Primary antiphospholipid syndrome in a male presents with acute digital ischemia: Dramatic response to glucocorticoid.

We present a rare case of primary antiphospholipid syndrome in a 38-year-old male who presented with painful digital ischemia. Early initiation of anticoagulation and addition of glucocorticoid led to a significant improvement in the patient.

Assessment of mental wellbeing of university students in Bangladesh using Goldberg's GHQ-12: A cross-sectional study.

Background and Aims: The mental well-being of university students is a primary public health concern worldwide, including in Bangladesh. The objective of this study was to determine the prevalence of the overall mental health status among Bangladeshi university students. The study used larger and more diverse sample compared to previous studies, and also explored factors associated with the mental health well-being of those students. Methods: Data were collected through an online questionnaire, utilizing the proportional allocation method, from students in various universities across Bangladesh. The sample included 2036 participants. The study applied Goldberg's General Health Questionnaire (GHQ-12) using the GHQ2+ threshold (i.e., having more than two symptoms). A binary outcome variable was created with two levels: "good mental health" and "poor mental health," to assess the mental health status of the university students. The explanatory variables were age, gender, academic year, type of university, and sources of personal expenses. Exploratory data analysis, association tests, and binary logistic regression models were used to identify factors influencing the outcome variable. Results: A total of 55.9% of students (male: 52.6% and female: 62.8%) exhibited poor mental health status. Female students' mental health was found to be worse (odds ratio [OR]: 1.49, 95% confidence interval [CI]: 1.23-1.81) compared to that of males. Similarly, public university students displayed a worse mental health condition than their counterparts in private universities (OR: 1.29, 95% CI: 1.03-1.61). Conclusion: The overall mental health of university students in Bangladesh is concerning. There is a pressing need for effective mental health policies and interventions to bolster the mental well-being of university students, with a specific focus on students from public universities and females.

Corrigendum: Association of household fuel with acute respiratory infection (ARI) under-five years children in Bangladesh.

[This corrects the article DOI: 10.3389/fpubh.2022.985445.].

Antibiotic prescription from qualified sources for children with fever/cough: cross-sectional study from 59 low- and middle-income countries.

Background: Children in low and middle-income countries (LMICs) receive a staggering number of antibiotic prescriptions, many of which are inappropriate. We aimed to explore the proportion of antibiotic prescriptions from qualified sources of children under five who had a fever/cough in the two weeks prior to the survey in LMICs. Methods: We used data from cross-sectional studies of the latest Demographic and Health Survey (DHS) datasets (n = 43,166) in 59 LMICs covering Sub-Saharan Africa, North Africa-West Asia-Europe, Central Asia, South & Southeast Asia, Oceania, and Latin America & the Caribbean regions. The study was conducted from March 2, 2020 to October 15, 2022. We only included the latest available surveys by country, and children under five who had taken antibiotics for fever/cough were included in the study. Finally, the outcome variable was classified into two distinct categories: those who had taken antibiotics from qualified sources and those who did not. Findings: About three in four children (74.0%) received antibiotics from qualified sources. Tanzania (22.4%) and Malawi (99.9%) had the lowest and highest percentages of antibiotic prescriptions by qualified sources, respectively. Oceania had the highest percentage of qualified antibiotic prescriptions with 88.9% and Central Asia had the lowest percentage with 56.3%. Interpretation: As unqualified sources of antibiotics for fever/cough in children under five were alarmingly high in some of the LMICs, the study emphasises the importance of nationwide efforts to regulate antibiotics prescriptions. Funding: None.

Evaluation of instrumental variable method using Cox proportional hazard model in epidemiological studies.

The instrumental variable (IV) method with a Cox proportional hazard (PH) model has been used to evaluate treatment effects in epidemiological studies involving survival data. The effectiveness of the IV methods in these circumstances has yet to be fully understood, though. The study aimed to evaluate the performance of IV methods using a Cox model. We evaluated the validity of treatment effects estimated by two-stage IV models using simulated scenarios with varying confounder strengths and baseline hazards. Our simulation demonstrated that when observed confounders were not taken into account in the IV models, and the confounder strength was moderate, the treatment effects based on the two-stage IV models were similar to the true value. However, the effect estimates diverged from the true value when observed confounders were taken into account in the IV models. In the case of a null treatment effect (i.e., hazard ratio=1), the estimates from the unadjusted and adjusted IV models (only two-stage) were close to the true value. The implication of our study findings is that the treatment effects obtained through IV analyses using the Cox PH model remain valid if the estimates are reported from unadjusted IV models with moderate confounding effects or if the treatment does not impact the outcome.•For every simulation, we utilized a sample size of 10,000 and performed 1,000 replications.•The true treatment effects (HR) of 3, 2, and 1 (null effect) were evaluated.•The 95% confidence intervals (CI) were calculated as the range between the 2.5 and 97.5 percentiles of the 1000 estimates.

Mother's functional difficulty is affecting the child functioning: Findings from a nationally representative MICS 2019 cross-sectional survey in Bangladesh.

Background: Functional difficulties in children can be transmitted from mother to child, which is a major concern. We sought to determine whether there was a correlation between a mother's functional difficulty and functional difficulty in kids between the ages of 2-4 and 5-17. We also want to evaluate other fundamental aspects that influence on child's functionality. Methods: We used Multiple Indicator Cluster Survey (MICS) data sets. For two different age groups, the children's difficulty status was evaluated. The sociodemographic factors served as explanatory variables in this study. We used χ 2 tests and survey logistic regression models to analyze the data. Results: Functional difficulties were less common in children aged 2-4 years (2.78%) but 8.27% in those aged 5-17 years. The study specifies that the mother's functional difficulty (odds ratio [OR]: 2.66, confidence interval [CI]: 1.35-5.24 for children aged 2-4 years and OR: 3.36, CI: 2.80-4.03 for children aged 5-17 years) were significantly associated with the functional difficulty of both age groups' children. Not attending early childhood education programs (OR: 1.89, CI: 1.16-3.10 for children aged 2-4 years and OR: 2.66, CI: 2.19-3.22 for children aged 5-17 years) and divisions were also significantly affecting the functional difficulty of both age groups' children. Moreover, area of residence and gender were significant factors for the older age group. Conclusions: The prevalence of difficulty among children in Bangladesh is high. Children's functional difficulty, regardless of age, is greatly influenced by the functional difficulty of their mothers, their absence from early childhood education programs, and divisions. Reducing the prevalence of child functioning difficulties will be more successful if the government and NGOs consider these factors while developing appropriate intervention programs.

Association of household fuel with acute respiratory infection (ARI) under-five years children in Bangladesh.

In developing countries, acute respiratory infections (ARIs) cause a significant number of deaths among children. According to Bangladesh Demographic and Health Survey (BDHS), about 25% of the deaths in children under-five years are caused by ARI in Bangladesh every year. Low-income families frequently rely on wood, coal, and animal excrement for cooking. However, it is unclear whether using alternative fuels offers a health benefit over solid fuels. To clear this doubt, we conducted a study to investigate the effects of fuel usage on ARI in children. In this study, we used the latest BDHS 2017-18 survey data collected by the Government of Bangladesh (GoB) and estimated the effects of fuel use on ARI by constructing multivariable logistic regression models. From the analysis, we found that the crude (the only type of fuel in the model) odds ratio (OR) for ARI is 1.69 [95% confidence interval (CI): 1.06-2.71]. This suggests that children in families using contaminated fuels are 69.3% more likely to experience an ARI episode than children in households using clean fuels. After adjusting for cooking fuel, type of roof material, child's age (months), and sex of the child-the effect of solid fuels is similar to the adjusted odds ratio (AOR) for ARI (OR: 1.69, 95% CI: 1.05-2.72). This implies that an ARI occurrence is 69.2% more likely when compared to the effect of clean fuel. This study found a statistically significant association between solid fuel consumption and the occurrence of ARI in children in households. The correlation between indoor air pollution and clinical parameters of ARI requires further investigation. Our findings will also help other researchers and policymakers to take comprehensive actions by considering fuel type as a risk factor as well as taking proper steps to solve this issue.

Mental health knowledge and awareness among university students in Bangladesh.

Negative attitudes toward mental illness and treatment are attributed to a lack of or inaccurate mental health knowledge. We aimed to assess the current mental health knowledge and awareness among Bangladeshi university students and identified socio-demographic factors that affect them. Between February and April of 2021, a cross-sectional study of 2036 university students in Bangladesh was conducted. Two different questionnaires (i.e., knowledge and awareness) were developed to assess mental health knowledge and awareness. The two outcome variables in this study were mental health knowledge level and awareness level. The cut-off value was taken as 80% of the total scores of both the knowledge and awareness scales and divided into higher and lower groups. Data were analyzed using different descriptive statistical tools and binary logistic regression model. We found more than half (62.1%) of the students had higher knowledge, and 85.1% of the students had a higher awareness of mental health problems. Female students (OR 1.41, 95% confidence interval (CI): 1.15-1.72) and students managing their expenses by personal income and family support were significantly positively associated with the high knowledge of the mental health (OR 1.79, 95% CI: 1.40-2.29). Similarly, age (OR 1.47, 95% CI: 1.01-2.14) was significantly associated with high awareness. Good mental health was significantly negatively associated with the high knowledge (OR 0.72, 95% CI: 0.6-0.87) and positively associated with the high awareness (OR 1.48, 95% CI: 1.15-1.91). Although mental health awareness is high among Bangladeshi university students, knowledge of mental health is insufficient. As a result, it is essential to comprehend the gaps in knowledge and awareness of mental health disorders, as well as how they are addressed.

Reporting methodological issues of the mendelian randomization studies in health and medical research: a systematic review.

BACKGROUND: Mendelian randomization (MR) studies using Genetic risk scores (GRS) as an instrumental variable (IV) have increasingly been used to control for unmeasured confounding in observational healthcare databases. However, proper reporting of methodological issues is sparse in these studies. We aimed to review published papers related to MR studies and identify reporting problems. METHODS: We conducted a systematic review using the clinical articles published between 2009 and 2019. We searched PubMed, Scopus, and Embase databases. We retrieved information from every MR study, including the tests performed to evaluate assumptions and the modelling approach used for estimation. Using our inclusion/exclusion criteria, finally, we identified 97 studies to conduct the review according to the PRISMA statement. RESULTS: Only 66 (68%) of the studies empirically verified the first assumption (Relevance assumption), and 40 (41.2%) studies reported the appropriate tests (e.g., R2, F-test) to investigate the association. A total of 35.1% clearly stated and discussed theoretical justifications for the second and third assumptions. 30.9% of the studies used a two-stage least square, and 11.3% used the Wald estimator method for estimating IV. Also, 44.3% of the studies conducted a sensitivity analysis to illuminate the robustness of estimates for violations of the untestable assumptions. CONCLUSIONS: We found that incompleteness of the justification of the assumptions for the instrumental variable in MR studies was a common problem in our selected studies. This may misdirect the findings of the studies.

Estimation of novel coronavirus (COVID-19) reproduction number and case fatality rate: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Realizing the transmission potential and the magnitude of the coronavirus disease 2019 (COVID-19) aids public health monitoring, strategies, and preparation. Two fundamental parameters, the basic reproduction number (R 0) and case fatality rate (CFR) of COVID-19, help in this understanding process. The objective of this study was to estimate the R 0 and CFR of COVID-19 and assess whether the parameters vary in different regions of the world. METHODS: We carried out a systematic review to find the reported estimates of the R 0 and the CFR in articles from international databases between January 1 and August 31, 2020. Random-effect models and Forest plots were implemented to evaluate the mean effect size of R 0 and the CFR. Furthermore, R 0 and CFR of the studies were quantified based on geographic location, the tests/thousand population, and the median population age of the countries where the studies were conducted. To assess statistical heterogeneity among the selected articles, the I 2 statistic and the Cochran's Q test were used. RESULTS: Forty-five studies involving R 0 and 34 studies involving CFR were included. The pooled estimation of R 0 was 2.69 (95% CI: 2.40, 2.98), and that of the CFR was 2.67 (2.25, 3.13). The CFR in different regions of the world varied significantly, from 2.49 (2.08, 2.94) in Asia to 3.40 (2.81, 4.04) in North America. We observed higher mean CFR values for the countries with lower tests (3.15 vs 2.16) and greater median population age (3.13 vs 2.27). However, R 0 did not vary significantly in different regions of the world. CONCLUSIONS: An R 0 of 2.69 and a CFR of 2.67 indicate the severity of the COVID-19. Although R 0 and CFR may vary over time, space, and demographics, we recommend considering these figures in control and prevention measures.

Finding the real COVID-19 case-fatality rates for SAARC countries.

The crude case fatality rate (CFR), because of the calculation method, is the most accurate when the pandemic is over since there is a possibility of the delay between disease onset and outcomes. Adjusted crude CFR measures can better explain the pandemic situation by improving the CFR estimation. However, no study has thoroughly investigated the COVID-19 adjusted CFR of the South Asian Association For Regional Cooperation (SAARC) countries. This study estimated both survival interval and underreporting adjusted CFR of COVID-19 for these countries. Moreover, we assessed the crude CFR between genders and across age groups and observed the CFR changes due to the imposition of fees on COVID-19 tests in Bangladesh. Using the daily records up to October 9, we implemented a statistical method to remove the delay between disease onset and outcome bias, and due to asymptomatic or mild symptomatic cases, reporting rates lower than 50% (95% CI: 10%-50%) bias in crude CFR. We found that Afghanistan had the highest CFR, followed by Pakistan, India, Bangladesh, Nepal, Maldives, and Sri Lanka. Our estimated crude CFR varied from 3.708% to 0.290%, survival interval adjusted CFR varied from 3.767% to 0.296% and further underreporting adjusted CFR varied from 1.096% to 0.083%. Furthermore, the crude CFRs for men were significantly higher than that of women in Afghanistan (4.034% vs. 2.992%) and Bangladesh (1.739% vs. 1.337%) whereas the opposite was observed in Maldives (0.284% vs. 0.390%), Nepal (0.006% vs. 0.007%), and Pakistan (2.057% vs. 2.080%). Besides, older age groups had higher risks of death. Moreover, crude CFR increased from 1.261% to 1.572% after imposing the COVID-19 test fees in Bangladesh. Therefore, the authorities of countries with higher CFR should be looking for strategic counsel from the countries with lower CFR to equip themselves with the necessary knowledge to combat the pandemic. Moreover, caution is needed to report the CFR.

Changes in prevalence, and factors associated with tobacco use among Bangladeshi school students: evidence from two nationally representative surveys.

BACKGROUND: Globally, tobacco kills more than nine million people per year. Annually in Bangladesh, smoking accounts for 1.2 million illnesses and over one hundred fifty thousand deaths. Worldwide, about one out of five school students smoke tobacco, and this problem is also growing significantly in Bangladesh. There is a need to address this problem. However, to the best of knowledge, no published study has been evaluated the changes in factors associated with tobacco use over time among Bangladeshi adolescent students using large, nationally representative comparable surveys. Our objective was to identify the factors associated with tobacco use among school going students, examine any changes in them over time, and explore policy options based on national surveys. METHODS: We analysed the data from the 2007 and the 2013 Global Youth Tobacco Survey (GYTS), a school-based survey targeting adolescents age 13-15 years (7th-9th grade), developed by the World Health Organization (WHO) and the Centres for Disease Control and Prevention (CDC). The samples were selected based on a two-stage cluster sample design. The data were collected in school classes using a self-administered anonymous survey. We applied chi-square tests and survey logistic regression models for analysing the data. RESULTS: Overall tobacco usage significantly declined from 8.4 to 6.9% over six years. The prevalence of tobacco use decreased among females (5.22 to 2.84%), those who received anti-tobacco messages (8.93 to 7.24%) and because of age restriction could not buy tobacco products (18.86 to 15.78%). Compared with the female, the odds of overall tobacco smoking among male students was 1.97 (CI: 0.99-3.92) in the year 2007 and it increased (OR = 3.07; CI: 1.56-6.04) in the year 2013. Moreover, the odds of smoking among those exposed to tobacco smoke had increased (OR = 3.26; CI: 1.46-7.29 vs 5.43; CI: 1.63-18.07) from 2007 to 2013. CONCLUSION: There was a decline in tobacco use, especially among female students. Male students were higher tobacco user. It appeared anti-smoking campaign and age restriction policies were working.