Public Health Problems in Bangladesh: Issues and challenges

In South-East Asia the main public health issues are infectious diseases and communicable diseases. Public health has improved markedly in Bangladesh over the past three decades. Nevertheless, Bangladesh faces major health challenges. A scoping study was performed according to York methodology. The study was aimed to find out the major public health issues and challenges in Bangladesh. Bangladesh has one of the worst burdens of childhood malnutrition in the world. Communicable diseases are a major cause of death and disability in Bangladesh. Unsafe food remains a major threat to public health each year, citizens suffer from the acute effects of food contaminated by microbial pathogens, chemical substances and toxins. Bangladesh still ranks among the top ten countries in the world with the highest TB burden. Pneumonia and other infections are major causes of death among young children. In Bangladesh only 1% of the population is reported to be HIV-positive, but rates are much higher among high-risk populations: injecting drug users, sex workers, and men who have sex with men. The toll of non-communicable diseases — chronic diseases, cancer, diabetes, cardiovascular diseases, and chronic respiratory diseases — is increasing in Bangladesh as the population becomes more urbanized. The converging pressures of global climate change and urbanization have a devastating effect on Bangladesh’s most vulnerable populations. The disease burden Bangladesh is further exacerbated by unsanitary living conditions that underscore the poor economic conditions of both urban and rural home dwellers. There are still several issues that Bangladesh health care system is yet to tackle, governance, accessibility, and affordability are key issues that are preventing the implementation of solutions to the public health issues in Bangladesh.South East Asia Journal of Public Health Vol.6(2) 2016: 11-16</jats:p

Anemia in Pregnancy

Anemia is the commonest hematological disorder that occurs in pregnancy. According to the recent standard laid down by ‘WHO’, anemia is present when the Hemoglobin (Hb) concentration in the peripheral blood is 11 gm/dl or less. The most common cause of anemia in pregnancy is lack of iron. Less often, it is caused by folic acid deficiency. In some populations, 80% of pregnant women are anemic. Those most at risk are women from low socio-economic groups and teenagers. Anemia is diagnosed by estimating the hemoglobin concentration and examining a peripheral blood smear for the characteristic red blood cell changes. Iron and folate supplementation is indicated during pregnancy to prevent the complications. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21314 Medicine Today 2014 Vol.26(1): 49-52</jats:p

Atypical Presentations of Appendicitis

Appendicitis has its acute, subacute, recurrent and chronic forms. Appendicitis is commonly predisposed to and precipitated by a single or a combination of multiple discrete factors like obstruction of lumen, ischemia from thromboembolic episodes, infection or idiopathic etc. Typically, it starts as umbilical or peri-umbilical or midline abdominal dull aching pain that soon gets localized in the right iliac region. Movements worsen the pain. Other typical features include nausea, vomiting, anorexia, pyrexia, preference to lie down with or without curling up, chills, constipation, diarrhea, fever, shaking etc. The atypical symptoms of appendicitis include a dull or sharp pain anywhere in the abdomen, back, rectum, painful urination, bloating, flatulence, generalized abdominal tenderness, distension simulating acute intestinal obstruction, enlarging abdominal mass with or without overlying skin erythema, normal bowel movements, normal vital signs and even with no pain, no nausea, no vomiting no pyrexia or no weight loss. These atypical symptoms very often misguide the primary care physicians and the surgeons resulting in failure of diagnosis putting the patients to the risks of life-endangering complications. Diagnosis of appendicitis in absence of typical features are to be made from pre-occupied knowledge and clinical suspicion with or without the help of biochemical and/or imaging studies. Early and timely diagnosis and appropriate treatment are essential to save the life and to reduce the morbidity as well. Appendicitis should be thought in all cases of abdominal pain irrespective of its type and location, as must meningitis be thought in all cases of headaches. KYAMC Journal.2021;12(02): 101-106</jats:p

Sonological Evaluation of Causes of First Trimester Bleeding

Background: Per vaginal bleeding in the first trimester is a common obstetrical situation ranging from an insignificant episode to life threatening emergency. The major causes are abortion, ectopic and molar pregnancies.&#x0D; Objectives of study: Ultrasonography is playing an increasing role in diagnosis of causes of Per vaginal bleeding in the first. This study was taken up to evaluate the value and utility of ultrasonography in correlation to the clinical findings of Per vaginal bleeding in the first trimester (sonographic evaluation).&#x0D; Materials and Methods: In this prospective study all obstetric cases (with a history of per vaginal bleeding in the first trimester of pregnancy between April, 2015 to November, 2015 (of 8 months) were included. A complete general physical examination including pelvic examination was done to arrive at a clinical diagnosis. Patients were then subjected to ultrasound examination. Clinical and ultrasound findings were correlated. We attempted to indentify the causes of vaginal bleeding occurring in the first trimester by clinical and trans-abdominal sonography and to evaluate the outcomes after instituting appropriate obstetric management.&#x0D; Results: Fatytun of all obstetric cases (200) had the First trimester bleeding (incidence being 21%). The common causes were abortion (85.68%), molar (9.52%) and ectopic (4.80%) pregnancies. The bleeding cases were common in the younger age group 21 to 25years, more in the multigravida within 5 to 8(47%) weeks of gestational age. The commonest cause of bleeding was threatened abortion (28.57%). Early institution of treatment after proper diagnosis has decreased morbidity, at times mortality of women. Ultrasound had not only clinched the diagnosis but also helped in timely management of first trimester vaginal bleeding.&#x0D; Conclusion: Ultrasound is a simple, non-invasive diagnostic modality available in the current day practice to diagnose and to manage first trimester vaginal bleeding.&#x0D; KYAMC Journal Vol. 10, No.-1, April 2019, Page 25-30</jats:p

Bmi-1 Expression Predicts the Progression of Malignant Hematopoietic Stem Cells in Myelodysplastic Syndrome.

Abstract Bmi-1 is a member of the Polycomb group (PcG) of transcriptional repressor genes, which could have an essential role in embryogenesis and be expressed restrictedly in the stem cells and proliferating cells. Some studies have recently reported that Bmi-1 is required to regulate the adult self-renewing hematopoietic stem cells. Others have shown that overexpressed Bmi-1 gene could cause the neoplastic proliferation of cells. A series of evidence on Bmi-1 suggests that it might be closely associated with the progression of the hematopoietic malignancies. Myelodysplastic syndrome (MDS) is a clonal bone marrow disorder characterized by aberrant hematopoiesis susceptible to acute leukemia. This category is quite heterogeneous with a variable clinical course and prognosis. Therefore, it is difficult to decide when to initiate therapies because some patients survive for years without treatment whereas others come to die in rapid progress in overt leukemia. Thus, we investigated whether the expression of Bmi-1 protein in CD34+ cells could be correlated with disease progression of MDS. Primary cells from patients with RA, RAEB, and MDS-AML, were stained with anti-CD34 antibody-PE and then fixed in PFA followed by staining with anti-Bmi-1-antibody-FITC. These cells were subjected to flow cytometric analysis. Bmi-1 expression in CD34+ cells was preferentially seen in RAEB and MDS-AML compared with RA (13.86%±6.40% in RA(n=4), 63.05%±8.19% in RAEB(n=6), 73.99%±33.40% in MDS-AML(n=6)). Patients were dead with &gt;70% at Bmi-1 expression level in CD34+. Moreover, two patients with RA at &gt;10% of Bmi-1 positivity made disease progression to RAEB. One patient with RAEB at &lt;10% at the Bmi-1 expression in CD34+ is still alive. Furthermore, we are dissecting gene profiling of cells from different types of MDS. These results show that the expression of Bmi-1 can distinguish the proliferating malignant stem cells from resting cells by using flow cytometry. Alternatively, IPSS in MDS patients is closely correlated with Bmi-1 expression of CD34+ cells. It may lead to the prediction of prognosis in patients with MDS in quality. Taken together, Bmi-1 expression could predict the disease progression and prognosis of MDS. Finally, Bmi-1 gene might be a target to control leukemogenesis by immunotherapy or gene therapy.</jats:p

Bmi-1 Expression Is Useful To Design Therapy and To Predict Prognosis in Patients with Acute Myeloid Leukemia.

Abstract Since prognosis of patients with acute myeloid leukemia (AML) is highly variable even in a single subpopulation in FAB classification, it would be useful to find prognostic molecular markers for AML. Thus, we investigated Bmi-1 expression in AML cells by flow cytometry and analyzed whether it predicts prognosis in AML patients and further it is helpful to choose therapies in the modalities of treatment options, because it is known to be required for self-renewal mechanism of leukemic stem cells. Bmi-1 expression in bone marrow or peripheral blood cells was analyzed in 49 patients with AML (M0(n=5), M1(n=7), M2(n=6), M3(n=5), M4(n=8), M5(n=5), M6(n=1)), granulocytic sarcoma(n=1), MDS-AML (n=9), and secondary AML(n=2). Freshly isolated AML cells were stained with a PE-conjugated anti-CD34-antibody followed by fixation and then with anti-Bmi-1-antibody-FITC. All of patients with low Bmi-1 positivity (&amp;lt;35%, n=11) except for de novo AML(M0) entered in complete remission (CR) with single induction chemotherapy(n=5) and accordingly had better overall survival, even though lower dose of chemotherapy (60% of standard dose) was given (n=3). Alternatively, patients with higher percentage of Bmi-1 expression in AML cells (&amp;gt; 70%, n=19) except for AML(M3) progressed to death within two years, unless they were treated with highly intensive therapy such as high dose AraC or allogeneic stem cell transplantation (n=3). Patients with intermediate degree of Bmi-1 expression (35–60%, n=5) responded to standard intensity of chemotherapy (n=2) and are alive for more than two years. Interestingly, patients with MDS-AML (n=9) had high Bmi-1 expression (79%) and all of them have died within 20 months. Binary logistic regression model showed that significant correlation was found among survival status as dependent variable, Bmi-1, and treatment intensity as independent variable (p = 0.004). On the other hand, Univariate analysis did not reveal any relation of Bmi-1 expression to karyotype, age, WBC count, or FAB subtype. In conclusion, Bmi-1 expression could be an independent prognostic marker and useful tool to design therapy for the AML patients.</jats:p

Acute Small Gut Obstruction as an Atypical Presentation of Acute Appendicitis without Rupture or Perforation of the Appendix

Acute appendicitis is a very common surgical emergency. It has got diverse presentations and various complications. Here, we report case history of a young male patient with a 2- year history of recurrent abdominal pain, who presented to our center with a 4-day history of increasing abdominal pain, constipation and vomiting. Clinical and radiological evaluation revealed it as a case of acute intestinal obstruction preoperatively. Per-operative findings suggested acute appendicitis without perforation, small gut obstruction by adhesions, appendicular lump or internal herniation. Appendicectomy was done along with other necessary procedures. His post-operative period was uneventful. This case is reported here to highlight that acute appendicitis may present with atypical features like acute small gut obstruction. J Bangladesh Coll Phys Surg 2021; 39: 261-265</jats:p

Relaxing music reduces blood pressure and heart rate among pre-hypertensive young adults:A randomized control trial

Prevalence of pre‐hypertension is higher among young adults and may increase the risk for hypertension and cardiovascular morbidity. Music therapy has been investigated to reduce the blood pressure in the hypertensive population; however, its efficacy on blood pressure in pre‐hypertensive young adults is not known. Thirty pre‐hypertensive (systolic blood pressure [SBP] = 120‐139 mmHg and diastolic blood pressure [DBP] = 80‐89 mmHg) young adults were recruited and randomly assigned into two groups. Music group (N = 15) received music therapy by passive listening to music for 30 minutes/day, 5 days/week for 4 weeks, along with Dietary Approaches to Stop Hypertension (DASH) eating plan (a diet rich in fruits and vegetables, low‐fat dairy or unsaturated fat) and limit the daily sodium intake less than 100 mmol/day. The control group (N = 15) practiced only DASH eating plan and sodium restriction. The SBP, DBP, and heart rate (HR) were measured before and after 4 weeks of intervention. There was a significant reduction in SBP (8.73 mmHg, p < .001) and HR (6.42 beats/minute, p = .002); however, the reduction in DBP (1.44 mmHg, p = .101) was not statistically significant in the music group. Control group did not exhibit any significant reduction in SBP (0.21 mmHg, p < .836), DBP (0.81 mmHg, p < .395) and HR (0.09 beats/minute, p < .935). In conclusion, music therapy reduced significantly SBP and HR suggesting that it could be a promising tool to prevent the progression of pre‐hypertension toward hypertension among young adults