Bangladesh Medical Research Council Bulletin

A rare case of rapidly progressive dementia- Creutfeldt Jakob disease: Case report

Maftahul Jannat — 2023-12-01

Background: Creutzfeldt Jakob disease is a rare and usually fatal neurodegenerative disorder characterized by rapidly progressive dementia with other neuropsychiatric manifestations like pyramidal, extrapyramidal, cerebellar, visual and behavioral abnormalities. Here we report a case of clinically probable Creutzfeldt Jakob disease in a 55 years old service holder lady presented with rapidly progressive dementia.

Objective: The aim was to report a rare case of rapidly progressive dementia caused by Creutzfeldt Jakob disease.

Methods: The case was thoroughly evaluated clinically then probable diagnosis was made by characteristic generalized periodic discharges on EEG and cortical and basal ganglia hyperintensity on FLAIR and DWI sequences of MRI of brain in addition to the clinical features of rapidly progressive dementia, rigidity, myoclonus, akinetic mutism and behavioral abnormalities. Other causes of dementia were excluded.

Result: Finally probable diagnosis of Creutzfeldt Jakob disease was done according to CDC diagnostic criteria. The case could not be confirmed due to lack of available newer investigations in our country and refusal of autopsy by the patient’s guardian.

Conclusion: Though rare, a suspicion of Creutzfeldt Jakob disease should be considered in patients with rapidly progressive dementia with complex neurological manifestations. Variable clinical presentation and rarity of the disease always delay the diagnosis. The disease is always fatal and no accepted treatment is available till date. So if early and accurate diagnosis is possible then the prognosis and plan of management could be explained to the caregiver properly.

Bangladesh Med Res Counc Bull 2023; 49: 190-194

Cell phone use and Self-reported wellbeing among teenage students of Bangladesh

Saida Ahmed — 2023-12-01

Background: Though cell phone is an essential instrument for modern communication, increasing use of it can cause detrimental effects on the health and well-being of adolescents and young adults.

Objectives: Present study aimed to determine the association between cell phone use and self-reported wellbeing among teenage students of Bangladesh.

Methods: This cross-sectional study was conducted from January-December 2021, among 382 teenagers who had been using cell phone for >6 months. Teenagers were selected by convenience sampling technique from selected schools of Dhaka city. Data were collected by face-to-face interviews using a semi-structured questionnaire. Data analysis was done by IBM SPSS software and quality of data was ensured in all steps of the study. Ethical issues were maintained strictly.

Results: Out of the 382 teenagers, 55.5% were female. Mean age of the teenagers was 15.82 years. Most frequently reported symptoms were fatigue (16.2%), headache (11.3%), and sleeping problems (10.7%). Statistical analysis indicated that fatigue was significantly increased in female teenagers (AOR=1.84, p=0.042) and teenagers from middle and upper social class (p=0.005), headache was significantly associated with female teenagers (AOR= 3.42, p=0.002), and sleeping problem was associated with duration of CP use ≥6 hours/day (AOR=3.36, p=0.003). Palpitation was associated with duration of CP use/day (For 4-5 hours: AOR=4.05, p<0.001; and for ≥6 hours: AOR=3.28, p<0.005) and depression was associated with years of CP usage >1 year (AOR=2.43, p=0.015).

Conclusion: The study revealed factors that were associated with potential negative effects of cell phone use on well being of teenagers. Guardians should pay adequate attention to the teenager to mitigate those negative effects of cell phone use. Further comprehensive research is needed in this area.

Bangladesh Med Res Counc Bull 2023; 49: 150-156

Mental stress of the spouses of the physicians working in COVID-19 dedicated tertiary public hospitals

Esrat Zahan Shawan — 2023-12-01

Background: In the COVID-19 pandemic spouses of the physicians were under a lot of stress.

Objective: The objective of the study was to assess the state of mental stress of the spouses of the physicians working in COVID-19 dedicated tertiary public hospitals.

Methods: A descriptive cross-sectional study was conducted among 265 spouses of the physicians working in COVID-19 dedicated tertiary public hospitals. The study period was from 1^st January to 31^st December 2021. Respondents were selected on the basis of inclusion and exclusion criteria and samples were taken by purposive sampling technique. Data were collected by face-to-face and telephone interview through pretested semi-structured questionnaires. To assess the state of mental stress, PSS (perceived stress scale) was used.

Results: Among 265 respondents 38.5% were male and 61.5% were female. Among them 72.8% had children and 49.8% had senior citizens in their families. About 12.8% were neglected by friends, 66.84% faced disturbances in ensuring parenteral care to child, about 91.7% respondents had fear of being infected with COVID-19, 66.4% had problem with sleeping disorders, 37.4% had problem with memory loss, and 54.7% had trouble in making right decision. Among 265 respondents, level of mental stress of respondents by perceived stress scale, around 77.7% respondents were at the level of moderate stress, 10.6% were in low mental stress and 11.7% were in high mental stress. Statistically significant associations were found among gender of the respondents (p=0.039), respondents with having children (p=0.004) and having senior citizens (p=0.006), being neglected by friends (p=0.005), facing disturbance in ensuring parenteral care to child (p<0.0001), having any disturbance in conjugal life (p<0.0001), fear of being infected (p=0.007), sleeping disorder (p=0.001), memory loss (p<0.0001), making in right decision (p<0.0001).

Conclusion: Majority of the spouses of the physicians were in moderate stress. So, counselling and support to physician, their family & community.

Bangladesh Med Res Counc Bull 2023; 49: 157-163

Optimizing Spinal Fusion in Degenerated Spinal Stenosis, proposing a hybrid scoring system for Bangladesh people in law Sack pain

Md Moshiur Rahman — 2023-12-01

Background: Degeneration is a progressive phenomenon in lumbar spinal stenosis patients. The outcome of surgery predictors is sometimes biased. Fusion and stabilization in such cases are unnecessary in many situations. There is still a debate to decompress only versus fusion in low-grade listhesis. Fusion and stabilization in the aged lumbar spine should have clear indications.

Objective: To assess whether the fusion is necessary in lumbar spinal stenosis in selected cases or not and to create a new scoring system among the patients of low backache in Bangladeshi people.

Method: A total of 120 cases were observed retrospectively from 2012 to 2018 in Comfort Hospital, Dhaka, Bangladesh. And 40 more cases data will be collected in the upcoming study period of 6 months. To assess the study we will conduct a survey. In previous cases, the patients had undergone three types of surgeries (Laminectomy, Unilateral approach, and Fusion surgeries). ODI and Swiss score were used for assessment of functional outcome. A new scoring system has been made for patients who may be benefited from fusion or non- fusion surgeries.

Results: In retrospective data, there were 80 male and 40 female patients. Maximum patients were between 41 to 50 years. 59.17% were heavy workers and 66.67% were smoker. Maximum patients (59.17%) had undergone unilateral surgical approaches and 18.33% undergone fusion surgeries. 98.33% patients had satisfactory outcome in our study. In our hybrid scale, the pain status showed, 52.50% had moderate pain, 22.50% had mild pain, 20% had severe pain and only 5% had very severe pain. Maximum participants having low back pain were below 30 years old and 65% lift weight more than 25 kg. The total pain score was significant in our correlation test. The Cronbach's Alpha (.784) was significant in Bangladeshi socio- demographic population.

Conclusion: The outcome of such a study will help to know either fusion surgeries in selected cases are effective for lumbar spinal stenosis or not. Also, it will probably help to select patients for such a study and to improve surgical treatment methods.

Bangladesh Med Res Counc Bull 2023; 49: 164-170

Association of Interleukin-10 Gene Polymorphism with Susceptibility and Severity of Axial Spondyloarthritis

Raisa Enayet Badhan — 2023-12-01

Background: This study aimed to determine the association of Interleukin-10 (IL-10) gene polymorphisms with the susceptibility and severity of axial spondyloarthritis (axSpA) that may guide to have an idea about the genetic basis of the disease and it’s association with severity.

Objective: Aim of the study was to demonstrate the IL-10 gene polymorphisms to determine their association with susceptibility and severity of axSpA.

Methods: According to Assessment of Spondyloarthritis International Society (ASAS) classification criteria total 38 patients with axSpA (clinically diagnosed by an expert Rheumatologist, attending in outpatient department (OPD) of Rheumatology, Bangabandhu Sheikh Mujib Medical University, BSMMU) and 38 healthy controls (resident doctors, laboratory staffs of BSMMU and general people) after fulfilling the inclusion criteria were enrolled in this study. Blood samples were collected after taking informed written consent and data were collected in a predesigned data collection sheet. The IL-10 gene polymorphisms IL-10 (819T/C), IL-10 (1082A/G) and IL-10 (592C/A) were detected by Polymerase chain reaction- Restriction fragment length polymorphism (PCR- RFLP) method at Department of Microbiology and Immunology, BSMMU, Dhaka.

Results: According to BASDAI score, 14 patients were in inactive disease group and 24 patients were in active disease group. The homozygous CC genotype and C allele of IL-10 (-819T/C) were found significantly higher in patients than control group (p=0.022 and p=0.045 respectively). The heterozygous GA genotype of IL-10 (-1082A/G) gene has significant association (p=0.001) with axSpA. It indicates that the homozygous CC genotype and C allele of IL-10 (819T/C) and heterozygous GA genotype of IL-10 (1082A/G) have an association with the susceptibility of axSpA.

Conclusion: CC genotype and C allele of IL-10 (-819T/C) and GA genotype of IL-10 (1082A/G) are associated with axSpA susceptibility. But no association of these genotypes were found with disease severity.

Bangladesh Med Res Counc Bull 2023; 49: 171-176

Time of Attainment of Clinical Remission and Peripheral Blood Count Recovery during Induction Chemotherapy for Childhood Acute Lymphoblastic Leukemia

Mst Arafatara Khatun — 2023-12-01

Background: Acute lymphoblastic leukemia(ALL) is the most common pediatric malignancy. Infection and bleeding are the leading cause of death during induction chemotherapy in childhood ALL. So, proper knowledge about anticipated infection and bleeding are very important during this period. But the duration of clinical remission and recovery of peripheral blood count during induction chemotherapy is not well reported in literature.

Objective: The aim of the study was to determine the time of attainment of clinical remission and recovery of peripheral blood count after initiation of induction chemotherapy and to determine if the duration of clinical remission and peripheral blood count recovery differs between therapeutic risk groups.

Methods: This prospective observational study was conducted from January 2021 to December 2021 in the Department of Paediatric Haematology and Oncology, BSMMU. Newly diagnosed admitted Eighty-Six ALL of both sexes aged 1 to 17.9 years were included. After commencing chemotherapy, physical examination was recorded every day until clinical remission and complete blood count (CBC) was recorded one to two days interval until peripheral blood count recovery. The number of packed red blood cell (PRBC) and platelet transfusions and the number of days of intravenous antibiotics were recorded.

Results: Mean duration of clinical remission, complete Hemoglobin (Hb), Absolute neutrophil count(ANC) and platelet recovery was 8.4 ± 4.5 days, 25±7.9 days, 23.3±5.6 days and 21.8±6.4 days respectively (p<0.01). Time to attain partial recovery of platelet was 14.0±4.9 days in high risk and 19.2±5.3 days in standard risk group. PRBC transfusion requirement was 2.2±1.2 units in high risk group and 1.7±0.8 units in standard risk group (p<0.05). Time to attain partial recovery of ANC, number of days with I/V antibiotics and duration of treatment interruption were higher in high risk group.

Conclusion: Time of clinical remission was similar between risk group. Platelet recovery occurred earlier than Hemoglobin (Hb) and absolute neutrophil count (ANC) recovery. Transfusion and supportive care requirement were more in high risk group during induction chemotherapy. So, more supportive care should be arranged up to three weeks of induction period to increase survival of high risk childhood ALL.

Bangladesh Med Res Counc Bull 2023; 49: 177-182

Preoperative Serum Vascular Endothelial Growth Factor as a predictor of malignant ovarian tumor

Marzina Faruq — 2023-12-01

Background: Effective biomarkers for accurate characterization of newly diagnosed ovarian tumors and adnexal masses are of paramount importance. The availability of an ideal serum marker is highly recommended. Vascular endothelial growth factor (VEGF) may be considered as a predictor of ovarian cancer.

Objective: This study explored the efficacy of preoperative serum VEGF for detection of malignant ovarian tumor.

Methods: This cross sectional analytical study was conducted among 86 patients who were enrolled for this study according to final histopathology report and who did not receive any kind of treatment. Serum levels of VEGF-A were determined by using ELISA method. ROC curve was plotted to achieve the best cutoff value of serum VEGF. The Mann-Whitney test was used to compare the VEGF distribution across sub-groups of patients.

Result: A statistically significant difference in the levels of serum VEGF level was observed between benign and malignant ovarian tumor patients. Ovarian cancer patients had a higher preoperative median S. VEGF level of 753.8 pg/ml than that of benign ovarian masses (median 241.8 pg/ml; p value 0.001). The ability of serum VEGF to differentiate malignancy from benign masses at a cut-off value of 547.85 pg/ml gave a sensitivity of 90.1%, a specificity of 93.5%.

Conclusion: This study revealed that preoperative serum VEGF may be used as a feasible vascular marker and predictor of malignant ovarian tumors.

Bangladesh Med Res Counc Bull 2023; 49: 183-189

Overview of Journals in Developing Countries

Shamima Parvin Lasker — 2023-12-01

Abstract not available

Bangladesh Med Res Counc Bull 2023; 49: 148-149