Acute disseminated encephalomyelitis following the COVID-19 Vaccine Sinopharm in low- and middle-income country: a case report.

Introduction and importance: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and various vaccines against it have been developed. Acute disseminated encephalomyelitis (ADEM) is a disease of the central nervous system that cause inflammation and demyelination and manifests as a multi-symptom acute neurological condition. Although infections are usually the cause of ADEM, vaccines may cause 5-10% of cases. Case presentation: A 40-year-old woman had received a second dose of the Sinopharm COVID-19 vaccine 4 months before her visit and experienced sudden gait imbalance and vertigo a day after her vaccination, which lasted for more than a month. On examination, no signs of skin bruising or bleeding were observed, and her vital signs were within the normal range. On neurological assessment, the patient had a Glasgow Coma Scale score of 14/15 (E4V5M5), had normal pupil size and light reaction, normal fundus, normal deep tendon reflexes and bilateral extensor plantar response. Meningeal symptoms were absent, and SARS-CoV-2 RNA tests using NAAT (Nucleic Acid Amplification Test) were negative. Development of central nervous system (CNS) manifestations during the recovery phase of fever, along with typical MRI findings; the diagnosis of para-infectious ADEM with COVID-19 vaccination was made. After the treatment with methylprednisolone sodium succinate injection, the patient showed improvement. Clinical discussion: ADEM associated with post-vaccinations is a rare condition. There has been growing evidence that shared epitopes between neuronal proteins and SARS-CoV-2 antigens may trigger autoimmune reactions against the CNS through molecular mimicry as its pathogenesis. Conclusion: We suggest the need for a strict vaccine safety monitoring system and post-vaccine monitoring and surveillance.

Covariates of Knowledge, Attitude, Practice, and Burdens among the Caregivers of Hypertensive Patients.

Caregivers of hypertensive patients play a significant role in ensuring adequate patient care and lowering the risk of hypertension-relatedcomplications. Caregivers are ideal study subjects for identifying gaps in hypertension management. Our study aimed to assess the knowledge, attitude, and practice (KAP) of hypertensive patients' caregivers, to identify their extent of involvement in patients' care, and to assess their care-related attributes. A descriptive cross-sectional study was conducted from August 2020 to February 2021 in the eight largest tertiary care medical college hospitals and all eight divisions of Bangladesh, with 949 caregivers enrolled. Data were collected using a pretested interviewer-administered questionnaire through snowball sampling and analyzed using a one-way ANOVA, independent-sample T-test, and chi-square test. Among the 949 interviewed caregivers, 541 (57.0%) were female, and 479 (50.5%) were aged 18 to 25 years. The percentage scores regarding overall knowledge, attitude, and practice of the caregivers were 54.83 ± 17.95, 47.95 ± 24.05, and 61.26 ± 17.50, respectively. Caregivers' education, history of hypertension, residence, age, relationship with the patient, occupation, and caregiving duration were significantly associated with the KAP scores. In addition, factors such as relationship with the patient, age, educational status, occupation, residence, and caregiving duration/day had significant correlations with all types of burden. Findings of this study suggest the necessity for awareness programs for the caregivers of hypertensive patients to diminish the gap in their KAP and improve their mental and physical health.

Knowledge, attitudes and biosecurity practices among the small-scale dairy farmers in Sylhet district, Bangladesh.

BACKGROUND: In the context of zoonosis, Bangladesh's small-scale dairying is yet to frame satisfactory levels due to poor biosecurity practices. OBJECTIVES: This study intended to reveal the degree of knowledge, attitudes and biosecurity practices among Sylhet district, Bangladesh's small-scale dairy farmers. We also focused on the association between biosecurity practices and the incidence of non-specific enteritis in humans. METHODS: A questionnaire-based survey was conducted on the farmers' KAP via personal interviews of 15 farmers from the randomly selected fifteen small-scale dairy farms. The questionnaire was developed with 6 questions for knowledge, 6 questions for attitude and 12 questions for the practice of biosecurity measures. Alongside that, data on the number of non-specific enteritis cases experienced by the farmers or their family members were also recorded. Spearman correlation was used to find out the correlation among KAP variables and between practice scores and non-specific enteritis incidences. RESULTS: We found an insignificant (p > 0.05) influence of demographic characteristics over knowledge, attitude and biosecurity practices. Significant (p < 0.05) and strong correlations were found in knowledge-attitude (r = 0.65), knowledge-practice (r = 0.71) and attitude-practice (r = 0.64). Incidences of non-specific enteritis and biosecurity measures' practice were also strongly correlated (r = -0.9232) and statistically significant (p < 0.05). CONCLUSIONS: Our study suggests that increasing knowledge and developing a good attitude are necessary to increase the adaptation of biosecurity measures as three of these factors are correlated. Moreover, farm biosecurity measures are closely related to human health.

Knowledge, attitude and perception among medical students and healthcare professionals regarding male infertility: a cross-sectional survey from Bangladesh.

OBJECTIVE: This study aimed to explore the knowledge, attitude and behaviour regarding male infertility among medical students and healthcare workers in Bangladesh. DESIGN: This was a cross-sectional study. SETTING: This study covered eight divisions of Bangladesh. PARTICIPANTS: The participants were medical students or healthcare professionals of Bangladesh who were surveyed anonymously on their knowledge, attitude and perception regarding male infertility. PRIMARY OUTCOME MEASURES: The level of knowledge, attitude and perception regarding male infertility. ANALYSIS: The mean knowledge and attitude scores were then correlated with sociodemographic factors using χ2 and two-independent sample t-tests. Finally, we performed binary logistic regression to explore predictors of good knowledge and positive attitude. RESULT: Among 556 participants, 49.82% did not have good male infertility knowledge, and nearly 60.79% had negative attitudes regarding male infertility. Young (23-26 years) healthcare professionals and medical students were more likely to have good knowledge than others (OR: 1.81; 95% CI 1.099 to 2.988). Surprisingly, women were more likely to have a positive attitude (OR=1.48; 95% CI 1.002 to 2.19, p=0.049) than men. Among all the professions, Bachelor of Medicine and Surgery doctors were most likely to have good knowledge and a positive attitude regarding male infertility. Good knowledge of male infertility predicted a positive attitude (OR=1.61; 95% CI 1.105 to 2.346, p=0.013) and vice versa. CONCLUSION: Our research found that healthcare professionals and medical students in Bangladesh had inadequate knowledge and negative attitudes regarding male infertility despite favourable opinions. This emphasises the need for interdisciplinary training programmes, standardisation of healthcare worker guidelines and curricular adjustments for medical students.

Risk factors associated with self-medication among the indigenous communities of Chittagong Hill Tracts, Bangladesh.

BACKGROUND: In developing countries like Bangladesh, self-medication has become a predicament associated with health risks and clinical complications. To date, no studies have been conducted on the practice of self-medication among the indigenous population living in Chittagong Hill Tract (CHT). OBJECTIVES: This study was aimed to determine the prevalence of self-medication and analyzing the factors associated with it among the indigenous population in CHT. METHODS: This cross-sectional study was conducted from late October to early December 2020; among different indigenous group populations residing in the three districts of CHT aged 18 or more. A pre-tested and semi-structured questionnaire was developed to collect data on socio-demographic characteristics, health status, frequency of self-medication, reasons for self-medication in last one year, as well as other variables. Multivariate logistic regression was performed to assess associated factors with self-medication. RESULTS: A total of 1350 people from different indigenous populations were interviewed, among whom 49.9% practiced self-medication. The rate of self-prescribed antibiotics usage (80.9%) was significantly higher compared to other drugs. Self-prescribed medications were mostly used for diarrhea and food poisoning (60.6%), cough, cold and fever (51.4%), and headache (51.4%). A common source of self-prescribed medicines was community or retail pharmacy and the most reported reason for self-prescribed medication was the long-distance of healthcare facilities from home. CONCLUSION: The prevalence of self-medication is substantially high among indigenous people and the effect is alarming. Particular concern is the misuse of antibiotics and analgesic drugs. Increasing awareness among the population of the negative effect of self-medication and implementation of proper policies and actions are urgently needed to prevent self-medication among indigenous population in Bangladesh.