Psychological Assessment of Health-Care Workers Working during COVID-19 Pandemic Condition in Bangladesh.

The study was aimed to assess the psychological aspects and relevant factors of the health-care workers (HCWs) working in COVID 19 pandemic condition in Bangladesh. This online cross-sectional survey was conducted from different tertiary, secondary and primary hospitals in Bangladesh. Eligible 638 HCWs who were directly involved in the caring of confirmed or suspected COVID-19 patients were recruited in this study. The mental health was assessed by the Patient Health Questionnare-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Athens Insomnia Scale (AIS). High frequency of depression 536(84.0%), anxiety 386(60.5%) and insomnia 302(47.3%) was found among the HCWs, which were significantly higher in physicians (p<0.001) than nurses. Moderate to severe depression was significantly higher in female, whereas minimal to mild depression was significant in male HCWs (p=0.014). Symptoms of depression (p<0.001), anxiety (p<0.001) and insomnia (p=0.004) were significantly higher among the HCWs of primary and secondary compared to the tertiary level. The HCWs developed psychological trauma due to family health (45.3%) and contagious disease property (66.6%). After adjusting confounders, multivariable logistic regression analysis showed that physicians and HCWs of secondary hospital had significant symptoms of severe depression (OR=2.95, 95% CI=0.50-17.24; p<0.001), anxiety (OR=2.64, 95% CI=0.80-8.72; p<0.001) and insomnia (OR=2.67, 95% CI=1.23-5.84; p=0.018); whereas female HCWs had more risk of developing symptoms of severe insomnia (OR= 1.84; 95% CI=1.23-2.75; p=0.003). High rate of depression, anxiety and insomnia was found among HCWs working in the COVID-19 pandemic condition in this survey.

Clinicopathological Findings of Haematological Malignancies in Hospital Admitted Patients.

The global burden of cancer is gradually rising. In our context we are also facing the same problem. Hematological malignancies (HMs) are important component of cancer. Early diagnosis and proper treatment at right time, a good number of HMs patients can be cured or lengthening the survival period. For this purpose a proper diagnostic criteria should be developed in our settings. This research work is carried out to find out the clinicopathological findings of HMs in our population. This was a cross-sectional descriptive type of observational study conducted in the Department of Medicine and Hematology of Mymensingh Medical College Hospital, Bangladesh from July 2016 to June 2017. Total 45 patients were purposively selected on the basis of inclusion and exclusion criteria with a view to observe the clinical and laboratory findings. Mean age of the patients was 44.5 years. Highest average age (70 years) was found in chronic lymphocytic leukaemia (CLL) and lowest (29 years) in acute lymphoblastic leukaemia (ALL). Majority of the respondents were male in all HMs except in non-Hodgkin's lymphoma (NHL) where male-female ratio was 0.3:7. Among male most of them were farmers or day laborers and most of the females were housewife. Almost all patients were exposed to single or multiple exposures like smoking, betel nut, betel leaf, tobacco leaf, fertilizer or pesticides. Acute myeloblastic leukaemia (AML) was the leading HMS with 31.11% representation followed by non-Hodgkin's lymphoma (NHL) 20%, Hodgkin's lymphoma (HL) 15.56%, acute lymphoblastic leukaemia (ALL) 11.11%, chronic myeloid leukaemia (CML) 11.11%, multiple myeloma (MM)6.67% and chronic lymphocytic leukaemia (CLL) 4.44%. Duration of symptoms was vary from 2 days to 5 years. In acute leukaemia duration was short (average 2 months). Common clinical findings were anaemia (95.5%), fever (80.0%), hepatosplenomegaly (42.2%), lymphadenopathy (40.0%), bony tenderness (22.2%) and bleeding manifestations (15.5%). Some uncommon findings were also reported like menorrhagia, facial nerve palsy, arthritis and disorientation. Common laboratory abnormalities were high ESR, anaemia, leukocytosis, thrombocytopenia and immature cell in PBF especially in acute leukaemia. Clinical suspicion along with history of positive exposure indicates strong possibilities of haematological malignancies. It should be kept in mind that haematological malignancies may also present with some isolated uncommon findings.

Molecular Diagnosis of Human Papilloma Virus by PCR.

Cervical cancer is a major world health problem and the fourth most leading cause of death in women around the world. High risk HPV DNA has been shown to be present in 99.7% of cervical cancers worldwide. So detection of HPV DNA by PCR may help in early detection and management of cervical cancer. This cross sectional observational study was done to detect L1 antigen gene of HPV from cervical swab by nested PCR. Following universal safety precautions a total of 141 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology department of MMCH from January 2015 to December 2015. Laboratory work was done in the department of Microbiology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh HPV DNA was tested among 141 VIA positive women aged between 20-70 years by nested PCR method. DNA was extracted by phenol-chloroform extraction method. Two pairs of consensus primers MY09-MY11 and GP5-GP6 were used in a nested PCR assay. Histopathological examination was done on 66 samples in the Department of Pathology, MMC, Mymensingh, Bangladesh. A total of 36.9% (52/141) cases were positive for HPV DNA by nested PCR. On Histopathological diagnosis PCR was positive in 42.9% chronic cervicitis, 21.2% CIN cases and 90.9% cervical carcinoma cases. Based on the findings of the study, it may be concluded that the HPV DNA testing has opened the door for an alternative surveillance mechanism to routine cytological screening. Detection of HPV may play an important role in diagnosis and clinical prognosis of precancerous lesions. So PCR may be done for all VIA positive cases for screening of cervical cancer.

OncoE6 Positivity among VIA Positive Suspected Cases from Colposcopy Clinic of Mymensingh Medical College Hospital, Mymensingh.

Cervical cancer is a major world health problem for women. It is the fourth most leading cause of death in women around the world. High risk HPV DNA has been shown to be present in 99.7% of cervical cancers worldwide. Oncoprotein E6 and E7 play an important role in the development of cervical cancer which can be detected by OncoE6 cervical test. This Cross sectional observational study was performed to detect E6 Oncoprotein from cervical swab by OncoE6 cervical test. Following universal safety precautions a total of 47 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2015 to December 2015. Laboratory work was done in the department of Microbiology, Mymensingh medical college. E6 strip test is an immunochromatographic test based on the detection of HPV-E6 oncoprotein in cervical swab samples. The swab specimen was treated with lysis solution and conditioning solution. Then the specimen solution was clarified by centrifugation. After that the sample solution was transferred into Detector mAb vial, wash solution vial and finally into developing solution vial. The test unit was then placed on a reading guide. Positive result was indicated by the appearance of purple colored test line. Out of 47 specimens 21(44.68%) were OncoE6 positive by OncoE6 cervical test. Among 21 positive cases 19(90.48%) were HPV-16 and 2 were (9.52%) HPV-18. Histopathologically out of 22 cervical carcinoma cases 20(90.90%) were positive by this test. Based on the findings of the present study, it may be concluded that screening with HPV E6 may minimize the overtreatment as well as the colposcopy referral. So it can be used as primary screening to aid colposcopy and to identify real disease. HPV based screening may help to control cervical cancer in Bangladesh. As HPV is a sexually transmitted infection; so, male screening method should be established.

Relationship between Echocardiographic Epicardial Adipose Tissue (EAT) Thickness and Angiographically Detected Coronary Artery Disease.

Epicardial adipose tissue (EAT) is a particular form of visceral adipose tissue deposited around the heart and there is growing evidence about the physiological and metabolic importance of EAT, especially in the association of cardiovascular risk profiles and the pathogenesis of atherosclerotic coronary artery disease. This observational, cross sectional study was done to determine the relationship between echocardiographic epicardial adipose tissue (EAT) thickness and coronary artery disease (CAD). Total 123 patients with established or suspected coronary artery disease admitted for coronary angiogram in the department of Cardiology of Bangabandhu Sheikh Mujib Medical University (BSMMU) from November 2010 to the end of April 2011 were included in this study. Epicardial adipose tissue (EAT) thickness measurements by echocardiography were compared with coronary angiographic findings. Echocardiographic epicardial adipose tissue (EAT) thickness was significantly higher in patients with CAD in comparison to those with normal coronary arteries (6.67±2.24mm vs. 4.61±1.62mm; p<0.001). Furthermore, EAT thickness increased with the severity of CAD (multi-vessel disease 7.99±2.12mm vs. single vessel disease 5.93±1.97mm; p<0.001). Gensini's score significantly correlated with EAT thickness (r=0.617, p<0.001). Optimum cut-off point (OCP) of epicardial adipose tissue (EAT) thickness as a predictor of angiographic CAD was 6.44mm with 45.31% sensitivity and 92.86% specificity [ROC area 0.756, p<0.001, 95%CI (0.66-0.85)]. Echocardiographic epicardial adipose tissue (EAT) thickness was significantly correlated with the presence and severity of angiographically detected coronary artery disease (CAD).

Clinical Presentation of Adult Pulmonary Tuberculosis (PTB): A Study of 103 Cases from a Tertiary Care Hospital.

Tuberculosis, one of the oldest diseases known to affect humans, is a major cause of death worldwide. The disease, which is caused by the bacteria Mycobacterium tuberculosis complex, usually affects the lungs, although other organs are involved in up to one-third of causes. If properly treated, tuberculosis caused by drug-susceptible strains is curable in virtually all cases. If untreated, the disease may be fatal within five years in 50-65% of cases. Transmission usually takes place through the airborne spread of droplet nuclei produced by patients with infectious pulmonary tuberculosis. This cross sectional observational study was conducted to detect various clinical presentations of pulmonary tuberculosis patients in the Department of Medicine, Sir Salimullah Medical College and Hospital from January 2009 to December 2009. Sample was selected through inclusion methods from patients who was admitted in to hospital and confirmed as pulmonary tuberculosis after appropriate investigations and who gave informed written consent was finally enrolled in this study. A total 103 patients were selected for the study. Out of 103 cases 34.9% were above 50 years old, followed by 26.2% between 30-40 years old, 22.3% between 40-50 years old and remaining 16.5% bellow 30 years old. The male to female ratio was roughly 1.2:1. The most of the patients were housewife and farmer which were 31% and 28.1% respectively. The most of the patients came from low socio-economic group. About 55.3% cases were smoker and 43.7 were non smoker. Among the frequency of symptoms 73.7% were chronic cough for above one month followed by 70.8% were low grade fever, 41.8% were night sweats and the 2% were admitted in hospital for other complaints and after evaluation diagnosed as PTB. The most of the patients about 67% were suffering from less than six weeks duration. Among the physical findings the 67% cases were lost significant weight, 56.3% had fever and 56.3% had apical crepitation over chest. There was sputum positive for acid fast bacilli about 64.7%. The traditional TB diagnosis methods are time consuming and the most of the patients are poor in our country, they are unable to afford the modern costly investigations. Therefore we should more emphasis on clinical examinations, so that we can diagnosis pulmonary TB rapidly and can start treatment as early as possible.

Aortic valve sclerosis is an indicator of coronary artery diseases.

Aim of this study is to establish the relationship between echocardiographically detected Aortic Valve Sclerosis (AVS) and angiographically detected Coronary Artery Diseases (CAD). This observational and cross-sectional study was carried out in the department of cardiology BSMMU, Dhaka from January 2010 to November 2010. A total 140 patients of established or suspected coronary artery disease admitted for coronary angiogram was included in this study. Echocardiography and coronary angiography was done. AVS was found in 88(63%) patients. With AVS 81(92.05%) had significant coronary artery disease. Fifty two patients without AVS, 42(80%) had significant coronary artery disease. No significant difference of SVD in both groups but patients with AVS had a higher rate of DVD, TVD and LM disease. Patients without AVS had a higher rate of normal coronary angiogram. Multivariate analysis identified AVS (p=0.018) is an independent predictor of CAD.