Pattern and Predictors of Infection Among Patients With Rheumatological Disease on Immunosuppressive Medications: A Retrospective Study in a Tertiary Care Hospital in Bangladesh.

Background Immunomodulatory therapy for chronic rheumatic disease carries a risk for infectious complications. In Bangladesh, there is limited information regarding patterns and factors associated with infections among patients receiving immunosuppressive medications. Objective The present study aimed to find out patterns and predictors associated with infection among patients who were on different immunosuppressive medications due to chronic rheumatological disease. Methodology This was a retrospective study; all confirmed cases of (new and old) different rheumatological diseases on disease-modifying agents attended at the rheumatology clinic of Dhaka Medical College Hospital from January 2019 to December 2021 were enrolled. Result Among 489 cases, 90 (18.4%) patients had documented infections. The most common rheumatological diseases were systemic lupus erythematosus (28, 31.1%), ankylosing spondylitis (26, 28.8%), and rheumatoid arthritis (20, 22.2%). COVID-19 (28, 31.1%) was the most commonly occurring infection followed by urinary tract infection (14, 15.6%), fungal infection (12, 13.3%), herpes zoster (10, 11.1%), pulmonary tuberculosis (TB) (eight, 8.8%), latent TB (seven, 7.7%), community-acquired pneumonia (six, 6.6%), and sepsis (three, 3.3%). Infection was most prevalent among patients who received steroids of more than 10 mg per day (17, 18.8%) than those less than 10 mg steroid per day (six, 6.7%), Factors associated with infections were (odds ratio, 95% CI, p-value) underweight (2.3, [1.3-2.7], 0.001), anemia (1.8, [1.1-5.7], 0.01), neutropenia (1.6, [1.1-2.9], <0.002), hypoalbuminemia (3.1, [1.6-4.9], 0.001), hypovitaminosis D (1.9, [1.3-4.5], 0.001), high blood sugar (1.5, [1.1-5.3], 0.02), inadequate counseling of steroid side effect (1.7, [1.1-3.9], 0.03), prednisolone >10mg/day (2.2, [1.19-4.10], 0.001). Conclusion COVID-19 pneumonia, urinary tract infections, fungal infection, tuberculosis, herpes zoster, and community-acquired pneumonia were commonly occurring infections among patients receiving different immunosuppressive medications. Factors like poor nutritional status, presence of anemia, leucopenia, hypoalbuminemia, hyperglycemia, and hypovitaminosis D had a significant association with infection. Moreover, inadequate counseling of steroid side effects and history of daily intake of prednisolone (>10mg/day) were also significant factors associated with infection.

Vision Impairment and Productivity Among Female Garment Workers in Bangladesh: A Cohort Study.

PURPOSE: To assess the prevalence of near and correctable distance visual impairment among screened participants in the garment industry and to explore associations with income, age, and urban versus rural residence. METHODS: Vision screenings were conducted at 4 garment factories, 2 urban and 2 rural locations during September and October 2019. Distance vision impairment was the presence of uncorrected vision of <6/12 in either eye, correctable to ≥6/7.5 with distance refraction. Near vision impairment was defined as 1 or more of the following: 1) either eye with presenting near vision 6/12 in the same eye; 2) having been prescribed near add spectacle power in examination records; and/or 3) clinical diagnosis of presbyopia at the time of screening. Demographic information and monthly income were self-reported by questionnaire completion. RESULTS: Among 915 participating workers (100% female, 18 to 70 years), 29.2% (n = 267) and 26.8% (n = 245) had correctable distance and near vision impairment respectively. Prevalence of near vision impairment was significantly higher among rural residents (34.2%, n = 160), compared to urban (19.0%, n = 85, P < 0.0001) with the largest differences in the 35 to 39 (68.2% vs 44.2%, P = 0.0019) and 40+ (85.9 vs 48.9%, P < 0.0001) year age ranges. Prevalence of near vision impairment was already high among urban (20.4%, n = 20) and rural (23.0%, n = 17) workers aged 30 to 34 years. In simple linear regression models, participants with near vision impairment earned $13.3 [standard error (SE) 2.44, P < 0.0001] less per month than those without, while urban residents earned $40.6 (SE 1.74, P < 0.0001) more than rural dwellers. In the final multivariate linear model, both near vision impairment ($6.51 lower monthly earnings, SE 1.84, P = 0.0004) and urban residence ($43.2 higher monthly earnings, SE 2.39, P < 0.0001) remained significantly associated with income. CONCLUSIONS: This study found high rates of near vision impairment among female garment workers, particularly rural dwellers, and at a younger age than expected. The high prevalence and association between near vision impairment and lower income suggest that focusing on industries with a high proportion of female workers, such as readymade garments, may be effective in addressing gender disparities in vision impairment and its economic impact.

Improved recipes provide better complementary feeding in young children: findings of community-based trials in Bangladesh.

BACKGROUND: In Bangladesh, only 34% of children receive minimum acceptable diets as complementary foods (CF) for appropriate age while the rest of them remain at the risk of growth faltering, micronutrient deficiency, compromised cognitive development, and increased morbidity and mortality. OBJECTIVE: The purpose of the study was to develop nutritious recipes for complementary feeding and provide necessary guidelines for improving complementary feeding practices for doctors, nutritionist and caregivers. METHODS: This qualitative study including a baseline survey and Trials of Improved Practices of recipes (TIPs) was conducted on families having 6-23 months old children selected by Multi-stage random sampling methods from 2010 to 2012 throughout seven divisions of Bangladesh. Thirty-five food recipes were developed from local food items based on the 'WHO indicators to assess the adequacy of CF practices' for the TIP. Thirty (30) cooked recipes were analyzed for 10 nutrients in an accredited laboratory in Bangladesh. RESULTS: The baseline survey found that energy density of local recipes was low and did not have the required diversity, adequacy, and nutrient density according to IYCF indicators established by WHO. The TIPs found that 28 recipes out of the 35 recipes were most acceptable by both mothers and children. A manual of improved complementary food recipes and a complementary feeding guideline has been developed with calculation of dietary diversity scores, energy and nutrient density. CONCLUSION: This report will provide evidence-based practical knowledge for training and serve as nutrition education tool for nutrition practitioners, policy makers, and academicians.

Alterations of serum trace elements and other biochemical parameters are correlated with the pathogenesis of systemic lupus erythematosus: A preliminary study on Bangladeshi population.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disorder in which the body's defense system wrongly attacks healthy body tissues. The objective of this current setup was to quantify and compare the serum concentration of ascorbic acid (Vit-C), malondialdehyde (MDA), c-reactive protein (CRP) and trace elements (Cu, Fe, Mn and Zn) in SLE and normal subjects. METHODS: The proposed case-control study was performed with 25 SLE patients and 25 healthy subjects as case and control, respectively. The serum level of malondialdehyde (MDA) and vitamin C was evaluated by UV spectrophotometric method. For the determination of CRP, the latex agglutination method was used, whereas serum trace elements were estimated by atomic absorption spectroscopy (AAS). RESULTS: This analysis demonstrated that patients with SLE possessed a significant (p < 0.001) higher level of MDA and lower level of vitamin C compared to control subjects. Pearson's correlation analysis found negative correlation between the serum level of MDA and vitamin C (r= -0.023, p = 0.887) for patients while control group also possessed similar result (r= -0.157, p = 0.453). The current findings have also revealed that serum level of Zn and Cu in SLE patients was significantly (p < 0.05) lowered to that of the control group, while serum level of Mn also showed a similar scenario. During Pearson's correlation analysis a significantly (p < 0.05) negative correlation was found between Zn and Mn (r= -0.410, p = 0.042) in patients' group. CONCLUSION: Although our study was limited to a small sample size and confined to a particular area of the country, the study results support a significant role of antioxidants, CRP, and trace elements in the generation of SLE and, therefore, recommends a large spectrum study of the associations between SLE and these biochemical parameters.

Ivermectin in combination with doxycycline for treating COVID-19 symptoms: a randomized trial.

OBJECTIVE: We evaluated whether ivermectin combined with doxycycline reduced the clinical recovery time in adults with COVID-19 infection. METHODS: This was a randomized, blinded, placebo-controlled trial in patients with mild-to-moderate COVID-19 symptoms randomly assigned to treatment (n = 200) and placebo (n = 200) groups. The primary outcome was duration from treatment to clinical recovery. Secondary outcomes were disease progression and persistent COVID-19 positivity by RT-PCR. RESULTS: Among 556 screened patients, 400 were enrolled and 363 completed follow-up. The mean patient age was 40 years, and 59% were men. The median recovery time was 7 (4-10, treatment group) and 9 (5-12, placebo group) days (hazard ratio, 0.73; 95% confidence interval, 0.60-0.90). The number of patients with a ≤7-day recovery was 61% (treatment group) and 44% (placebo groups) (hazard ratio, 0.06; 95% confidence interval, 0.04-0.09). The proportion of patients who remained RT-PCR positive on day 14 and whose disease did not progress was significantly lower in the treatment group than in the placebo group. CONCLUSIONS: Patients with mild-to-moderate COVID-19 infection treated with ivermectin plus doxycycline recovered earlier, were less likely to progress to more serious disease, and were more likely to be COVID-19 negative by RT-PCR on day 14. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04523831. DATA REPOSITORY ID: Dryad. doi:10.5061/dryad.qjq2bvqf6.

Association of ABO blood groups with presentation and outcomes of confirmed SARS CoV-2 infection: A prospective study in the largest COVID-19 dedicated hospital in Bangladesh.

BACKGROUND: Globally, studies have shown conflicting results regarding the association of blood groups with SARS CoV-2 infection. OBJECTIVE: To observe the association between ABO blood groups and the presentation and outcomes of confirmed COVID-19 cases. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective cohort study of patients with mild-to-moderately severe COVID-19 infections who presented in the COVID-19 unit of Dhaka Medical College Hospital and were enrolled between 01 June and 25 August, 2020. Patients were followed up for at least 30 days after disease onset. We grouped participants with A-positive and A-negative blood groups into group I and participants with other blood groups into group II. RESULTS: The cohort included 438 patients; 52 patients were lost to follow-up, five died, and 381 completed the study. The prevalence of blood group A [144 (32.9%)] was significantly higher among COVID-19 patients than in the general population (p < 0.001). The presenting age [mean (SD)] of group I [42.1 (14.5)] was higher than that of group II [38.8 (12.4), p = 0.014]. Sex (p = 0.23) and co-morbidity (hypertension, p = 0.34; diabetes, p = 0.13) did not differ between the patients in groups I and II. No differences were observed regarding important presenting symptoms, including fever (p = 0.72), cough (p = 0.69), and respiratory distress (p = 0.09). There was no significant difference in the median duration of symptoms in the two group (12 days), and conversion to the next level of severity was observed in 26 (20.6%) and 36 patients (13.8%) in group I and II, respectively. However, persistent positivity of RT-PCR at 14 days of initial positivity was more frequent among the patients in group I [24 (19%)] than among those in group II [29 (11.1%)]. CONCLUSIONS: The prevalence of blood group A was higher among COVID-19 patients. Although ABO blood groups were not associated with the presentation or recovery period of COVID-19, patients with blood group A had delayed seroconversion.

Serum CRP, MDA, Vitamin C, and Trace Elements in Bangladeshi Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is an autoimmune disorder that is a painful health crisis. This study aimed to assess the serum C-reactive protein (CRP), malondialdehyde (MDA), non-enzymatic antioxidant (vitamin C), and trace elements (Zn, Cu, Mn, and Fe) in RA patients, and thereby correlate these parameters with the association of RA. This study included 20 Bangladeshi RA patients and 20 normal healthy volunteers as control subjects. CRP level was determined using a laboratory-based latex agglutination-enhanced immunoassay. The lipid peroxidation level was determined by measurement of the serum level of MDA. Non-enzymatic antioxidant vitamin C was assessed by UV spectrophotometric method. Trace elements were determined by atomic absorption spectroscopy (AAS). Our study observed significantly higher concentrations of CRP (p < 0.001) and MDA (p < 0.001), and significantly lower concentrations of vitamin C (p < 0.001) in the RA patient. The mean values of Zn, Cu, Mn, and Fe were 6.62 ± 0.34, 1.42 ± 0.17, 7.51 ± 0.23, and 29.25 ± 0.41 ppm for the RA patients respectively and 13.57 ± 9.13, 1.15 ± 0.17, 1.59 ± 0.18, and 62.47 ± 5.25 ppm for the control subjects, consequently. There was a significant difference (p < 0.05) in the trace element levels between the RA patients and control subjects. Our study suggests that a higher concentration of CRP and MDA, lower levels of vitamin C, and altered trace elements may be linked to RA.

Clinical and Laboratory Characteristics of an Acute Chikungunya Outbreak in Bangladesh in 2017.

From April to September 2017, Bangladesh experienced a huge outbreak of acute Chikungunya virus infection in Dhaka. This series describes the clinical and laboratory features of a large number of cases (690; 399 confirmed and 291 probable) suffered during that period. This observational study was carried out at Dhaka Medical College Hospital, Bangladesh. The median age of the patients at presentation was 38 years (IQR 30-50) with a male (57.3%) predominance. Hypertension and diabetes were the most common comorbidities. The mean (±SD) duration of fever was 3.7 (±1.4) days. Other common manifestations were arthralgia (99.2%), maculopapular rash (50.2%), morning stiffness (49.7%), joint swelling (48.5%), and headache (37.6%). Cases were confirmed by anti-chikungunya IgG (173; 43.3%), IgM (165; 42.3%), and reverse transcription polymerase chain reaction (44; 11.0%). Important laboratory findings include high erythrocyte sedimentation rate (156; 22.6%), raised serum glutamic pyruvic transaminase (73; 10.5%), random blood sugar (54; 7.8%), leukopenia (72; 10.4%), thrombocytopenia (41; 5.9%), and others. The oligo-articular (453; 66.1%) variety of joint involvement was significantly more common compared with the poly-articular (237; 34.5%) variety. Commonly involved joints were the wrist (371; 54.1%), small joints of the hand (321; 46.8%), ankle (251; 36.6%), knee (240; 35.0%), and elbow (228; 33.2%). Eleven cases were found to be complicated with neurological involvement and two of them died. Another patient died due to myocarditis. Public health experts, clinicians, and policymakers could use the results of this study to construct the future strategy tackling chikungunya in Bangladesh and other epidemic countries.

Effect of self-purging pyrolysis on yield of biochar from maize cobs, husks and leaves.

In this study, biochar was produced from maize residues (cobs, husks, leaves) in a lab-scale pyrolysis reactor without using a purging gas. The physicochemical properties of biomass and biochar were analysed. Box-Behnken design was used to optimise operational conditions for biochar yields. Multivariate correlations of biochar yields were established using reduced quadratic models with R(2)=0.9949, 0.9801 and 0.9876 for cobs, husks and leaves, respectively. Biochar yields were negatively correlated with the temperature, which was significantly influenced by the exothermic reactions during the pyrolysis of maize residues. The heating rate was found to have the least effect on biochar yields. Under optimal conditions, the maximum biochar yields from cobs, husks and leaves were 33.42, 30.69 and 37.91%, respectively. The highest biochar yield from maize leaves was obtained at a temperature of 300°C, a heating rate of 15°C/min and a holding time of 30min.

Mainstreaming nutrition into maternal and child health programmes: scaling up of exclusive breastfeeding.

Interventions to promote exclusive breastfeeding have been estimated to have the potential to prevent 13% of all under-5 deaths in developing countries and are the single most important preventive intervention against child mortality. According to World Health Organization and United Nations Children Funds (UNICEF), only 39% infants are exclusively breastfed for less than 4 months. This review examines programme efforts to scale up exclusive breastfeeding in different countries and draws lesson for successful scale-up. Opportunities and challenges in scaling up of exclusive breastfeeding into Maternal and Child Health programmes are identified. The key processes required for exclusive breastfeeding scale-up are: (1) an evidence-based policy and science-driven technical guidelines; and (2) an implementation strategy and plan for achieving high exclusive breastfeeding rates in all strata of society, on a sustainable basis. Factors related to success include political will, strong advocacy, enabling policies, well-defined short- and long-term programme strategy, sustained financial support, clear definition of roles of multiple stakeholders and emphasis on delivery at the community level. Effective use of antenatal, birth and post-natal contacts at homes and through community mobilization efforts is emphasized. Formative research to ensure appropriate intervention design and delivery is critical particularly in areas with high HIV prevalence. Strong communication strategy and support, quality trainers and training contributed significantly to programme success. Monitoring and evaluation with feedback systems that allow for periodic programme corrections and continued innovation are central to very high coverage. Legal framework must make it possible for mothers to exclusively breastfeed for at least 4 months. Sustained programme efforts are critical to achieve high coverage and this requires strong national- and state-level leadership.

Clinicopathological correlation of blistering diseases of skin.

Blistering diseases are alarming skin conditions where blister formation occurs in various ways and cannot be differentiated clinically. For confirmation of diagnosis, along with routine histological examination, immunofluorescence study is essential. Tzanck smear may be used as a rapid diagnostic tool. We included here 34 cases of different blistering lesions. Other than routine Hematoxylin and Eosin stain, direct immunofluorescence test was done in 31 cases, indirect immunofluorescence in 28 cases and Tzanck smear in 33 cases. Direct immunofluorescence stain was also applied on Tzanck smears. The most frequent diagnoses were pemphigus (n = 16), bullous pemphigoid (n = 11) and linear IgA dermatosis (n = 3). Clinical findings and histological examination were sufficient for the diagnosis of most cases. Direct immunofluorescence study is essential in many cases, and indirect immunofluorescence study is a useful method for diagnosis of some of the blistering diseases, especially in pemphigus. Direct immunofluorescence staining on Tzanck smear is a novel technique for the diagnosis of pemphigus.

Prevalence of exclusive breastfeeding in Bangladesh and its association with diarrhoea and acute respiratory infection: results of the multiple indicator cluster survey 2003.

The objective of this study was to investigate the association between the prevalence of exclusive breastfeeding and morbidity (diarrhoeal diseases and acute respiratory infection) in infants aged 0-3 month(s) using the Multiple Indicator Cluster Survey (MICS) 2003 data from Bangladesh. The study population included 1633 infants aged 0-3 month(s). The prevalence of diarrhoea and acute respiratory infection was compared using the chi-square tests between infants aged 0-3 month(s) who were exclusively breastfed and infants who were not exclusively breastfed. Logistic regression was used to adjust for confounders and for calculating adjusted odds ratios. To adjust for cluster sampling and reduced variability, the adjusted chi-square value was divided by the design effect, and a re-estimated p value was calculated. The prevalence of diarrhoea and acute respiratory infection in this sample of 0-3-month old infants in Bangladesh was 14.3% and 31.2% respectively. The prevalence of both illnesses was significantly associated with lack of exclusive breastfeeding. The adjusted odds ratio for diarrhoea was 0.69 (95% confidence interval [CI] 0.49-0.98, p = 0.039), and the adjusted odds ratio for acute respiratory infection was also 0.69 (95% CI 0.54-0.88, p = 0.003). Only 192 infants (11.7% of total sample) were exclusively breastfed at the time of interview, and 823 infants (50.3%) were never exclusively breastfed. The prevalence of prelacteal feeding was 66.6%. The results confirmed a protective effect of exclusive breastfeeding against infectious diseases-related morbidity in infancy and showed that frequently-collected cross-sectional datasets could be used for estimating effects. The low prevalence of exclusive breastfeeding in Bangladesh needs to be improved to decrease child morbidity.

Thoracic actinomycosis.

Thoracic actinomycosis represents about one-fourth of all cases of the disease. Isolated pleural effusion due to Actinomycosis is rare. We report a case of right sided pleural effusion with discharging sinus in the right anterior chest wall. Actinomycosis was suspected and confirmed by microscopic identification of "sulfur granules" in the discharge of the sinus tract and also identification of gram-positive filamentous bacteria in the specimen of discharging sinus. The patient improved clinically and radiologically after treatment with intravenous penicillin G followed by oral penicillin and aspiration of pleural fluid.

Acinetobacter bacteremia in patients with diarrhoeal disease.

In 1994, 171 (27%) of all positive blood cultures in our hospital were due to Acinetobacter species. Of these, 138 cultures were considered significant, 91 (66%) were community-acquired and 47 (34%) were nosocomial. Most acinetobacter bacteraemia in children < or = 1 year old was community-acquired, while nosocomial infection was more common in children > 1 year old (P = 0.01). Most children < or = 5 years old were severely malnourished. The incidence of bacteraemia was lowest during the post-monsoon to early winter months. Acinetobacter bacteraemia associated mortality was twice (16%) that of all other patients (7.7%, P < 0.0005) and accounted for 4.5% of all hospital deaths during the study period. Bacteraemia caused by Acinetobacter species is an important cause of morbidity and mortality among our patient population with diarrhoeal disease.

Production, characterization and immunodiagnostic application of a monoclonal antibody to Shiga toxin.

A mouse monoclonal antibody (MAb ICT7) that is specific for Shiga toxin was produced. The MAb neutralises the cytotoxic effects of both purified Shiga toxin and culture extracts of Shigella dysenteriae type 1 in HeLa cells. Using MAb ICT7 and polyclonal rabbit antiserum, a sandwich ELISA was developed. This test detects Shiga toxin in both S. dysenteriae type 1 bacterial extracts and in stools of patients with S. dysenteriae type 1 infection. The ELISA also detects toxin in enterohaemorrhagic Escherichia coli (EHEC) strains positive for Shiga-like toxin I. The test could detect a minimum of 100 pg of purified Shiga toxin. Furthermore, the ELISA did not detect toxin in non-S. dysenteriae type 1 Shigella species or Shiga-like toxin II produced by EHEC strains.

The synthesis of some fluoro derivatives of sucrose.

2,3,1',3'4',6'-Hexa-O-benzylsucrose was obtained by mild acid-catalysed hydrolysis of the 4,6-O-isopropylidene derivative and then converted into its 4,6-di-O-mesyl derivative. Selective displacement of this disulphonate with fluoride anion (from tetrabutylammonium fluoride) then afforded the 6-fluoro-4-mesylate. Removal of the protecting groups yielded 6-deoxy-6-fluorosucrose, which was characterised as its crystalline hepta-acetate. A derivative of 6-deoxy-6-fluoro-galacto-sucrose was formed when the above 6-fluoro-4-mesylate was subjected to nucleophilic displacement with benzoate anion.

Oral therapy in children with cholera: a comparison of sucrose and glucose electrolyte solutions.

We performed a double-blind trial comparing sucrose electrolyte oral solution with glucose electrolyte oral solution in children less than 5 years of age with severe cholera-like diarrhea. Of 111 patients studied (102 with bacteriologically confirmed cholera), 55 received sucrose solution and 56 received glucose solution. The success rates, as defined by the absence of the need to give unscheduled intravenous therapy, were similar in the two groups (73% and 77% in the sucrose and glucose groups, respectively). There was no difference in purging rates between the two groups. The primary determinant of success for oral fluid regardless of the sugar was the purging rate. Sucrose malabsorption was responsible for oral therapy failure in one child. This study demonstrates that sucrose is an effective alternative to glucose in the oral therapy solution, but either must be used in conjunction with intravenous solution when treating severe dehydrating diarrhea.

PIP: This study compared, in children with cholera-like severe diarrhea, an oral glucose-electrolyte solution with an oral sucrose-electrolyte solution in equimolar amounts (WHO formula) in a double-blind manner. Of 111 patients, 55 were given sucrose and 56 glucose solutions. An absence of the need to use unscheduled intravenous therapy defined the success rate, which was similar in both groups: 73 and 77%, respectively, in the sucrose and glucose groups. Purgation rates also showed no difference between groups. The main determinant of success for oral fluid regardless of the sugar used was the purging rate. 1 failure of therapy in the sucrose group was attributed to sucrose malabsorption. It is concluded that sucrose is an effective alternative to glucose for oral rehydration therapy, but if the diarrhea has caused severe dehydration before the start of treatment, intravenous supplementation must also be used.