bluuebunny/crossref_metadata_2025 huggingface dataset:
Kesenjangan Penghasilan Antar Gender di Pulau Jawa Sebelum dan Saat Pandemi COVID-19
Authors: Mardiana Mardiana
Published: August 2023

Pulau Jawa merupakan daerah yang paling terdampak pandemi COVID-19 di Indonesia. Kebijakan Pembatasan Sosial Berskala Besar (PSBB) yang diterapkan di Pulau Jawa mengakibatkan menurunnya jumlah penduduk yang bekerja dan penghasilannya. Terjadi penurunan penghasilan hampir di seluruh lapangan usaha baik laki-laki maupun perempuan. Penghasilan laki-laki secara umum lebih tinggi daripada perempuan. Penelitian ini bertujuan untuk mengetahui besar kesenjangan penghasilan antar gender di Pulau Jawa pada periode sebelum dan saat pandemi COVID-19 dengan menggunakan metode Dekomposisi Binder-Oaxaca. Metode ini membagi penyebab kesenjangan penghasilan antar gender menjadi dua bagian, yaitu faktor endowment dan faktor diskriminasi. Probit partisipasi bekerja dilakukan sebelum melakukan estimasi penghasilan berdasarkan gender untuk menghilangkan bias dalam pemilihan sampel. Dari data Sakernas Agustus 2019 dan 2020, ditemukan bahwa kesenjangan penghasilan antar gender di Pulau Jawa semakin mengecil saat terjadinya pandemi COVID-19 dibanding sebelum pandemi COVID-19 dari 46,24 persentase poin menjadi 45,34 pesentase poin. Faktor diskriminasi berkontribusi lebih besar dibandingkan faktor endowment dalam menjelaskan kesenjangan penghasilan antar gender di Pulau Jawa. Sebelum pandemi COVID-19 faktor endowment berperan 13,74 persentase poin (29,73 persen) dan faktor diskriminasi berperan 32,49 persentase poin (70,27 persen), sedangkan saat pandemi COVID-19 faktor endowment berperan 11,66 persentase poin (25,72 persen) dan faktor diskriminasi berperan 33,68 persentase poin (74,28 persen).
Letter of Credit: Uniform Custom Practice dan Fraud dalam Perdagangan Internasional
Authors: Ruslan Zuhri
Published: August 2023

Letter of Credit (LC) adalah metode pembayaran yang dipercaya lebih aman dalam perdagangan internasional karena melibatkan bank untuk memastikan bonafiditas pembeli dan penjual. LC diatur oleh Uniform Customs Practice (UCP), yaitu aturan yang bersifat sukarela dan berterima umum oleh pihak-pihak yang terlibat dalam LC. Meskipun demikian, risiko dalam perdagangan internasional tidak dapat disangkal, bahkan ketika menggunakan LC. Contohnya antara lain adalah risiko tidak ada barang yang dikirim setelah pembayaran dilakukan, barang yang dikirim berkualitas lebih rendah dari yang diperjanjikan sebelumnya, dan nilai invoice yang digelembungkan. Semua hal tersebut merupakan bagian dari risiko penipuan (fraud) dalam perdagangan internasional. Oleh karena itu, penelitian ini bertujuan untuk menyelidiki bagaimana UCP berhadapan dengan fraud dan melindungi para pihak pengguna LC. Penelitian ini merupakan penelitian kualitatif yang bersifat eksploratoris, menggunakan metode penelitian studi kasus (case study), dan menganalisa data sekunder berupa UCP, undang-undang, buku, dan artikel yang relevan. Hasil penelitian selanjutnya disajikan dalam bentuk narasi. Penelitian mengungkapkan bahwa UCP kalah saat berbenturan dengan hukum nasional. Selain itu, aturan fraud di dalam UCP lebih melindungi pihak bank daripada pihak pembeli. Jika fraud terjadi, hukum nasional yang akan berlaku, dan bahkan pengadilan dapat membatalkan LC. Penelitian ini akan bermanfaat bagi para importir untuk mengenali risiko dalam perdagangan internasional dan mendorong mereka untuk melakukan mitigasi risiko tambahan. Selain itu, sehubungan dengan kerja sama G20 yang akan meningkatkan nilai dan volume perdagangan antar negara, sangat penting bagi importir untuk melindungi diri mereka dari risiko fraud dalam perdagangan internasional.
Efek Dividen Policy terhadap Firm Value (Studi Empiris pada Bank Publik di Indonesia)
Authors: Eprianto Idel , Feni Dewi Pupaningtyas , Hadita Hadita
Published: August 2023

Riset ini bertujuan untuk menguji efek dividen policy terhadap nilai perusahaan melalui pemoderasi kepemilikan manajerial. Sampel penelitian dilakukan terhadap 20 bank go publik yang ada di Indonesia tahun 2018-2020. Hasil penelitian didapatkan kebijakan dividen yang diproksikan dengan Dividen Payout Ratio berpengaruh  positif dan signifikan terhadap nilai perusahaan. Namun, kepemilikan manajerial tidak memiliki peran moderasi pada pengaruh kebijakan dividen terhadap suatu nilai perusahaan. Hal ini berarti jika dilakukan kebijakan membagikan dividen atau porsi pembagian dividen yang lebih tinggi akan berdampak terhadap tingginya kepercayaan investor dimasa selanjutnya dapat berimbas meningkatknya nilai perusahaan. Namun, kepemilikan bank yang dimiliki manajemen ternyata tidak berimbas bagi nilai perusahaan industri bank publik di Indonesia.
Identification and Economic Contribution of Intercrops to the Income of Oil Palm Farmers on Bangka Island
Authors: Sitorus Rostiar , Zasari Maera
Published: August 2023

Oil palm smallholders have the initiative to plant intercrops in immature smallholder oil palm plantations to obtain additional income ahead of the oil palm harvest. The research was conducted to identify which intercrops were cultivated by farmers and to calculate the value of the contribution made to the income of oil palm farmers. The survey method was carried out in smallholder oil palm plantations on the island of Bangka. The researchers concluded that the types of intercrops cultivated by farmers included cucumber, tomato, long beans, and cassava. The intercropping contributes to income while at the same time supporting the maintenance costs of young oil palm plants. In this study, intercropping contributed 13.5% toward covering these costs. This means that intercrops are feasible to cultivate in order to intercrop with TBM oil palm plants so that they can cover the costs of oil palm farming before producing FFB.
Analysis of Regional Government Expenditures of Central Bangka Regency
Authors: Kusumastuti Ratih , Anggraeni Septi
Published: August 2023

Analysis of Regional Government Expenditures in Central Bangka Regency. This study aims to analyze spending in terms of spending growth, spending compatibility and the ratio of spending to PDRB in Central Bangka Regency in 2018-2022. This study uses secondary data in the form of Budget Realization Reports (LRA) of the Central Bangka Regency regional government and Central Bangka Regency economic statistics sourced from the Central Bureau of Statistics (BPS) of Central Bangka Regency. The data analysis technique is in the form of quantitative analysis, namely by using the formula for growth and spending ratios. The results of the analysis show that the realization of regional government spending in Central Bangka Regency in 2018-2022 has fluctuated with an average growth of 17.85% per year, this is not in line with the growth in realized revenues which tends to decrease each year. The ratio of operational expenditure to total expenditure tends to increase with an average of 70.85% per year and this ratio dominates the total regional expenditure expenditure while the ratio of capital expenditure to total expenditure tends to decrease with an average of 15.31% per year . The ratio of regional spending to PDRB for the regional government of Central Bangka Regency in 2018-2022 tends to decrease with an average ratio of 15.01% per year. The value of this ratio is also influenced by the growth value of PDRB and total spending. The growth of total regional government spending in Central Bangka Regency is relatively smaller when compared to the PDRB growth.
ОРГАНІЗАЦІЯ ОСВІТНЬО-ПРОСВІТНИЦЬКОЇ РОБОТИ З БАТЬКАМИ НА ОСНОВІ АНАЛІЗУ ОСОБЛИВОСТЕЙ ВНУТРІШНЬОШКІЛЬНОЇ АТМОСФЕРИ ЗЗСО З ІНКЛЮЗИВНОЮ ФОРМОЮ НАВЧАННЯ
Authors: Матвєєва Олена , Лапін Андрій
Published: August 2023

У статті визначено причини та окреслено шляхи удосконалення взаємодії батьків і педагогів у навчально-виховному процесі, що є одним з чинників появи нової філософії взаємодії сім’ї та ЗЗСО з інклюзивною формою навчання, в основу якої покладено ідею про те, що за успішність навчання та виховання дітей несуть відповідальність батьки. Визначено особливості та напрями освітньо-просвітницької роботи з батьками на основі аналізу внутрішньошкільної атмосфери.

Розкрито основні принципи відносин у системі «педагог-батьки», зазначено, що їх варто проектувати на основі взаємодії узгодженості поглядів і поведінки, зокрема, ґрунтуючись на принципах партнерства. Науковці наголошують на тому, що стан внутрішньошкільної атмосфери можна визначити за допомогою системи заходів внутрішньошкільного контролю.

Основною метою освітньо-просвітницької роботи визначено те, що батьки мають бути поінформовані щодо справ у закладі, щодо успішності їхньої дитини, а також щодо перспектив перебування дитини у ЗЗСО з інклюзивною формою навчання. Разом із традиційними застосовуються і нетрадиційні, інноваційні форми роботи з батьками. Їх різноманіття залежить від креативності педагогічного колективу і бажання втілювати ці форми у життя. На основі дослідження зазначено, що у світлі сьогодення новим трендом у роботі педагогів із батьками став буктрейлер. Детально описано принципи застосування зазначеної методики. Однією з традиційних для ЗЗСО з інклюзивною формою навчання стала також така комплексна форма співпраці з сім’єю, як батьківські комітети або батьківські ради, які мають давню історію і дієві сьогодні.

Науковці наполягають на доцільності залучення батьків у дидактичний процес. Це може відбуватися в активній формі, наприклад, коли самі батьки залучаються до проведення навчальних занять самостійно або разом з вихователем чи вчителем.
Cardiovascular assessment in Noncardiovascular surgery: what evidences say?
Authors: Maskey Arun
Published: August 2023

Annually more than 300 million patients (about 5% of the world population) undergo major surgery worldwide. Nearly 85% of major operations are noncardiac surgical procedures. Proper preoperative evaluation is important to reduce cardiovascular morbidity and mortality in patients undergoing noncardiac surgery. Cardiac risk is determined by two main factors: patient-related risk and surgical risk. Timing of surgery (Immediate, Urgent, time-sensitive, elective), type of surgical approach ( laparoscopy, vascular and endovascular procedure, open surgeries) , risk of surgery ( Low, intermediate, high surgical risk) determine surgical risk. Patient-related risk is assessed by patient’s age, the presence of cardiovascular risk factors (e.g. smoking, hypertension, diabetes, dyslipidaemia,) or established cardiovascular disease, and comorbidities (heart failure, arrhythmia etc.).In emergency surgery preoperative evaluation is limited as saving life is more important. In elective surgery patient related risk factors, comorbidity, associated cardiovascular diseases, timing and risk of surgery , functional capacity determine further preoperative evaluation with necessary investigations like ECG, Echo, laboratory investigations, biomarkers, stress test, coronary angiogram etc.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 179
Fluid & Electrolytes in Clinical Practice
Authors: Mostafi Mamun
Published: August 2023

Despite the fact that fluid and electrolyte preparations are the most commonly prescribed medications in hospitals, a number of studies have shown that the knowledge and practice of fluid and electrolytebalance among young doctors is suboptimal, possibly due to inadequate attention to this most common but less taught chapter. This is responsible for errors in management, which continue to cause avoidable morbidity and even mortality. This presentation is aimed to create interest and further studies amongst the physician to assist them in understanding and solving some of the most common practical issuesof day- to-day clinical practice.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 180
Kidney replacement therapy: Pros and Cons
Authors: Roy Dilip Kumar
Published: August 2023

Kidney replacement therapy (KRT) is a term used to encompass life-supporting treatments for kidney failure. Kidney replacement therapy except kidney transplantation replaces nonendocrine kidney functions in patients with kidney failure. Researchers have noted that dialysis, which is one of the most common KRT used, cannot compensate for all the tasks performed by a kidney, and thus the term ‘Kidney support therapy’ has been suggested to be a better name. Support of kidney function in modern times encompasses a wide array of methods and clinical scenarios, from the ambulatory patient to the critically ill. The ability to safely and routinely deliver ongoing organ support in the outpatient setting has, until recently, separated kidney replacement therapy from other organ support. Kidney replacement therapy (KRT) can be applied intermittently or continuously using extracorporeal (hemodialysis) or Para corporeal (peritoneal dialysis) methods. All modalities exchange solute and remove fluid from the blood, using dialysis and filtration across permeable membranes. Nearly 4 million people in the world are living on kidney replacement therapy(KRT),and haemodialysis (HD) remains the commonest form of KRT, accounting forapproximately 69% of all KRT and 89% of all dialysis. Continuous therapy although costly is used mainly for hemodynamically unstable patients; benefits over intermittent therapy are improved tolerability as a result of slower removal of solute and water. Kidney transplantation is the ultimate step for end stage kidney failure management, as it replaces native kidney function completely. The main disadvantages of KRT relate to: Catheter related complications – blood loss, disconnection, infection or failure of access, mechanical complications of the extracorporeal circuit, fluctuations in the salt-water balance, activation of the coagulation cascade. Specific complications of peritoneal dialysis include: peritonitis, catheter- associated infections, hyperglycemia, protein loss etc. Current trends in artificial kidney research are ongoing with the lofty goal of a small device, preferably implanted with little or no maintenance required by the wearer that would deliver safe and highly effective renal replacement therapy including metabolic and endocrine functions.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 181
Heart failure with preserved ejection fraction (HFpEF): A missed diagnosis
Authors: Ahmed Chaudury Meshkat
Published: August 2023

One of the most common cause for “unexplained shortness of breath” is heart failure with preserved ejection fraction (HFpEF), that is frequently missed by the physician. Untill the wide use of BNP/NT ProBNP the term even remained unfamaliar to many of them. More over the concepts that, to make a diagnosis of HFpEF, a diastolic dysfunction is mandatory accounts for another cause of missing the diagnosis of HFpEF.The reality is Half of the all forms of heart failure is attributed to HFpEF. The diagnosis based on : the symptom of heart failure, the raised BNP/NT Pro BNP and any of the two of the either left venticular hypertrophy (LVH)/ left atrial enlargement (LAE) or features of diastolic dysfunction( as assessed by an echocadiography).The first criteria that is the symptom of heart failure is often non specific and frequently difficult to distinguish from other clinical conditions. The levels of BNP/NT ProBNP also needed to be defined according to various clinical conditions where there may be raised level of this biomarkers in the absence of heart failure.On the other hand the echocardiographic detection of LVH, LAE or left ventricular diastolic dysfunction is either time consuming or inconclusive in many patients. The various clinical phenotypes of HFpEF in the clinical back ground also make it diffcult to “fit one size for all”. Our presentation will focus on the various facets of missed diagnosed HFpEF.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 181-182
New Hope in Parkinson’s Disease Management
Authors: Rahman Aminur
Published: August 2023

Parkinson’s disease (PD) is the second most common neurodegenerative disorder worldwide, projected to affect at least 12 million people worldwide by 2040. The Hoehn and Yahr Scale stages 4 or 5 are referred to as advanced Parkinson’s disease (PD), which is characterized by significant motor deficits, a high risk of falling, extremely limited independence in terms of mobility, and cognitive and psychotic disorders. Motor fluctuations and dyskinesias frequently affect persons living with advanced PD, in which dyskinesia develops within 5.81 years from diagnosis, and motor fluctuations within 10 years. Continuous monitoring is necessary when motor fluctuations first appear to decide when to start an advanced treatment. Consequently, there is a vast need for improved treatments to address these motor symptoms. Deep brain stimulation, apomorphine subcutaneous infusion, levodopa-carbidopa intestinal gel infusion, and magnetic resonance-guided high-intensity focused ultrasound (FUS) are four device-aided therapies that provide new hope for treating PD in its advanced stages. The selection of device-assisted therapies is now mostly driven by the motor profile of the patient, with non-motor symptoms having a minimal impact on the decision-making process for the delivery and maintenance of successful therapy. In preliminary human trials, passive and active antiprotein á—synuclein vaccinations are being investigated. Monoclonal antibodies (mAbs) like prasinezumab that target the aggregates of á— synuclein can reduce the levels of free á—synuclein in serum by 97% by passive vaccination. The use of á—synuclein fragments or equivalent epitopes in active vaccination to stimulate an immune response is also being investigated. Although cell-based regeneration therapies utilizing fetal brain cells are successful in a small number of cases, this treatment is not practical due to the lack of fetal tissue. A sustainable source of dopamine-producing cells, such as stem cells, dopaminergic progenitors obtained from induced pluripotent stem cells (iPSCs), or cells derived from embryonic stem cells (ESCs), is currently being researched.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 182-183
Epilepsy: Evidence-based management
Authors: Hussain Mohammad Enayet
Published: August 2023

Epilepsy is a chronic neurological disorder characterized by recurrent seizures. It affects millions of people worldwide and can have a significant impact on a person’s quality of life. Evidence-based management is gaining popularity in all fields of Medicine. In the treatment of epilepsy it involves the use of proven strategies and interventions based on the best available research like systematic reviews and meta analysis. The goal of evidence-based management is to achieve seizure control while minimizing adverse effects and improving quality of life. Close collaboration between healthcare professionals, patients and caregivers is essential to developing and implementing effective management plans. Ongoing research and evaluation of management strategies are crucial to continuously improving the quality of care for the people with epilepsy.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 183
Internet addiction: issues and concerns
Authors: Ahmed Helal Uddin
Published: August 2023

There is some addictive use of the internet which ultimately refers to a disorder. Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviors regarding computer use and internet access that led to impairment or distress. The diagnosis “Internet Gaming Disorder” (IGD) has been included in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. This proposed condition is limited to gaming and does not include problems with general use of the internet, online gambling, or use of social media or smartphones.Co morbidity found in this addictive behavior like depression and anxiety. Treatment options are limited, including Cognitive behavioral therapy, family therapy, couple therapy, antidepressant, anti-anxiety drugs and naltrexone. The mental health professionals, information technologists, young and students affairs professionals should be alert to this disorder. Internet addiction is a growing concern in today’s digital age. With the widespread availability and use of the internet, many people are finding it difficult to control their usage, leading to negative consequences in their daily lives. Some of the issues and concerns related to internet addiction include: Social isolation, Poor academic or work performance, Physical health problems, Sleep disturbances, Risks of Cyber bullying, financial problems, Behavioral and Relationship issues. It is important to seek help if you or someone you know is struggling with internet addiction. Management options may include psychotherapy, support groups, and behavior modification techniques to help individuals regain control of their internet use and improve their overall well-being and sometimes medication need when intractable behavioral issues persist.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 183-184
Medically unexplained somatic complaints: management in real life
Authors: Syed Sifat E
Published: August 2023

Medically unexplained somatic complaints (MUSC) are a common phenomenon in primary care settings, and they pose a challenge to clinicians in terms of diagnosis and management. MUSC refers to the presence of physical symptoms that are not attributed to any known medical or organic cause. These symptoms can significantly affect patients’ quality of life and impose a substantial burden on healthcare systems. In real-life clinical practice, managing MUSC requires a multifaceted approach that includes a thorough clinical evaluation, psychoeducation, and collaborative care. The management of MUSC should start with establishing a good rapport with the patient and understanding their concerns and beliefs about their symptoms. Clinicians should also rule out any underlying medical conditions that may contribute to the symptoms. Once medical causes are excluded, the focus should shift to addressing the psychosocial factors that may be contributing to the symptoms. This can include educating patients about the nature of MUSC and the role of stress and anxiety in exacerbating their symptoms. Collaborative care involving primary care clinicians, mental health professionals, and other specialists is an effective approach for managing MUSC. It is essential to tailor the treatment to the individual needs of the patient and to ensure that they are engaged and motivated to participate in their care. In conclusion, managing MUSC in real-life clinical practice requires a collaborative, patient-centered approach that addresses the physical, psychological, and social factors contributing to the symptoms. Clinicians should adopt a biopsychosocial model of care and that maximizes patient engagement and improves their quality of life.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 184
Atypical Mycobacterial Infection: An Achilles heel for Clinician
Authors: Ahasan HAM Nazmul
Published: August 2023

Atypical mycobacteria or nontuberculous mycobacteria are organisms that cause various diseases such as skin and soft tissue infection, lymphadenitis, pulmonary infection, disseminated infection, and a wide range of more rarely encountered infections. The mycobacteria that most commonly cause this condition are most commonly found in the soil, indoor and outdoor water sources, and are recognized to colonize poorly sanitized medical equipment. Atypical mycobacteria most commonly infect young children, immunocompromised individuals, individuals with indwelling medical equipment, and those who have recently undergone surgical or non-surgical procedures. These bacteria can be further categorized into slow and rapidly growing organisms and grouped by the organ systems they commonly affect. Due to their morphology and growth patterns, atypical mycobacteria are difficult to identify on diagnostic testing. Treatment often requires extended courses of combination antibiotic therapy, frequently with surgical intervention.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 184
Global Burden of Hypertension and Strategic Approach to Overcome It
Authors: Hossain Md Zakir
Published: August 2023

Globally an estimated 1.28 billion people have hypertension, most (two thirds) living in low and middle income countries. It is the leading cause of preventable death and is responsible for 10-20% of all death worldwide. Moreover, untreated hypertension can lead to a number of serious health consequences like stroke, heart disease, renal failure, dementia, vision loss etc. Antihypertensive treatment substantially reduces incidence of stroke (35-40%), myocardial infarction (20-25%) and heart failure (>50%). But hypertension remains undiagnosed in about 46% cases and only about 21% hypertensive individuals have adequately controlled blood pressure. There are several misconceptions regarding hypertension among people that hinders diagnosis or leads to false diagnosis and impair proper management of hypertension. In attempt to reduce burden of hypertension awareness generation is the first necessary step. To create awareness among people several seminar, free blood pressure check-up campaigns etc can be conducted, billboard placement and leaflet distribution can be done in different public gathering sites like bazaar, fairs, mosques, school, college, hospital etc, and necessary knowledge on hypertension can be circulated through primary or secondary school textbooks and printing and electronic media. The next essential step is to provide quality service for hypertensive patients at an affordable cost through dedicated hypertension centers or hypertension corners. These centers should be designed to provide proper training for the stuff and proper education or counseling for patients and to perform necessary research works. Government initiatives to distribute free antihypertensive drugs should be enhanced and non-government aids can be added to it. National policy to control price of antihypertensive medications is also necessary. Finally, regular follow-up is necessary to ensure regular intake of medications, adherence to lifestyle advices, adequate titration of medications and early detection and treatment of any target organ damage. Proper counseling at each visit and reminder through phone calls or mobile SMS can improve follow-up tendency.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 185
Basic approach to poisoning focusing “Toxidrome”
Authors: Amin Md Robed
Published: August 2023

Background: The term “toxidrome” is derived from the term “toxic syndrome.”A toxidrome is a constellation of signs and symptoms that are seen with particular classes of poisons.
Methods: A systematic review of English literature was done with search item naming toxidrome and or basic approach to poisoning. Search engine was multiple leaded by pubmed having mesh term of toxidrome. The journal sites of asiajol and banglajol was also searched for related topics. Personal communication with toxicology related paper was also applied during the process.
Results: All of the toxidromes can be identified using the a quick “toxicological physical exam.” No laboratory tests are necessary! The toxicologic physical exam focuses on the following components: Vital Signs, behavior like sleepy, normal, euphoric, agitated ? Pupils whether small, normal, big? Mucus membranes like checking the axillae whether it is dry, normal, wet?Bowel sounds to see whether it is decreased, normal, increased? There are 7 toxidromes that the emergency physician should be able to recognize and treat.These include: The anticholinergic toxidrome, cholinergic toxidrome, opioid toxidrome, opioid withdrawal toxidrome, sedative-hypnotic toxidrome, sedative-hypnotic withdrawal toxidrome, and sympathomimetic toxidrome. Beside these, two additional toxidrome has recently been introduced, one is serotonergic toxidrome and neuroleptic malignant toxidrome. Patients who take several substances may have a mixed toxidrome. For example, a patient who “speedballs” cocaine and heroin may have features of both the opioid and sympathomimetic toxidromes.
Conclusion: Like all clinical syndromes, patients almost never exhibit every single feature of a particular toxidrome. When diagnosing a patient with a specific toxidrome you are looking for the one which best fits.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 185-186
Delayed puberty: How to approach?
Authors: Biswas Rabi
Published: August 2023

Disorders of puberty can profoundly impact physical and psychosocial well-being. Delayed puberty is the absence of breast development in girls by 13 years of age and absence of testicular growth to at least 4 mL in volume or 2.5 cm in length in boys by 14 years of age. Hypogonadism occurs when there is a disruption in the hypothalamic-pituitary-gonadal axis. Two categories of delayed puberty are: hypergonadotropic (primary) hypogonadism and hypogonadotropic (secondary) hypogonadism. The etiology of delayed puberty varies from relatively benign to life threatening conditions, which may be either congenital or acquired. Constitutional delay of growth and puberty is the commonest cause of delayed puberty, which is a diagnosis of exclusion. There is a notable delay in puberty but eventually progress through normal stages of puberty. History concerns about stature are often present and a familial pattern of inheritance is usually present. Delayed bone age but corresponding to height age helps in diagnosis. Reversible hypogonadotropic hypogonadism may be observed due to associated conditions including chronic malnutrition, systemic disease, untreated hypothyroidism, hyperprolactinemia, anorexia nervosa. Permanent causes include structural damage either to hypothalamic-pituitary axis or linked to the sexual organs of the individual. Complete physical examination should include proper anthropometry, pubertal staging and assessment to look for any signs of chronic illness or stigmata of syndromes. In laboratory analysis, hypogonadotropichypogonadism (pHH) showing low serum testosterone or estradiol and blunted follicle-stimulating hormones (FSH) and luteinizing hormones (LH) levels may be due to abnormalities in the central nervous system. Magnetic resonance imaging is necessary to exclude morphological abnormalities and neoplasia. Low serum testosterone in male patients and low estradiol values in female patients, associated with high serum FSH and LH levels, suggest a diagnosis of hypergonadotropic hypogonadism due to dysfunction of peripheral sex organs. Abnormal growth velocity necessitates assessment of serum thyroid function, prolactin, and insulin like growth factor-1. Karyotyping can reveal a chromosomal abnormality like Turner syndrome or Klinefelter syndrome. Beside reassurance, in cases where the adolescent with CDGP is experiencing psychological difficulties, short courses of sex hormones may be used to allow individuals to catch up with their peers. Definitive treatment for underlying cause is worthy where possible. Long-term hormone replacement therapy is recommended for permanent causes of delayed puberty.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 192
Crohn’s Disease and intestinal tuberculosis: allusion and illusion
Authors: Ghosh Chanchal Kumar
Published: August 2023

Differentiating Crohn’s disease (CD) and Intestinal tuberculosis (TB) is a diagnostic dilemma for most of the Clinicians in the developing world where ITB is endemic and CD incidence is increasing. These two granulomatus diseases are remarkably similar in their clinical, endoscopic, radiologic and pathologic features. The only exclusive features are caseation necrosis on biopsy, positive smear for acid-fast bacillus (AFB) and / or AFB culture, and necrotic lymph node on cross-sectional imaging in ITB. These exclusive features are limited by poor sensitivity ( pauci bacillary disease ) and nonspecific diagnostic criteria for CD.However, ITB is potentially curable whereas CD is incurable disease. But rate of misdiagnosis of CD and ITB range between 50% and 70% worldwide. An incorrect diagnosis and treatment may increase complications, morbidity and mortality. A high index of suspicion and critical analysis of clinical, endoscopic, histologic, microbiologic, radiologic and serologic features are required for differentiation between CD and ITB. However, therapeutic anti-tubercular therapy (ATT) trial is still required in a significant proportion of patients to establish the diagnosis.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 196
Unnecessary Prescription of Proton Pump Inhibitors (PPI): An Analysis of Inpatient Discharge Practices
Authors: Ahamed Akhlak
Published: August 2023

Background: Proton pump inhibitors (PPI) have reportedly been used in inappropriate clinical settings, often leading to an increased risk of adverse effects, drug interactions, and costs.
Aim: The aim of this study was to evaluate the appropriateness of PPI prescription on discharge of patients in medicine ward of a tertiary care hospital in Bangladesh.
Methods: A cross-sectional study was done for 3 months in the department of medicine in a tertiary care hospital to evaluate the indications of PPI use, appropriateness of PPI use and types of PPI prescribed. A total of 107 patients who were prescribed PPI on discharge were enrolled after written informed consent and data were collected in a structured questionnaire.
Results: Among the 107 patients discharged, 64 were males and 43 were females. The mean age was 51.3 ±17.6(SD) years.Among the study population, 49 were appropriately prescribed PPI and 58 were inappropriately prescribed PPI. Regarding indications, 53.1% received PPI for prevention of anti-platelet induced gastric erosion and 18.9% were prescribed PPI for no apparent reason. Age (p=0.199) and gender (p=0.605) was not significantly associated with the appropriate prescription of PPI.Of the various preparations of PPI prescribed, esomeprazole was prescribed in most of the discharged patients (56%).
Conclusion: This study demonstrates the existence of an overprescription ofPPI. PPI prescription needs to be improved, thereby reducingdrug interactions, adverse effects and unnecessary economical expenses.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 202
Spot Urine Sodium to Potassium Ratio as a Tool To Assess Severity & Mortality Among Patients With Decompensated Cirrhosis Having Ascites
Authors: Azam Mohammad Golam , Islam Safikul
Published: August 2023

Background: Decompensated cirrhosis (DC) of liver is considered as a systemic disease affecting the functions of several other organs. Renal function is an independent prognostic factor for patients with decompensated cirrhosis, but assessing renal function through glomerular filtration rate are not convenient, specially for routine use. Previous study found that spot urinary sodium to potassium ratio (UNa/K) was associated with renal dysfunction which influences the severity and outcome in decompensated cirrhosis of liver patients having ascites.The present study was aimed to determine the relation of the ratio of sodium to potassium in randomly collected urine samples (UNa/K) with severity of disease and mortality in decompensated cirrhosis having ascites.
Methods: This longitudinal study was conducted at the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Shahbagh, Dhaka, Bangladesh, from July, 2019 to August, 202l. A total of 150 patients with a confirmed diagnosis of decompensated cirrhosis with ascites were enrolled in this study. A detailed history and thorough clinical examination were carried out in each patient, along with relevant investigations. Data collection was done through a structured questionnaire. Data were analyzed using the statistical software SPSS 23.
Results: Age of the patients was 59.0±12.91(mean±SD) years, male predominance was observed (52%). The UNa/K ratio was 4.24±3.25(mean±SD) with a range of 0.42 to 18.46. Diagnostic accuracy of UNa/K ratio in the detection of severity and mortality was estimated by the receiver operating characteristic (ROC) curve. The AUC of UNa/K ratio was 0.608 and 0.640 for severity and mortality respectively. Sensitivity, specificity, PPV and NPV at cut-off 2.55 were 50.0, 66.0, 42.4 and 72.5; at 2.65 were 54.0, 66.0, 44.3, and 74.2; at 2.87 were 58.0, 62.0, 43.3, and 74.7; at 3.21 were 58.0, 58.0, 40.8, and 73.4 respectively for severity score(MELD). Patients with UNa+/K+ less than 2.87 or equal, had a significantly higher MELD score category (p= 0.02). At 3 months follow-up, 24.7% mortality was observed. Sensitivity, specificity, PPV and NPV at cut-off 1.62 were 51.4, 85.8, 54.3 and 84.3; at 1.79 were 54.1, 79.7, 46.5 and 84.1; at 1.83 were 59.5, 77.0, 45.8 and 85.3; at 2.87 were 58.0, 62.0, 43.3, and 74.7 respectively for mortality. The UNa/K ratio was statistically low among the patients who didn’t survive (p<.05).
Conclusion: This study revealed that decreased ratio of spot urinary sodium to potassium was associated with the severity and mortality among decompensated cirrhosis of liver patients with ascites.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 203
Frequency and Risk Factors Stratifi-cation of Hypertension among the Rural Population of Bangladesh
Authors: Acherjya Goutam Kumar , Tarafder Keya , Dutta Debasish , Mortuza Md Golam , Sarkar Alok Kumar , Das Nanda Lal , Ali Mohammad
Published: August 2023

Background: One of major predictors of premature mortality and morbidity; and scarcity of epidemiological data regarding hypertension among the rural people in Bangladesh, the study has been designed to find out the frequency and risk factors stratification of hypertension among the rural people in Jashore, Bangladesh.
Methods: A cross-sectional study recruited 1812 participants above 18 years attending on national hypertensive week of 2019 in Bagherpara and Keshabpur upazila (sub-district) health complex in Jashore, Bangladesh. 2020 International Society of Hypertension Global Hypertension Practice Guidelines had been demonstrated to classify hypertension.
Results: Out of the total study population, the frequency of hypertension was 20.6% (Grade 1 and Grade 2 hypertensive patients 15.8% and 4.9% respectively), and high normal blood pressure was 9.0%. The mean age of the study population, Grade 1 hypertensive and Grade 2 hypertensive cohorts were 42 ±16, 49±15 and 51±14 years respectively with a male and female ratio was 1:2. Progressive rise of mean systolic and diastolic blood pressure occurred with increasing age. Age(p:<0.001), sex(p:0.004), occupation (p:<0.001), BMI(p:<0.001), family(p:<0.001) and past history (p:<0.001) of hypertension, sedentary life style(p:0.004), additional salt intake(p:<0.001) and smoking(p:0.011) were significantly associated with hypertension following bivariate analysis. Multivariate logistic regression analysis revealed that age after 50 years (AOR=1.866, 95% CI: 1.210-2.876), positive past history of hypertension (AOR=3.493, 95% CI: 2.676- 4.558), additional salt intake (AOR=0.591, 95% CI: 0.453-0.770) and obesity (AOR=3.389, 95% CI: 1.830-6.274) were significantly associated with developing hypertension.
Conclusion: High frequency of hypertension was found among the rural population in Bangladesh where a lot of significantly associated risk factors. The data would be helpful for the health policy makers dealing Non-communicable diseases to reach the sustainable goal and mitigate morbidity and mortality of cardiovascular diseases in Bangladesh.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 205
Nailfold Video-Capillaroscopic Changes in Adult Bangladeshi Patients With Systemic Lupus Erythematosus: Correlation With Disease Activity
Authors: Mahmud S , Paul S , Sattar MA , Mirzada MR , Ullah EE , Rajib MSA , Razzaque MA
Published: August 2023

Background: Peripheral microangiopathy is an important feature in systemic lupus erythematosus (SLE). Nailfold capillary (NFC) changes observed by nailfold videocapillaroscopy (NVC) may play a role in early detection of microangiopathy and assessment of disease activity in SLE. The aim of the study was to evaluate nailfold capillary changes, their diagnostic accuracy and NFC-pattern of changes in a group of Bangladeshi SLE patients in comparison to healthy subjects and to determine the correlation with disease activity in SLE.
Methods: This cross-sectional study with a comparison group was conducted in CMCH, Chattogram; a Tertiary Care Hospital in Bangladesh.
Results: Twenty-seven (n=27) Bangladeshi SLE patients who were diagnosed by ACR-1997 revised criteria for diagnosis of SLE and Twenty-seven (n=27) age-sex matched health subjects were included. All participants were subjected to full history taking, clinical examination, laboratory investigations as well as NVC examination. SLE disease activity was assessed by SLEDIA scoring tool and nailfold capillary changes were assessed with NFC-pattern of changes by applying NVC. Results: Mean (±SD) age of the SLE patient group was 31.2 (±7.8) years and female to male ratio was around 6:1. 23 out of 27(85.2%) patients had multiple phenotypes and 18 (66.6%) had either high or very high disease activity. Sub-papillary venous plexus (SPVP) was prominently visible more frequently in SLE patients and capillary density was reduced in SLE patients compared with healthy controls. Capillary changes in NVC were observed in 26 out of 27 (96.3%) patients. Major and scleroderma pattern were detected in 51.9% and 11.1% of the SLE patients; respectively. Nailfold capillary abnormalities were significantly more frequent in SLE patient than in healthy controls. More frequently found different abnormal morphological changes were seen with crossed capillary (66.7%), tortuous capillary (63%) and meandering capillary (37%). There was a significant positive correlation between disease activity of SLE and NFC-pattern of changes (r=0.443, p=0.021).
Conclusion: Different abnormal nailfold capillary changes are quite common among patients with SLE, and nailfold capillary changes positively correlate with disease activity in SLE.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 208
Cardiac Rehabilitation in Coronary Artery Disease: Improving Outcomes and Adherence
Authors: Rahman Md Toufiqur , Islam AKM Monwarul , Majumder AAS
Published: August 2023

Cardiac rehabilitation (CR) is a program that aims to improve the cardiovascular health of patients with coronary artery disease (CAD) through a multidisciplinary approach. CR typically includes exercise training, risk factor modification, psychosocial support, and education. Studies have shown that CR can improve exercise capacity, reduce angina symptoms, enhance overall quality of life, and reduce the risk of recurrent cardiovascular events. Despite the benefits of CR, adherence remains a challenge, and many patients with CAD do not participate in these programs. Strategies to improve adherence to CR include patient education, personalized goal setting, motivational interviewing, and peer support. Encouraging and supporting patients with CAD to participate in CR programs is crucial for the secondary prevention and long-term management of their condition. CR programs are typically supervised by healthcare professionals, such as cardiac rehabilitation specialists, exercise physiologists, and dietitians, who work together to develop personalized treatment plans for each patient. Exercise training is a key component of CR, and programs may involve aerobic and resistance training, as well as other forms of physical activity such as yoga or tai chi. Risk factor modification focuses on controlling blood pressure, reducing cholesterol levels, managing diabetes, and promoting smoking cessation. Psychosocial support and education may include counseling, stress management, and education on nutrition and medication management. While CR programs are effective, access to these programs may be limited for some patients, particularly those in underserved communities or rural areas. Tele-rehabilitation, which uses technology to provide remote delivery of CR services, has shown promise in increasing access to CR for patients who may not have access to traditional in-person programs. Overall, CR is a vital component of the management of CAD, and its benefits extend beyond cardiovascular health to include improvements in overall quality of life. It is important to raise awareness about the importance of CR and to work towards increasing access to these programs for all patients with CAD.
J Medicine 2023; Vol. 34, No. 2(1) Supplement: 213
Hereditary Persistence Of Alpha-fetoprotein: A Rare Entity From A Primary Care Center In Bangladesh
Authors: Podder Chinmay Saha , Amin Mohammod Feroz , Chowdhury Nandini
Published: August 2023

Hereditary persistence of alpha- fetoprotein (HFAFP) is a rare benign autosomal dominant disorder.Here we report a case of 15 years old boy who was found to have elevated alpha-fetoprotein during her routine evaluation for gynaecomastia. All other common possibilities for raised alpha-fetoprotein were excluded.Subsequently, 2 of his family members were found to have raised alpha-fetoprotein.One is his father and another one is his brother.Raised alpha-fetoprotein has a wide differential diagnosis including, pregnancy, germ cell tumors, hepatocellular carcinoma and others.But after exclusion of other possibilities, persisting elevated alphafetoprotein raises the suspicion for HPAFP.Testing other family members for AFP and specific genetic study aid in diagnosis.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 216-217
Acute Medicine: A New Horizon
Authors: Ahmad J , Nizhu L , Haroon MA , Anam AM
Published: August 2023

Background: Acute medicine is concerned with the immediate and early management of adult patients suffering from a wide range of medical conditions requiring urgent care. It is a new concept in the context of our country. Given the current situation of the burden of patients against available resources, management of acute conditions under the umbrella of acute medicine may have a promising result.
Methods: All the information was collected from the department of Acute Medicine of Square Hospitals Limited since it started its journey on the 15th October, 2022. Data of first 175 days (15th October, 2022 to 7th April, 2023) were compiled and the outcome was observed.
Results: Among 615 patients of department of Acute Medicine, 50% were male and 50% were female. Among them 84% were managed within 72 hours; 92.4% improved and 7.2% needed treatment escalation. Among the patients who got improved, 76% were shifted to cabin and 13% were discharged home after management of acute condition.
Conclusion: The observation revealed better patient outcome with less hospital stay.
J Medicine 2023; Vol. 34, No. 2(1) Supplement: 218