic and few were symptomatic. We still comprehensively did not know the exact estimated COVID-19 (symptomatic & asymptomatic) population. We had needed to identify the asymptomatic population of COVID-19 through the immune response of IgG antibody titer against spike protein of SARS CoV-2. The aim of the study is to determine the seroconversion in hospitalized COVID-19 patients and seroprevalence among healthcare workers and control community group against SARS CoV-2 infection.
Methods: This observational study was carried out in COVID-19 unit of Bangabandhu Sheikh Mujib Medical University (BSMMU). Information about sociodemographic status, comorbidities, results of antibody response (IgG titer) and other relevant information was collected using a pre-designed data collection sheet. In this study, total 211 participants included and total 343 samples was taken for IgG titer measurement by ELISA method. The data was analyzed by SPSS version 25 and Graph pad prism version 8. Statistical analysis was done by using Chi-square test, Student’s t-test or Mann-Whitney U test. Statistical significance was defined as p value d”0.05.
Results: Among COVID-19 patients 58.6% (34) were male and 41.4% (24) were female, median (IQR) age was 45.5 (33 to 57) and median (IQR) Body Mass Index (BMI) was 25.4 (23.39 to 27.42). Among the Healthcare workers 54.9% (84) were male and 45.1% (69) were female, median (IQR) age was 30 (25 to 33) and median (IQR) Body Mass Index (BMI) was 24 (21.53 to 25.71). The antibody titer persisted for more than 3 months in all hospitalized patients and no one was seronegative during the study period. The overall seroprevalence of healthcare workers were 54.9% and Doctors- 38%, Nurses-53.84% & Support staff- 72.54%. Anti-spike IgG titer was significantly higher in severe diseases but had no significant change with age, sex, body mass index, or diabetic status.
Conclusion: This study shows persistence of antibody titers after 3 months in recovered COVID-19 patients. The results demonstrate high seroprevalence among the healthcare workers and control community group.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 207
Prediction of the Need for Niv in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Comparative Study Between Decaf And Modified Decaf Score
Authors: Ahmed Mushfiq Newaz , Saha Nihar Ranjan , Islam Md Sayedul
Published: August 2023

Background: Exacerbation of chronic obstructive pulmonary disease (COPD) leads to multiple hospital admissions, longer hospital stays, increased treatment costs as well as increased morbidity and mortality. Currently, no optimal scoring system exists that can predict need for NIV in patients with acute exacerbation of COPD. Accurate prognostic tool can help physicians to select the appropriate level of care and preparedness.To compare DECAF [(D) dyspnoea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) atrial fibrillation] and modified DECAF score [(D) dyspnoea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) frequency of hospital admission] in predicting the need for NIV in patients with acute exacerbation of chronic obstructive pulmonary disease.
Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine, NIDCH, Mohakhali, Dhaka from June 2021 to August 2022. A total of 91 patients with acute exacerbation of COPD were enrolled in this study. All patients were subjected to complete medical history taking, chest examination, dyspnoea assessment by extended modified Medical Research Council Dyspnoea (eMRCD), complete blood count, chest radiograph, ECG, and arterial blood gas analysis. Both DECAF and modified DECAF score were calculated and the need for NIV was documented. All collected data were analysed using appropriate statistical formula and SPSS programme.
Results: Out of 91 patients, 20 patients (21.97%) required non-invasive ventilation. The area under the ROC curve of DECAF and modified DECAF score was 0.973 and 0.974 respectively in predicting the need for NIV. The sensitivity, specificity, PPV and NPV of DECAF score were 84.21%, 94.44%, 80.00% and 95.77% respectively at a cut off value of 3. The sensitivity, specificity, PPV and NPV of modified DECAF score were 84.52%, 100%, 100% and 96.51% respectively at a cut off value of 4
Conclusion: Both DECAF score and the modified DECAF score are practical and can be calculated easily using simple questions and routine investigations available during the initial admission. Both were good predictors, but modified DECAF was superior in predicting need for NIV in patients with acute exacerbation of COPD Bangladesh
J Medicine 2023; Vol. 34, No. 2(1) Supplement: 208-209
Impact of Adipokines and Inflammatory Cytokines On Abnormal Glucose Tolerance in Young
Authors: Hasan Mashfiqul , Sultana Nusrat , Roy Indira , Rijal Amrit , Hasanat MA
Published: August 2023

Background: Adipokines and inflammatory cytokines may have an important impact on rising trend of diabetes in young across the globe. To see the association of serum adiponectin, leptin, resistin, tumor necrosis factor-alpha (TNF-á) and C-reactive protein (CRP) with obesity and abnormal glucose tolerance (AGT, includes both prediabetes and diabetes) in young Bangladeshi.
Methods: This case-control study included 40 young participants with AGT [age 26 years (IQR 24-29); 60.0% female] and 40 with normal glucose tolerance [NGT; age 25 years (IQR 22-28); 44.0% female] encompassed following the oral glucose tolerance test (OGTT) and HbA1c. Insulin resistance (IR) was calculated by homeostasis model assessment (HOMA). The measurement of serum adiponectin, leptin, resistin and TNF-á was done by ELISA whereas CRP by Chemiluminescent tests.
Results: Level of TNF-á, leptin, and adiponectin as well as frequency of raised resistin and CRP were statistically similar between AGT and NGT (p=NS for all). TNF-á, leptin and CRP were positively correlated while adiponectin and resistin were negatively correlated with measures of obesity. No adipokines or inflammatory cytokines had any significant correlation to glycemic measures, except negative correlation in AGT with leptin and CRP. Fasting insulin and IR had a positive correlation with leptin and CRP, negative correlation with adiponectin and resistin while no significant correlations with TNF-á. None of the cytokines or inflammatory markers were independent predictors of AGT in youth.
Conclusion: The serum levels of cytokines do not differ significantly between AGT and NGT subgroups of young subjects and none of the cytokines was observed to be independent predictor over AGT in young.
J Medicine 2023; Vol. 34, No. 2(1) Supplement: 209-210
Insulin Receptor (RS2059807) And Insulin Receptor Substrate 1 (RS1801278) Genes Polymorphismsin Polycystic Ovary Syndrome
Authors: Banu Hurjahan , Morshed Md Shahed , Hasanat Muhammad Abul
Published: August 2023

Background: Insulin resistance (IR) plays central role in the pathogenesis of polycystic ovary syndrome (PCOS). Alteration of single nucleotide polymorphisms (SNP) of gene encoding insulin receptor (INSR) and insulin receptor substrate 1 (IRS1) may be associated with insulin resistance and development of PCOS. To see the allele frequency of INSR (rs2059807) and IRS-1(rs1801278) genes polymorphisms and their associations with Bangladeshi women with PCOS.
Methods: This cross-sectional study was done among 93 PCOS women (13-35 years) and 79 of age-matched healthy control in the department of Endocrinology, BSMMU. Clinical, biochemical and hormonal profile were recorded. Venous blood was taken in fasting state to measure blood glucose, insulin and genotypes Blood glucose was analyzed by glucose oxidase and insulin by chemiluminescent microparticle immunoassay. SNP genotyping were done by commercial sequencing services.
Results: The risk allele (G) frequency for INSR (rs2059807) (p=1.00) and risk allele (T) for IRS-1 (rs1801278) (p=0.367) were statistically similar. Considering dominant, recessive, co-dominant, and over-dominant models, there were no significant differences between the study groups for both genes. Among the different manifestations percentage of IR was significantly raised in wild group of only IRS1 gene.
Conclusion: This study failed to reveal any association between PCOS and Insulin Receptor (rs2059807), Insulin Receptor Substrate 1 (rs1801278) gene polymorphism. Only the percentage of IR was found higher in wild group than the mutant group in IRS1 gene.
J Medicine 2023; Vol. 34, No. 2(1) Supplement: 210
Pre-transplant Medical Evaluation: A Multidisciplinary Approach
Authors: Kabir Alamgir
Published: August 2023

Conventional autologous and allogenic hematopoietic stem cell transplants (HSCT) are lifesaving or life extending medical procedures but associated with significant risk for non-infectious and infectious complications. The center for international blood and marrow transplant research estimates that worldwide about 100000 transplants are performed yearly. The frequency of transplantation is varied widely from country to country, with a close association of transplant rates with gross national income (GNI) per-capita. Appropriate indication for transplant is mandatory for these rigorous procedures. Hematological malignancies, bone marrow failure syndromes, inherited immune deficiencies, hemoglobinopathies and inherited metabolic disorders are usual indications for BMT. Sources of hematopoietic stem cells are crucial. Patient evaluation includes psychosocial and systems evaluation. Foundation for the Accreditation of cellular therapy (FACT) is required. General guidelines for patient eligibility are chemo sensitive, adequate performance status, adequate nonhematopoietic organ function, ability to provide informed consent and adequately matched available donor or adequate collection of autologous stem cells. Exclusion criteria include chemo refractory, life expectancy severely limited by other illness, inability to tolerate preparative regimen and pregnancy. Relative contraindications are major medical comorbidities, major psychiatric illness and lack of insurance/financial resources. Comorbidities are cardiac arrhythmia, EF d” 50%, body mass index e” 35 kg/m2, serum creatinine > 2 mg/dl and EFV1 d” 65%. Allogeneic donor evaluation is also vital and includes HLA typing for HLA-A, -B, -DRBI; screening of transmissible diseases, laboratories, consents and notifications.
J Medicine 2023; Vol. 34, No. 2(1) Supplement: 212