Asymptomatic COVID-19 patients are the most challenging and feared obstacles in resuming these surgical procedures. The purpose of this study was to evaluate the proportion of asymptomatic carriers detected by RT-PCR in pre-operative orthopaedic evaluation during the peak of the second wave.514 asymptomtomatic COVID-19 patients, negative for TOCC (Travel, Profession, Cluster, Contact) risk factors were observed retrospectively. A nasopharyFngeal RT-PCR test was obtained 48 to 72 h before the surgery in all cases. Possible risk factors for a positive test was identified.The detected asymptomatic COVID-19 infection rate during the peak of the second wave among the pre-operative orthopaedic patients was 12.3%. Younger age, female gender, longer duration of admission to RT-PCR test interval were found to be significant (p= < 0.05) risk factors for asymptomatic RT-PCR to be positive. The hazard ratio (HR) for being asymptomatic RT-PCR positive was 4.3 (p = 0. 025), while the RT-PCR was performed at 14 days, but the HR increased to 9.2 (p = 0.049) when the test was performed after 45 days.According to our findings, pre-operative testing to rule out COVID-19 should be regarded as a critical step in preventing the disease clusters in hospitals.
Iron deficiency is the most important but preventable nutritional problem in Bangladesh. Thyroid peroxidase, an iron containing enzyme, is essential for initial two steps of thyroid hormone synthesis which is a component of tissue iron. Tissue iron diminishes early in the course of iron deficiency. So thyroid hormone level may be altered in iron deficient patients. This case-control study was carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2006 to June 2007. This study was done to find out the changes of thyroid hormonal activity in iron deficiency.In this study 72 subjects were selected from the out-patient department of the hospital. Patients with low serum ferritin level <12 mgm/L were selected as cases (n=36) and healthy persons with normal serum ferritin level were taken as controls. Serum ferritin, thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) were measured in all study subjects. Values were expressed as mean ± SD. Unpaired 't' test and Pearson's correlation test were performed to see the level of significance and p value <0.05 was taken as significant. Serum ferritin level in cases and controls were 6.78±4.05 mgm/L and 79.04±28.08 mgm/L respectively which showed significant difference (P<0.0001).Serum TSH concentration in cases and controls were 3.32±1.54 mIU/L and 1.89±0.86 mIU/L respectively. Serum FT4 concentration in cases and controls were 11.66±1.77 pmol/L and 13/10±1.36 pmol/L respectively and that of FT3 were 3.00±0.68 and 3.31±0.61 pmol/L respectively. All showed significant difference between groups.Serum ferritin and Serum TSH showed significant negative correlation in controls whereas in cases they showed negative correlation which was not statistically significant.Both serum FT4 and FT3 revealed positive correlation with serum ferritin but that too was not significant statistically.Though the study failed to show any significant positive correlation between serum ferritin and thyroid hormones, lower level of thyroid status in iron deficient patients suggest that it could be a reflection of disturbed activities of iron dependent enzymes such as thyroid peroxidase that impairs thyroid hormone synthesis. However, a large scale study is recommeded to establish the fact.This study showed that there was significant difference in thyroid hormonal status between iron deficient patients and normal healthy persons. Therefore it can be concluded that iron deficiency may impair normal thyroid hormone status. DOI: http://dx.doi.org/10.3329/bjmb.v5i1.13424 Bangladesh J Med Biochem 2012; 5(1): 5-11
The SARS-CoV-2 pandemic has affected millions of people worldwide claiming more than two
hundred and fifty thousand lives. Whereas researchers are trying to decode the nature of this novel coronavirus,
it has become a challenging task for the government and health departments of various countries to contain its
spread. The study proposes to add a new dimension in understanding the dynamics of the spread of the virus and
anticipate future trends based on a quantitative research method by analysing the Oxford COVID-19
Government Response Tracker (OxCGRT), which has recorded the response of various countries and assigned
policy scores to evaluate the stringency level of the countries. An analysis of the data in OxCGRT shows that
the spread of the virus was dependent upon four kinds of responses on the part of the countries: Proactive,
Immediate, Sustained and Delayed Response. The paper explains how these four responses, in varying
proportions, have influenced the spread of the virus and can be used along with other mechanisms in countering
the spread.
This cross-sectional analytical study was conducted in the department of Paediatrics, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from March 2017 to August 2018 to assess the pattern of serum iron profile and red cell indices in children with severe acute malnutrition. Seventy children having severe acute malnutrition were compared with 70 age matched children those had normal growth. Age range of the studied children was 6 months to 59 completed months. Male was found predominant (54.3%) in both study group and comparison group. Mean serum iron, serum ferritin, serum total iron binding capacity and transferrin saturation in severely malnourished children were 45.3±19.3μg/dl, 26.5±20.0ng/ml, 246.3±47.5μg/dl and 16.4±2.0% respectively which were significantly lower than that of healthy children (p<0.05). Mean Hb level in children with severe acute malnutrition was found 8.3±1.6gm/dl which was also found significantly lower than that of normal children (p<0.05). Anaemia was found in all (100%) severely malnourished children compared to 25.7% of children in comparison group. Mean MCV, MCH and MCHC in children with severe acute malnutrition was found 71.7±13.5fl, 24.0±5.8pg and 31.4±4.0gm/dl respectively which were significantly lower than that of comparison group (p<0.05). Serum iron profile and red cell indices should be routinely done in severely malnourished children for early intervention and management of iron deficiency anaemia.
Hyponatremia is an independent predictor of mortality in cirrhotic patients but little is known regarding the relationship between the level of serum sodium and 24-hour urinary sodium with the development of severity and complications of cirrhotic ascites. To observe the association of serum sodium and 24-hour urinary sodium levels with different grades of ascites and its complications in cirrhotic patients. In the department of Gastroenterology in a tertiary care hospital, this cross-sectional study was conducted from April 2019 to September 2020. A total of 96 admitted cirrhotic patients with ascites were enrolled in this study by consecutive sampling. Out of 96 patients with cirrhotic ascites, 48 patients had mild, moderate, and severe ascites and 48 patients had complications of ascites like refractory ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome. The mean serum sodium level was 131.69 ± 4.90 and 124.88 ± 5.67 mmol/L and the 24-hour urinary sodium level was 76.82 ± 45.64 and 35.26 ± 22.57 mmol/L in uncomplicated and complicated ascites groups respectively with P value < .001. In grade 1, grade 2, and grade 3 ascites, there was a significant (P = .001), association between mean serum sodium (mmol/L) level (R -0.777) and 24-hour urine sodium (mmol/L) level (R -0.704) but no significant difference was seen when refractory ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome were considered. In our finding, low serum sodium and low 24-hour urinary sodium levels were associated with the development of severe complications of cirrhotic ascites. Hence, Serum sodium and 24-hour urinary sodium levels can be good predictors of grading and complications of cirrhotic ascites.
Saphenous vein graft aneurysm (SVGA) is an uncommon complication of coronary artery bypass graft surgery (CABG). An 82-year-old man underwent contrast-enhanced computed tomography to investigate aorto-iliac disease. He was coincidentally noted to have an aneurysm of the saphenous vein graft to his right coronary artery. This was visualised on transthoracic echocardiography, computed tomography and coronary angiography. In the absence of symptoms and in view of high surgical risk, conservative management with anticoagulation was chosen. The patient was commenced on warfarin and remains asymptomatic.
AbstractIntroduction: Sarcoidosis is a chronic disorder. Its hallmark is the presence of noncaseating granuloma. Most cases are asymptomatic. However, few of them progress to liver cirrhosis and liver failure. Treatment of hepatic sarcoidosis is challenging as there is no large randomized controlled till date has been done to evaluate the efficacy of drugs. The Unique characteristic of this case report is that Sarcoidosis may present with jaundice and need to be borne in mind when a patient presenting with jaundice and no usual cause failed to be identify any usual cause. Despite having sarcoidosis, the patient did not have any respiratory symptom. Case presentation: We are presenting a case of hepatic sarcoidosis who presented with abdominal pain, fever and jaundice. After excluding of all common causes of jaundice, hepatic sarcoidosis was diagnosed with liver biopsy. Conclusion: High levels of suspicion is needed to diagnose hepatic sarcoidosis as this is an unusual cause of jaundice. Although rare, hepatic sarcoidosis can be treated with steroids. The prime take-away message from this case report is to consider Sarcoidosis as an unusual but treatable cause of jaundice when the conventional causes are failed to be the cause of jaundice.
Globally various incentive schemes have been employed in primary care to improve early diagnosis and management of several rheumatic conditions. In the UK, the Primary Care Quality and Outcomes Framework (QOF) rewards general practices for the provision of 'quality care' and helps to fund further improvements in the delivery of clinical care. Currently, there is one quality indicator in place for secondary prevention of osteoporosis. In order to help establish an integrated care pathway encompassing the whole patient journey between primary and secondary care, we undertook a detailed survey of two GP practices.
Objectives
The aims of the exercise were to identify the utility of quality indicator and any gaps in the model of care for the high-risk osteoporosis patients.
Methods
An independent service evaluation tool was employed to interrogate the IT system used in the GP surgeries. All patients over the age of 65 were extracted from the database and FRAX analysis was undertaken. Those with medium to high FRAX score (i.e. ten-year risk of >20% for major osteoporotic fracture and/or >5% for hip fracture) were captured to explore whether they were offered further evaluation and bone-sparing therapy as necessary.
Results
Of 18,248 patients registered in the multi-cultural urban practices, 6796 were >65 years old. 793 had pre-defined moderate-high FRAX score. 300 (37%) had a confirmed diagnosis of osteoporosis. Median age was 78 (range 65-103 years). 249 (83%) were women. 88.5% were White and remaining of other ethnicities. 20/300 (6.6%) had been coded to have ever sustained a fragility fracture. 178 (59.3%) were prescribed bone-sparing therapy with five people taking it for over five years. 91% were prescribed oral therapy (78% alendronic acid, 10% risedronic acid and 3% others) and remaining had parenteral therapies. Of the 27 patients not receiving any treatment, 11 (30%) were incorrectly coded. The remainder's reasons for lack of treatment include intolerance, poor adherence and comorbidities.
Conclusion
This study highlights the inadequacy of quality indicators in the overall management of osteoporosis burden in primary care. It relies heavily on active identification process for high-risk individuals and correct coding of fragility fracture. However the vast majority of patients with moderate-high risk, based on case finding strategy advised by international bodies e.g. FRAX, remain hidden. Less than 10% of patients with confirmed osteoporosis fulfil the quality outcome in this survey. The QOF hence fails to reflect the nature of disease burden in the primary care thereby risking the management strategies skewed towards too small a cohort and missing the big picture. It is clear that quality indicators for osteoporosis need to be aligned to risk stratification model. This will allow better identification of at-risk individuals and improved care pathway for patients requiring bone active therapies.
Disclosure of Interests
Sultana Parvin: None declared, Manraj Barhey: None declared, Talib Abubacker: None declared, Muhammad Khurram Nisar Grant/research support from: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Novartis, Celgene, Mallinckrodt, UCB and Lilly, Consultant for: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Novartis, Celgene, Mallinckrodt, UCB and Lilly, Speakers bureau: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Novartis, Celgene, Mallinckrodt, UCB and Lilly
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