Barriers to quality of work life among Bangladeshi nurses: a qualitative study.

AIM: To explore and provide understanding of the barriers to quality of work life among registered nurses in Bangladesh. BACKGROUND: Globally, there is growing interest in the working environments of nurses, especially at a time of nursing shortages and with the focus on safety and care quality in health systems. In a low socio-economic country like Bangladesh, nurses struggle in a grossly underfunded healthcare system to deliver care to the people but no studies have been conducted on their quality of work life. METHODS: This qualitative descriptive study was conducted at three Bangladeshi tertiary hospitals in May 2015-January 2016. Three focus group discussions were held with 30 registered nurses exploring their perceived barriers to quality of work life. Data were analysed with content analysis. FINDINGS: Seven barriers to their work-life arose: heavy workloads; lack of government accommodation and transportation; poor health status; lack of support from nursing supervisors; lack of promotion opportunities; incomplete hospital policies and procedures; and lack of night shift and risk allowances. DISCUSSION: Participants described many issues and barriers impacting on their work-life. They perceived little reward for their hard work, felt that their health suffered from their working conditions and described a low QWL. CONCLUSION AND POLICY IMPLICATIONS: Findings provide information for nursing and health policymakers and leaders to reduce barriers to improve work-life quality among nurses that can contribute better to quality of nursing care, and nursing retention and satisfaction. Work policies and practices, and funding and other resources need to be scrutinized to ensure better working conditions for Bangladeshi nurses. LIMITATIONS: Interviews were conducted with nurses only in tertiary hospitals in the Bangladeshi capital, and understanding of barriers to work-life quality of nurses in other health settings and regions needs to be explored.

The challenges of prenatal care for Bangladeshi women: a qualitative study.

BACKGROUND: Maternal and infant morbidity and mortality are major issues in developing countries, but the literature reveals there are limited studies on the sociocultural issues affecting adequate prenatal care in Bangladesh. AIM: To explore the sociocultural influences underlying perceived barriers to prenatal care among pregnant women in an urban area of Bangladesh. METHODS: A descriptive qualitative research was conducted with 20 women and 20 of their significant others in three purposively sampled hospitals using individual in-depth interview between November 2016 and March 2017. Content analysis was used for analysis. FINDINGS: Six themes emerged as follows: women's lack of opportunity to make decision; pregnancy as a normal life event; insufficient money for prenatal care; heavy family workload without family support; no permission to go to hospital without a guardian; and inconvenient transportation. DISCUSSION: Good prenatal care is vital for maternal and infant health, but our participants were challenged by a number of key issues as follows: they lacked empowerment to make their own pregnancy decisions, they were impoverished financially, struggled to get to their prenatal appointments by local transport and they lacked family understanding and support for necessary prenatal care. CONCLUSION AND POLICY IMPLICATIONS: Based on the findings, it is recommended that promoting prenatal care adequacy among pregnant women in Bangladesh needs socioculturally sensitive health education programmes which target are not only pregnant women, but also their significant others who are authorized persons in the family. It should be established remote PNC services. Empowerment of women is vital in the country and free antenatal education programmes are needed through a variety of media. Findings provide information for nursing and health policymakers to develop policies to improve adequacy of prenatal care among pregnant women.

Elucidation of novel budding yeast separase mutants.

The mitotic separase cleaves Scc1 in cohesin to allow sister chromatids to separate from each other upon anaphase onset. Separase is also required for DNA damage repair. Here, we isolated and characterized 10 temperature-sensitive (ts) mutants of separase ESP1 in the budding yeast Saccharomyces cerevisiae. All mutants were defective in sister chromatid separation at the restricted temperature. Some esp1-ts mutants were hypersensitive to the microtubule poison benomyl and/or the DNA-damaging agent bleomycin. Overexpression of securin alleviated the growth defect in some esp1-ts mutants, whereas it rather exacerbated it in others. The Drosophila Pumilio homolog MPT5 was isolated as a high-dosage suppressor of esp1-ts cells. We discuss various features of separase based on these findings.

Response of broiler chickens to different levels of calcium, non-phytate phosphorus and phytase.

1. Five hundred and seventy six-d old Ross 308 broiler chicks (6 cages per diet, 8 birds per cage in 3 × 2 × 2 factorial arrangement) were fed on maize-soybean meal-based diets containing three concentrations of Ca (6, 8 or 10 g/kg), two concentrations of non-phytate phosphorus (NPP) (3 or 4 g/kg) and two levels of exogenous microbial phytase (0 or 500 FTU/kg) from d 0 to 35. 2. Body weight (BW), feed intake (FI) and mortality records were collected. Two birds per replicate were killed at 24 d of age to obtain tibia samples. 3. Increasing Ca level significantly reduced the FI and body weight gain (BWG) between hatch and 10 and 24 d, especially with the phytase-supplemented diets. However, phytase supplementation of the diet containing 4 g NPP/kg improved the FI and BWG at d 10 and 24. At d 24, phytase supplementation improved feed conversion ratio (FCR) of birds that consumed diets containing high NPP. The overall FCR was better in birds offered the phytase-supplemented, medium-Ca diet. 4. There was a significant reduction in length, width and breaking strength of the tibia bone in birds fed on a diet with high Ca and low NPP. Phytase supplementation improved the tibia ash content and bone breaking strength of chicks fed on the diet containing 8 and 4 g/kg Ca and NPP, respectively. The Ca content of the tibia bone was low in birds fed on diets with 6 and 4 g/kg Ca and NPP, respectively, but this was counteracted by phytase supplementation. 5. Birds fed on diets with 4 g/kg NPP had the best carcass percentage and parts yield. Phytase supplementation to high-Ca diets significantly reduced the carcass yield of birds. 6. These results confirmed the detrimental effect of high dietary Ca on phytase activity and subsequent growth and bone development of birds, especially when NPP is in short supply.

Effects of Intensive versus Non-Intensive Physical Therapy on Children with Cerebral Palsy.

Cerebral Palsy (CP) is one of the most common causes of all childhood disorders. There are tone, posture and movements difficulty due to non-progressive damage to the immature brain in CP. The hallmark of CP is a disability in the development of gross motor function (GMF). The influence of gross motor development on fine motor development is more important in early developmental period, specially under three years old and in children with CP. Various therapeutic interventions have been used in the management of GMF development. Among them physical therapy is the most common intervention in CP and is usually a component of mandated programs. Physical therapy means physical stimulations in the form of various therapeutic exercises, touch, massage, limbs and trunk movement, balancing and coordination training, gait and ambulation training, cognitive stimulation as well as speech, language and occupational therapy. Our study focused to see the effect by short term intensive versus non-intensive physical therapy on children GMF development by using gross motor function measure (GMFM) Score sheet, GMFM-88, version 1.0. Study provides the information that physical therapy intervention is effective in GMF development and intensive interventions are more effective in children with spastic CP than non-intensive one. Study also inform that the more early treatment the more effective result.

Yvh1 protein phosphatase is required for pre-autophagosomal structure formation after TORC1 inactivation.

The pre-autophagosomal structure (PAS) is a putative site for autophagosome formation in budding yeast. Upon nutrient depletion or rapamycin treatment, target of rapamycin complex 1 (TORC1) becomes inactive, inducing PAS formation and autophagy. Here, we show that Yvh1 phosphatase is critical for PAS formation, but not autophagy induction, after TORC1 inactivation.

'The clock keeps ticking'--the role of a community-based intervention in reducing delays in seeking emergency obstetric care in rural Bangladesh: a quasi-experimental study.

OBJECTIVE: To explore the role of a community-based intervention in reducing delays in accessing emergency obstetric care (EmOC) in rural Bangladesh, and the factors associated with delayed decision making, reaching the health facility and receiving treatment. STUDY DESIGN: Quasi-experimental study. METHODS: Multistage random sampling was used to select 540 villages, from which 1200 women who reported obstetric complications in March-April 2010 were interviewed. RESULTS: The median time taken to make the decision to access health care was significantly lower in the intervention areas compared with the control areas (80 vs 90 min). In addition, the median time taken to reach the health facility was significantly lower in the intervention areas compared with the control areas (110 vs 135 min). However, no difference was found in the median time taken to receive treatment. Multiple linear regressions demonstrated that the community intervention significantly reduced decision making and time taken to reach the health facility when accessing EmOC in rural Bangladesh. However, for women experiencing haemorrhage, the delays were longer in the intervention areas. Protective factors against delayed decision making included access to television, previous medical exposure, knowledge, life-threatening complications during childbirth and use of a primary health facility. Financial constraints and traditional perceptions were associated with delayed decision making. Complications during labour, use of a motorized vehicle and use of a primary health facility were associated with faster access to EmOC, and poverty, distance, transportation difficulties and decision made by male guardian were associated with slower access to EmOC. CONCLUSIONS: The intervention appeared to reduce the time taken to make the decision to access health care and the time taken to reach the health facility when accessing EmOC. This study provides support for a focus on emergency preparedness for timely referral from the community.

Comparative Efficacy and Safety of Amlodipine and Losartan Potassium in Essential Hypertension in a Tertiary Hospital of Bangladesh.

Hypertension is a common disorder of major clinical, public health and economic importance. It affects men and women of all ages, and the prevalence is increasing in most countries. Maintenance of blood pressure below 140/90 mm of Hg is recommended by most of the guideline available around the world. Various classes of drugs are being used in the treatment of hypertension. Losartan potassium and amlodipine are two different antihypertensive agents belonging to two different groups used commonly around the world in treating essential hypertension. Losartan potassium is non-peptide Angiotensin-II receptor antagonist. Amlodipine which is the third generation dihydropyridine group of calcium channel blocker. The aim of the study was to compare the efficacy and safety of amlodipine and losartan for the treatment of essential hypertensive patients (18-75 years). A non-randomized comparative observational study was conducted in the Department of Pharmacology and Therapeutics in collaboration with Department of Medicine, Sylhet, MAG Osmani Medical College, Sylhet, Bangladesh from July 2021 to June 2022. In this study non-randomization was in two groups. Group A received amlodipine 5mg daily at morning and Group B received losartan potassium 50mg daily at night. The study parameters were systolic blood pressure (SBP), diastolic blood pressure (DBP), ankle oedema, serum K+ level. The result of treatment outcome was compared between two groups. After treatment the reduction of SBP was 5.19±2.93mm of Hg versus 3.27±1.34mm of Hg (p<0.001); reduction of DBP was 1.7±0.70 mm of Hg versus 0.68 mm of Hg (p<0.001) and serum K+ level 4.22±0.27mmol/L versus 4.21±0.16mmol/L (p<0.719) in amlodipine and losartan group respectively. Amlodipine is more effective than losartan potassium in respect to treatment of essential hypertension. Regarding adverse events losartan potassium causes angioedema, hyperkalemia, headache, dizziness etc. The study concluded that amlodipine is superior to losartan potassium in treating essential hypertension.

Clinico-Pathological Profiles of Multiple Myeloma Patients in a Tertiary Care Hospital.

Multiple myeloma (MM), mature B-cell lineage neoplasm, is characterized by abnormal clonal proliferation of plasma cells and presence of monoclonal protein (M protein). The study was conducted to reveal presenting features, laboratory findings, Eastern Cooperative Oncology Group (ECOG) performance status and skeletal survey on patients with multiple myeloma. This descriptive, cross-sectional study was carried out in the Department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2019 to July 2020 with a sample size of 81. Data were collected in a case record form after obtaining informed verbal consent from patients and /or their legal guardians. Relevant ethical issues and data quality assurance were taken into consideration. Data were analyzed with SPSS, Version 25.0 with presentation in figures and tables with frequency, percentage, mean and standard deviation based on data nature. Statistical tests were carried out as appropriate with 5.0% level of significance for assessing statistical association. Mean age of the patients was 58.9±12.0 years. Male female ratio was 2:1. 35(43.2%) patients were smokers with only 2(2.5%) had family history of haematological malignancies. Bone pain (72.8%) was the most common presenting feature, while hypertension (59.1%), diabetes mellitus (29.5%), respiratory illness (11.3%) and cardiac disease (11.4%) were the common co-morbidities. Most common ECOG performance status was ECOG-1(48.1%). Mean haemoglobin (Hb) was 9.4±2.3gm/dl and mean erythrocyte sedimentation rate (ESR) was 89.5±42.1 mm in 1st hour. Mean serum creatinine level was 2.0±1.85 mg/dl and ≥2.0mg/dl in 42(34.2%). Among 50 documentation serum lactate dehydrogenase (LDH) was raised in 18(36.0%). Mean serum calcium level was 9.6±1.8mg/dl >11.0mg/dL in 10(14.5%) cases. Serum albumin <3.5gm/dl in 37(49.3%), ß2-microglobulin >5.5mg/dl in 37(57.8%) cases, International staging system (ISS) stage III was in 59.4% and Bence Jones Protein (BJP) was present in 46.7% cases. Lytic lesions were present in 75.0%, In 38(74.5%) patients vertebrae were involved, while in 18(35.2%) ribs were involved, in 14(27.5%) patients skull was involved and in 3(5.9%) patients involved bones were femur, humerus, sternum and scapula. Mean plasma cells percentage was 62.1±24.9%. Immuno-Fixation Electrophoresis (IFE) revealed IgG (72.7%), IgA (18.2%), Free light chain (FLC) (9.1%). FLC ratio was ≥100 in 29.0% cases. Significant statistical association was observed between serum creatinine with Hb concentration (p<0.05), serum creatinine level with ISS staging (p<0.05) and serum calcium level (p<0/05), while insignificant association was revealed between BJP present status and serum creatinine level (p>0.05). Bone pain, fatigue, fever and neurological impairment were the common presenting features. Anaemia, renal impairment and skeletal lytic events were the prominent physical findings. ISS staging was statistically associated with serum creatinine level, while serum calcium level was associated with serum creatinine and lytic lesions.

Chromium (VI) induced acute toxicity and genotoxicity in freshwater stinging catfish, Heteropneustes fossilis.

Acute toxicity and genotoxicity of Chromium(VI) as K2Cr2O7 were evaluated in freshwater stinging catfish, Heteropneustes fossilis. Fish showed behavioral alterations after K2Cr2O7 exposure and 96h-LC50 was 35.724mg/L in semi-static bioassay. Fish were exposed to three sub-lethal concentrations (concentration I=1/4th of 96h-LC50, concentration II=1/10th of 96h-LC50 and concentration III=environmental concentration of Cr reported in the river Buriganga). Blood, liver and gill samples were collected after 48h, 96h and 192h. Micronucleus (MN) assay was conducted in blood erythrocytes and DNA damage was evaluated by comet assay in whole blood, gill and liver tissues. Cr(VI) significantly (p<0.05) induced MN frequency and tail DNA (percent) which increased in a concentration depended manner in all types of tissues. Frequency of MN and tail DNA (percent) increased after 48 and 96h of exposure which decreased after 192h of exposure. The liver was the most sensitive to chromium (VI) exposure among the tissues with highest tail DNA (33.70±0.68 percent) at 9.0mg/L after 96h. This study found MN and comet assays in combination as an adequate approach for ecotoxicological monitoring and Cr(VI) as potential genotoxic agent.

Medical Undergraduates' Assessment Status Regarding Clinical Neuroanatomy.

The study of Anatomy is essential to the learning of different subjects of medicine. Neuroanatomy is a fundamental part of the Anatomy portion of the undergraduate medical (MBBS) curriculum of different universities of Bangladesh. The clinical relevance of Neuroanatomy is beyond doubt in the context of increasing numbers of cases like stroke, head injury and meningitis in Bangladesh. Contemporary Neuroanatomy books are inclined to a clinically-oriented approach in their presentation. However, there is no organized attempt to analyze these recent trends of highlighting the significance of clinically-oriented approach reflected in the learning pattern or student-assessment in the medical undergraduate courses of Bangladesh. Such analyses can offer an insight into the situation and facilitate teachers and curriculum planners to make necessary modifications. The present study was planned- i) to analyze the Neuroanatomy portion of the recent undergraduate Anatomy written question papers of four public universities of Bangladesh for understanding how clinically relevant knowledge has been assessed in the questions ii) to determine the ability of the medical undergraduates to answer clinically-oriented written questions as compared to their ability to answer non-clinically-oriented questions in Neuroanatomy. It was a comparative study with some descriptive components. For Part-A of the study, all the 'Question-segment's of question (SAQ and MCQ) dealing with Neuroanatomy in all the available First Professional MBBS Exams' Anatomy written question papers of four public universities of Bangladesh of the last five years (2005 to 2009) were identified. The frequency of 'Question-segment's those assessing the ability of the clinically relevant knowledge were determined. It was a descriptive study. For Part-B of the study, total 136 New 3rd year medical undergraduates of one Bangladeshi governmental medical college and one private medical college were taken as participants. The medical undergraduates of each medical college were divided into two equal groups by randomization. One group was given 100 clinically-oriented questions and the other was given 100 non-clinically-oriented questions based on the content of Snell. The scores (frequencies of correct responses) of the two groups were compared using an unpaired 't' test. The frequencies of 'Question-segment's assessing clinically relevant knowledge was 6.14%. The performance of the undergraduates answering clinically-oriented questions was significantly poorer (p=0.01) than answering non-clinically-oriented questions (the mean score being 38.49±10.50 and 45.04±8.48 respectively). Teaching and assessment of Neuroanatomy should be designed in a way to orient medical undergraduates towards more clinically-oriented understanding and performance in Neuroanatomy. The clinically relevant knowledge dealing with Neuroanatomy needs to be addressed with appropriate weighting in the First Professional MBBS written questions of Bangladesh. Necessary changes in the curriculum are also suggested in meeting the above expectations.

Role of Rehabilitation Exercise on Myofascial Pain Syndrome Causing Upper Back Pain.

Upper back pain is as painful or troublesome as the pain in the lower back or the neck. Myofascial pain syndrome which is most common cause of upper back pain is characterized by localized musculoskeletal pain and tenderness in association with trigger points. The aim of the study was to correlate the improvement of myofascial pain syndrome patients with proper and timely physical therapy. This quasi experimental study was conducted in the department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, from 1st January 2008 to 31st August 2008 to see the role of rehabilitation exercise on myofascial pain syndrome causing upper back pain. Sixty (60) patients of myofascial pain syndrome causing upper back pain were randomly assigned for treatment; out of which 23(38.33%) were male and 37(61.66%) were female. The male and female ratio was 1:1.6. The patients selected for the trial were divided into two groups: Group A and Group B. In group A (n=28) the patients were treated with thermotherapy- Microwave diathermy, non-steroidal anti inflammatory drugs and activities of daily living instructions and in Group B (n=32) with same interventions in addition to rehabilitation exercises. Treatment duration was 6 weeks. The difference of treatment improvement was statistically significant (p<0.05) from 1st week up to 6th week. After complete course of treatment 67.86% patients in Group A and 78.13% patients in group B reported improvement. So rehabilitation exercises can be a valuable adjunct to other modalities of treatment of myofascial pain syndrome causing upper back pain.

Thyroid Hormone Level in Children with Nephrotic Syndrome.

Nephrotic syndrome is the most common glomerular disease affecting children. Hypothyroidism is one of the most important complications which occur due to urinary loss of protein bound thyroid hormones, such as thyroxin binding globulin, transthyretin and albumin. This cross sectional study was conducted in the Department of Pediatric, Mymensingh Medical College Hospital (MMCH), Bangladesh from February 2018 to October 2019. This study was carried out to find out the thyroid profile in children with nephrotic syndrome and compared with thyroid profile of other acute illness in children. Total 122 children aged 2-12 years, further subdivided into Group A (n=61) suffering from nephrotic syndrome (1st attack, infrequent relapse) and Group B (n=61) other disease like viral fever, pneumonia, bronchiolitis, diarrhoea, UTI. Demographic details of patients and their relevant clinical details were obtained by an interviewer administered questionnaire. Blood for free T4, TSH were taken and compared between both groups. The mean FT4 values in Group A and Group B were 16.09±22.32fmol/ml and 68.22±11.65fmol/ml respectively, whereas the TSH level was significantly higher in Group A than controls (5.42±1.04 vs. 3.53±1.44). The T4 levels in nephrotic syndrome (Group A) patients were low. Analysis was done by using SPSS 22.0 version for windows software. Continuous and catagorical parameters were compared by unpaired 't' test and Chi-Square test. A p-value of 0.05 was considered significant. Hypothyroidism was found more in younger children i.e. age less than 6 years. This study concluded that children with nephrotic syndrome have a state of hypothyroidism.

Knowledge, Attitude and Practice of Undergraduate Medical Students of Bangladesh Regarding COVID-19 and its Vaccination.

Medical students are one of the socially active, reliable, and persuading population of information, prevention and control, and incentive of vaccination to stop the current pandemic situation. Consequently, knowing the status of medical students' knowledge, about symptoms, and transmission of disease, prevention of COVID-19 and their attitudes towards a vaccine is important. This multi-center cross-sectional descriptive study was one of the first ones in Bangladesh among the undergraduate medical students who completed pathology, microbiology, and pharmacology. The study was conducted from March to April 2021, using a convenience sampling method in twelve government and non-government medical colleges. Among 1132 who completed the questionnaire, and 15 students from different centers were excluded from the pre-testing and face validation. The age of the 1117 respondents were 22 to 23 years, of which the majority of the respondents were female 749 (67.0%), and 368 (33.0%) were male. Almost all participants had correct knowledge (84.1%) about the symptoms of COVID-19. But 59.2% had wrong knowledge about transmission of disease by an afebrile person. Above 60.0 % of the participants have worn a facial mask when contacting people, refrained from shaking hands, washed hands, avoided people with signs and symptoms suggestive of COVID-19, and avoided crowded places as a practice of prevention. 37.6% of medical students showed positive attitudes about the participation of management of a COVID-19 patient. Most of the participants' decided to have a vaccine depending on its availability. But 31.5% had trust in natural immunity rather than vaccination. Most undergraduate Medical college students understood the basic information, possessed a positive attitude, and presented good practice towards the COVID-19 and vaccination. They play a crucial role in motivation and acceptance of vaccines among the general citizen to fight back against the pandemic in the country with limited resources.

Effect of maternal oral hydration therapy in oligohydramnios.

This was a randomized controlled trial on 64 pregnant women from 32 to 35 weeks gestation, in one year period to determine the effect of maternal hydration by oral water in oligohydramnios amniotic fluid index (AFI) ≤ 5. Studied women were randomly divided into two groups. Group A (intervention group) women were instructed to drink 2 liters of water within 2 hours and from the next day extra 2 liters of water daily for 7 days. Group B (control group) women were allowed for routine water intake. AFI was done after 2 hours, 24 hours and 7 days of oral hydration therapy in both the groups. P values less than 0.05 was considered statistically significant. Pre-treatment mean AFI was 4.77 ± 0.42 (mean ± SD) vs. 4.80 ± 0.43 (mean ± SD) and post treatment AFI after 2 hours was 6.35 ± 0.65 vs. 4.81 ± 0.42; after 7 days was 7.08 ± 0.21 vs. 5.0 ± 0.20 in oral hydration group and control group respectively. Delivery at 37-40 weeks was 53.1% vs. 12.4%, normal vaginal delivery in 71% vs. 21.8%, caesarean section in 29% vs. 78.2% and low birth weight babies were 12.5% vs. 81.25% in intervention and control group respectively. Foetal outcome was healthy in 87.1% vs. 59.4%, asphyxiated in 12.9% vs. 50% and perinatal death was 3.22% vs. 21.8% between intervention and control group. Still born were 6.3% cases in control group. Maternal oral hydration therapy significantly increases the AFI, reduces the caesarean section rate and improves the foetal outcome.

Clinical profile of periodic paralysis.

This cross sectional descriptive study was done to find out common clinical presentations, etiologies and laboratory investigation abnormalities in patients of periodic paralysis. Study was carried out in 30 patients with an age range from 8 to 70 years who were enrolled from July 2008 to June 2009 in Mymensingh Medical College Hospital (MMCH) medicine unit. Individuals who were admitted with sudden onset generalized muscle weakness, had history of previous attack and serum potassium level <3mmol/l or >5.5mmol/l were included in this study. In this series, majority of the patients were male (66.67%). Male: female ratio was approximately 2:1. The mean age of the patients was 27.4±4.5 years. Majority (26.67%) of them were in age range of 31-40 years. About 30% of the patients experienced the first attack of paralysis at the age of 20-24 years. Majority of patients (53%) were from middle class family with occupation of private service (26.66%) and farmer (20%). Positive family history was reported in 20% of patients. Regarding the precipitating factors, majority of patients (83.3%) were related to high carbohydrate meal, 56.67% related to temperature, 41.67% to exercise. Flaccid muscle weakness with variables muscle power (MRC grade 4/5 to 2/5 in 60% and 1/5 to 0/5 in 40%) was found. Cerebellar functions, all modalities of sensations and functions of cranial nerves were intact in all patients. In this series, laboratory investigations revealed reduced serum potassium level (<3mmol/l) in 90% of patients. Serum potassium value >5.5mmol/l was found in only 3.33% of patients. Creatine kinase (MM) was raised in 23% of the patients and Thyroid stimulating hormone (TSH) level was 0.8-2mmol/l in 6% of the patients. More than half of the patients (56%) showed variable ECG changes. Impaired nerve conduction function was found in 28.00%. So, careful history taking, meticulous clinical examination and simple laboratory investigations is sufficient to make a prompt diagnosis and rapid management of patients with periodic paralysis.

Pattern of Initial Clinical Presentation of Systemic Lupus Erythematosus: A Hospital-Based Cross-Sectional Study from Bangladesh.

Systemic lupus erythematosus (SLE) is an autoimmune disorder involving multiple systems and often presents with diverse clinical manifestations. The objective of the present study was to investigate the initial clinical presentations of SLE patients attending a tertiary care hospital in Bangladesh. This cross-sectional study was conducted among 85 SLE patients diagnosed according to the 1997 ACR Revised Criteria for Classification of SLE attending the Lupus Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2012 to June 2013. Sociodemographic and clinical data were collected from patient interviews, physical examinations and medical records. Almost 75.0% of the patients aged below 30 years had a female predominance (male-female ratio 1:5.6). Fever (71.0%), joint pain (60.0%) and alopecia (28.0%) were the most common initial presentations among the patients. Constitutional symptoms such as fatigue, malaise and weakness (23.5%), malar rash (21.0%), oral ulcer (20.0%), photosensitivity (15.0%) and Raynaud's phenomenon (13.0%) were also present in variable proportions. The musculoskeletal and mucocutaneous systems were most commonly affected (85.0% and 75.0% respectively), followed by lupus nephritis (40.0%), hematological symptoms (22.0%) and vasculitis (17.6%). Out of 85 patients, 78 (92.0%) tested positive for anti-nuclear antibodies. SLE patients commonly present with musculoskeletal and nonspecific symptoms at the initial phase. Hence, physicians should consider this clinical and immunological evidence along with conventional symptoms included in the ACR criteria.

Cooperative cargo transportation by a swarm of molecular machines.

Cooperation is a strategy that has been adopted by groups of organisms to execute complex tasks more efficiently than single entities. Cooperation increases the robustness and flexibility of the working groups and permits sharing of the workload among individuals. However, the utilization of this strategy in artificial systems at the molecular level, which could enable substantial advances in microrobotics and nanotechnology, remains highly challenging. Here, we demonstrate molecular transportation through the cooperative action of a large number of artificial molecular machines, photoresponsive DNA-conjugated microtubules driven by kinesin motor proteins. Mechanical communication via conjugated photoresponsive DNA enables these microtubules to organize into groups upon photoirradiation. The groups of transporters load and transport cargo, and cargo unloading is achieved by dissociating the groups into single microtubules. The group formation permits the loading and transport of cargoes with larger sizes and in larger numbers over long distances compared with single transporters. We also demonstrate that cargo can be collected at user-determined locations defined by ultraviolet light exposure. This work demonstrates cooperative task performance by molecular machines, which will help to construct molecular robots with advanced functionalities in the future.

Characterization of spinal cord lesion in patients attending a specialized rehabilitation center in Bangladesh.

STUDY DESIGN: This study was designed as a cross-sectional study. OBJECTIVES: The objective of this study was to find out the clinical types and sociodemographic characteristics of patients with spinal cord lesion (SCL). SETTING: Centre for the Rehabilitation of the Paralysed (CRP). METHODS: Data were collected by face-to-face interview, with a structured interview schedule from admitted patients. Descriptive measures and χ(2)-test were applied for data analysis. RESULTS: Of 107 patients, majority (20%) belonged to age group of 25-29 years (mean 31±12.2 years). About 83% were males; 65% married and 54% illiterate. Agricultural and other day laborers constituted the major occupation groups with mean monthly family income of US $60 (±$53). About 92% came from rural area and 84% belonged to nuclear family. About one-third of the patients were referred by the medical college hospitals. About 65% of the patients were admitted at 1-29 days of lesion with longest duration of 3 years. Patients were mostly (93%) traumatic. Fifty-four percent had paraplegia and most common skeletal level segment was cervical (44%). About 43% had pressure sores at admission. Eighty-nine percent needed management for bladder function through the use of catheter. Age, sex and occupation were associated with type of paralysis, skeletal level of injury and neurological condition; physical status, causes of lesion, type of injury and skeletal level of injury; and skeletal level of injury, respectively (P<0.05). CONCLUSION: Major cause of SCL was traumatic. Available treatment facilities were inadequate and needed improvement through government and private initiatives.

Proportion of Low Back Pain among Physicians Working in a Tertiary Level Hospital of Bangladesh.

Low back pain (LBP) is a common problem and is an important public health issue. A major proportion of LBP is concomitant with prolong and repetitive awkward postures, related with occupation like miners, health workers and professional drivers. Physicians are exposed to a wide range of occupational risk factors which results in LBP. A variety of occupational and personal factors are responsible for increased risk of low back pain among physicians. This cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to June 2018, to estimate the proportion of LBP among physicians. Data were collected from purposively selected 102 physicians of different levels by face to face interview using a case record form. Informed written consent of participants was taken prior to interview. Data were analyzed by using SPSS version 20.0. The study results revealed that majority (60.8%) of the physicians were in the age group of 31-50 years. Mean age of the physicians was 49.9 years with a standard deviation (SD) of 3.61 years. More than three fourth (79, 77.5%) of the physicians were male and 23(22.5%) were female. Out of 102 physicians more than two third (70, 68.6%) had LBP while 32(31.4%) did not have any LBP. Proportion of low back pain among physician was 68.6%. Low back pain was found in all age group. Among the physicians having low back pain, 55(78.6%) were male and 15(21.4%) were female. Among 102 physicians, 45(44.1%) had different types of comorbidities while 57(55.9%) did not have any comorbidities. Among the co-morbidities HTN, DM, Dyslipidemia, CHD and asthma were common. Results of the study concluded that 68.6% physicians had low back pain. Physicians of age group 31-60 years (88.5%) and male (78.6%) experienced LBP more. Further multi-centric large scale case control study is recommended to determine the risk factors of LBP among physicians of Bangladesh.