Bangabandhu Sheikh Mujib Medical University

Background: Fatty liver disease in the absence of excessive alcohol consumption is an increasingly common condition with a global prevalence of ~ 25-30% and is also associated with cardiovascular disease (CVD). Since systemic metabolic dysfunction underlies its pathogenesis, the term metabolic (dysfunction)-associated fatty liver disease (MAFLD) has been proposed for this condition. MAFLD is closely intertwined with obesity, type 2 diabetes mellitus and atherogenic dyslipidemia, which are established cardiovascular risk factors. Unlike CVD, which has received attention in the literature on fatty liver disease, the CVD risk associated with MAFLD is often underestimated, especially among Cardiologists. Methods and results: A multidisciplinary panel of fifty-two international experts comprising Hepatologists, Endocrinologists, Diabetologists, Cardiologists and Family Physicians from six continents (Asia, Europe, North America, South America, Africa and Oceania) participated in a formal Delphi survey and developed consensus statements on the association between MAFLD and the risk of CVD. Statements were developed on different aspects of CVD risk, ranging from epidemiology to mechanisms, screening, and management. Conculsions: The expert panel identified important clinical associations between MAFLD and the risk of CVD that could serve to increase awareness of the adverse metabolic and cardiovascular outcomes of MAFLD. Finally, the expert panel also suggests potential areas for future research.

Background The intrinsic apoptotic pathway of neutrophils in Human Immunodeficiency Virus (HIV) infection results in spontaneous neutrophil death. There is a scarcity of data regarding the gene expression of an intrinsic apoptotic pathway of neutrophils in HIV patients. Objective The objective of this study was to observe the differential expression of some important genes involved in the intrinsic apoptotic pathway of HIV patients, including those who were receiving antiretroviral therapy (ART). Methods Blood samples were collected from asymptomatic, symptomatic, HIV, ART receivers HIV patients, and healthy individuals. Total RNA was extracted from neutrophils and subjected to quantitative real-time PCR assay. CD4+T cells and an automated complete blood count were performed. Results Among the asymptomatic, symptomatic, and ART receivers HIV patients (n=20 in each group), median CD4+T counts were 633, 98, and 565 cells/ml, and the length of HIV infection in months (±SD) was 24.06±21.36, 62.05±25.51, and 69.2±39.67, respectively. Compared with healthy controls, intrinsic apoptotic pathway genes, i.e., BAX, BIM, Caspase-3, Caspase-9, MCL-1, and Calpain-1, were upregulated to 1.21±0.33, 1.8±0.25, 1.24±0.46, 1.54±0.21, 1.88±0.30, and 5.85±1.34 fold in the asymptomatic group, and even more significantly, i.e., 1.51±0.43, 2.09±1.13, 1.85±1.22, 1.72±0.85, 2.26±1.34, and 7.88±3.31 fold in symptomatic patients, respectively. Despite CD4+ T-cell levels increased in the ART receiver group, these genes did not approach the level of healthy or asymptomatic and remained significantly upregulated. Conclusion The genes involved in the intrinsic apoptotic pathway in circulating neutrophils during HIV infection were stimulated in vivo, and ART reduced the expression of those upregulated genes but did not return to the level of asymptomatic or healthy individuals.

It is quite well documented that the COVID-19 pandemic disrupted cancer screening services in all countries, irrespective of their resources and healthcare settings. While quantitative estimates on reduction in volume of screening tests or diagnostic evaluation are readily available from the high-income countries, very little data are available from the low- and middle-income countries (LMICs). From the CanScreen5 global cancer screening data repository we identified six LMICs through purposive sampling based on the availability of cancer screening data at least for the years 2019 and 2020. These countries represented those in high human development index (HDI) categories (Argentina, Colombia, Sri Lanka, and Thailand) and medium HDI categories (Bangladesh and Morocco). No data were available from low HDI countries to perform similar analysis. The reduction in the volume of tests in 2020 compared to the previous year ranged from 14.1% in Bangladesh to 72.9% in Argentina (regional programme) for cervical screening, from 14.2% in Bangladesh to 49.4% in Morocco for breast cancer screening and 30.7% in Thailand for colorectal cancer screening. Number of colposcopies was reduced in 2020 compared to previous year by 88.9% in Argentina, 38.2% in Colombia, 27.4% in Bangladesh, and 52.2% in Morocco. The reduction in detection rates of CIN 2 or worse lesions ranged from 20.7% in Morocco to 45.4% in Argentina. Reduction of breast cancer detection by 19.1% was reported from Morocco. No association of the impact of pandemic could be seen with HDI categories. Quantifying the impact of service disruptions in screening and diagnostic tests will allow the programmes to strategize how to ramp up services to clear the backlogs in screening and more crucially in further evaluation of screen positives. The data can be used to estimate the impact on stage distribution and avoidable mortality from these common cancers.

Key Clinical Message Children with Pierre Robin syndrome (PRS) often have trouble breathing and eating as soon as they are born. If conservative therapy fails to alleviate airway obstruction, surgical surgery may be considered. Patients with PRS require multidisciplinary approaches for treatment. Abstract Pierre Robin syndrome is a common craniofacial abnormality that causes glossoptosis and blockage of the upper airway. This renders it difficult to feed, which leads to severe malnutrition. This condition is also often marked by an absence of a soft palate. We mention a newborn with Pierre Robin syndrome with the absence of a soft palate and pneumonia complications, whose impending respiratory failure was treated successfully. To solve the complex problems that these babies and their families are facing, a multidisciplinary approach is needed.

Objective: To evaluate the results of Anterior Cervical Discectomy and Fusion by Stand-alone PEEK cage for the treatment of double level cervical spondylotic myelopathy. Background: Cervical spondylotic myelopathy is a common cause of neck pain and radiating arm pain which develops when one or more of the intevertebral discs in the cervical spine start to degenerate. Anterior cervical discectomy and fusion (ACDF) is the gold standard treatment for degenerative cervical spine disease.Multiple techniques and modalities of fixation are used in ACDF, among them use of Stand-alone PEEK cage is standard one. To counteract the complications with the plating for ACDF, Stand-alone cage concept was constructed and favourable outcomes have been described with a low rate of dysphagia. Stand-alone PEEK cage provides immediate load bearing support to the anterior column and may facilitate fusion. Materials & methods: This retrospective study was conducted in the spine unit of Orthopaedic Surgery department of Bangabandhu Sheikh Mujib Medical University, Shahbag and other private hospitals in Dhaka, Bangladesh from January 2016 to December 2021. A total number of 50 patients with cervical spondylotic myelolopathy with two level involvement confirmed by MRI were selected for the study who were failed to improve after conservative treatment. Outcome was evaluated by usingvisual analog score (VAS), Modified Odom`s criteria, Nurick’s grading and fusion rate by Bridwell’s criteria. Results: Mean patient age was 48.4 ± 6.49 years. Male: female ratio 2:1. Pre-operatively, mean VAS score was 7.13±1.51 whereas post-operatively VAS score was decreased significantly to 0.47±0.64 after 12 months of follow up (p value <0.001). Neurological outcome was assessed by Nurick grading system, where all patients were in grade I (80%), grade II (14%) & grade III (6%) pre-operatively. Post-operatively at 12 months follow up, maximum patients (92%) were in grade 0 (p value <0.001). Radiological fusion was assessed by Bridwell fusion criteria, fusion was found in 80% and 90% of patients after 6 and 12 months follow up. Overall improvement was assessed by modified Odom’s score; excellent improvement was seen in majority patients after 12 months of post-operative follow up (86%) Conclusion: ACDF by stand-alone PEEK cage is the best technique for the treatment of double level cervical spondylotic myelopathy with excellent functional outcome. This can be used with minimum risk as well excellent fusion rate.

Over the last 10 years, there has been a rise in neurointerventional case complexity, device variety and physician distractions. Even among experienced physicians, this trend challenges our memory and concentration, making it more difficult to remember safety principles and their implications. Checklists are regarded by some as a redundant exercise that wastes time, or as an attack on physician autonomy. However, given the increasing case and disease complexity along with the number of distractions, it is even more important now to have a compelling reminder of safety principles that preserve habits that are susceptible to being overlooked because they seem mundane. Most hospitals have mandated a pre-procedure neurointerventional time-out checklist, but often it ends up being done in a cursory fashion for the primary purpose of 'checking off boxes'. There may be value in iterating the checklist to further emphasize safety and communication. The Federation Assembly of the World Federation of Interventional and Therapeutic Neuroradiology (WFITN) decided to construct a checklist for neurointerventional cases based on a review of the literature and insights from an expert panel.

Importance: The association between place of birth and hypothermic neuroprotection after hypoxic-ischemic encephalopathy (HIE) in low- and middle-income countries (LMICs) is unknown. Objective: To ascertain the association between place of birth and the efficacy of whole-body hypothermia for protection against brain injury measured by magnetic resonance (MR) biomarkers among neonates born at a tertiary care center (inborn) or other facilities (outborn). Design, setting, and participants: This nested cohort study within a randomized clinical trial involved neonates at 7 tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh between August 15, 2015, and February 15, 2019. A total of 408 neonates born at or after 36 weeks' gestation with moderate or severe HIE were randomized to receive whole-body hypothermia (reduction of rectal temperatures to between 33.0 °C and 34.0 °C; hypothermia group) for 72 hours or no whole-body hypothermia (rectal temperatures maintained between 36.0 °C and 37.0 °C; control group) within 6 hours of birth, with follow-up until September 27, 2020. Exposure: 3T MR imaging, MR spectroscopy, and diffusion tensor imaging. Main outcomes and measures: Thalamic N-acetyl aspartate (NAA) mmol/kg wet weight, thalamic lactate to NAA peak area ratios, brain injury scores, and white matter fractional anisotropy at 1 to 2 weeks and death or moderate or severe disability at 18 to 22 months. Results: Among 408 neonates, the mean (SD) gestational age was 38.7 (1.3) weeks; 267 (65.4%) were male. A total of 123 neonates were inborn and 285 were outborn. Inborn neonates were smaller (mean [SD], 2.8 [0.5] kg vs 2.9 [0.4] kg; P = .02), more likely to have instrumental or cesarean deliveries (43.1% vs 24.7%; P = .01), and more likely to be intubated at birth (78.9% vs 29.1%; P = .001) than outborn neonates, although the rate of severe HIE was not different (23.6% vs 17.9%; P = .22). Magnetic resonance data from 267 neonates (80 inborn and 187 outborn) were analyzed. In the hypothermia vs control groups, the mean (SD) thalamic NAA levels were 8.04 (1.98) vs 8.31 (1.13) among inborn neonates (odds ratio [OR], -0.28; 95% CI, -1.62 to 1.07; P = .68) and 8.03 (1.89) vs 7.99 (1.72) among outborn neonates (OR, 0.05; 95% CI, -0.62 to 0.71; P = .89); the median (IQR) thalamic lactate to NAA peak area ratios were 0.13 (0.10-0.20) vs 0.12 (0.09-0.18) among inborn neonates (OR, 1.02; 95% CI, 0.96-1.08; P = .59) and 0.14 (0.11-0.20) vs 0.14 (0.10-0.17) among outborn neonates (OR, 1.03; 95% CI, 0.98-1.09; P = .18). There was no difference in brain injury scores or white matter fractional anisotropy between the hypothermia and control groups among inborn or outborn neonates. Whole-body hypothermia was not associated with reductions in death or disability, either among 123 inborn neonates (hypothermia vs control group: 34 neonates [58.6%] vs 34 [56.7%]; risk ratio, 1.03; 95% CI, 0.76-1.41), or 285 outborn neonates (hypothermia vs control group: 64 neonates [46.7%] vs 60 [43.2%]; risk ratio, 1.08; 95% CI, 0.83-1.41). Conclusions and relevance: In this nested cohort study, whole-body hypothermia was not associated with reductions in brain injury after HIE among neonates in South Asia, irrespective of place of birth. These findings do not support the use of whole-body hypothermia for HIE among neonates in LMICs. Trial registration: ClinicalTrials.gov Identifier: NCT02387385.

Tin Sulfide (SnS) is a promising absorber material for solar energy harvesting owing to the high absorption coefficient. Here, a novel inverted planar heterostructure of SnS based solar cell (ITO/NiOX/SnS/ZnO/Al) has been proposed for better efficiency among the different electron transport layers (ETLs), PCBM, C60, CeOX, and ZnO. The performance of the SnS based solar cell was theoretically studied by the Solar Cell Capacitance Simulator (SCAPS) software. Initially, we have been observed the device performance with different ETL materials to find the better ETL material. The layer parameters of the HTL, absorber layer, and ETLs have been optimized to find out the best performance of the device. The device showed efficiencies of around 26.44%, 26.33%, and 26.38% with the ETLs PCBM, C60, and CeOX respectively. The maximum power conversion efficiency (PCE) of ~28.15% has been observed after incorporating ZnO ETL in the designed architecture of the SnS-based solar cell. Then, we have been investigated the performance of the SnS-based solar cell with ZnO ETL for the various value of carrier concentration, thickness, and bulk defect of the SnS absorber layer, defect of the interfaces of NiOX/SnS and SnS/ZnO, back metal contact's work function, and its operating temperature. The variation of the different parameters has exhibited a substantial effect on the device performance. The VOC, JSC, FF, and PCE of the optimized SnS-based solar cell with ZnO ETL showed 0.8954 V, 37.316452 mA/cm 2 , 84.24%, and 28.15%, respectively. The visualization of the results indicates that ZnO might be a potential ETL for the highly efficient, low-cost inverted planar solar cells based on SnS.

Hepatitis C virus infection is an emerging problem for children and adolescents. Chronic HCV infection affects approximately 3.5–5 million children worldwide. Unaddressed HCV infection in children progresses to decompensated liver disease and hepatocellular carcinoma during adulthood. Early detection of HCV and the administration of appropriate antiviral therapy are required for the prevention of long-term morbidity associated with chronic HCV infection. The perinatal route is the most common source of childhood HCV infection. Anti-HCV positivity at or after 18 months of age necessitates an HCV-RNA assay after age 3 to recognize chronic HCV infection. Both anti-HCV and HCV-RNA positivity are the indications for antiviral therapy. At present, various combinations of oral, direct-acting antivirals (DAAs) have been approved for children above 3 years of age. Their efficacy is high. Apart from the effectiveness of DAA therapy, steps should be taken to screen pregnant women to prevent the transmission of viral infection from mother to child. To increase awareness about the mode of HCV spread, NAT-based tests in blood banks for better screening and making the DAAs available at a subsidized rate in the public sector are necessary to eradicate HCV infection.

Background/Aims Primary Sjogren syndrome (pSS) is a chronic autoimmune multi-system disease characterized by inflammation of exocrine glands, particularly the lacrimal and salivary glands, as well as multiple extra-glandular involvements. Treatment is often challenging, and until now, no disease-modifying anti-rheumatic drugs (DMARDs) have been approved for this condition. There is a lack of data about the efficacy of Janus kinase inhibitors in pSS. Here we report a patient with pSS successfully responding to upadacitinib. Methods A 68-year-old woman presented with pain in multiple joints for 16 years with intermittent use of NSAIDs. She had no low back pain and no self or family history of psoriasis or red eye. She denied dry mouth but required frequent water drinking during meals to aid swallowing and occasionally used artificial tears. MTX was started for her two-month articular flare and positive rheumatoid factor (RF). MTX caused severe vomiting and hyponatremia, and she was hospitalized. After the correction of hyponatremia, she was put on tofacitinib. We reevaluated the case when she came to us. She had grade 2-3 tenderness of most peripheral joints and was bedridden. Immunological parameters revealed RF 127 IU/ml (reference value <14), anti SSA antibody 147 U/ml (normal <3.2), anti SSB antibody 149 U/ml (reference value <8) and anti CCP antibody; ANA, anti-ds-DNA Ab were negative. There was no erosion on the X-ray hands. Schirmer's test was positive (3 mm bilaterally). Unstimulated salivary flow after five minutes was 0.04 ml/min (≤0.1 ml/min indicates salivary hypofunction). She fulfilled the 2016 ACR/EULAR classification criteria, and we diagnosed her with primary Sjogren syndrome. Hydroxychloroquine was initiated, but she discontinued it for anorexia. Considering her age, she was switched to upadacitinib, as European Medicines Agency restricted the use of tofacitinib beyond 65 years. Results Her EULAR Sjogren Syndrome's Disease Activity Index (ESSDAI) was six at baseline, indicating moderate disease activity. Her joint pain improved significantly within two months with infrequent use of pilocarpine in the sixth month. Six months after treatment with upadacitinib, ESSDAI came down to 2; the Patient's Global Assessment score was 02 and achieved STAR (Sjogren's Tool for Assessing Response) response 7 (STAR responder if score ≥5). Conclusion To our knowledge, this is the first case report on the efficacy of upadacitinib in pSS. Further high-quality clinical trials are required to confirm the benefit of upadacitinib in pSS. Disclosure M. Momen Majumder: None. S. Haq: None.

The primary objective of this study was to measure the influence of the current account balance (CAB) on foreign direct investment (FDI) in India’s economy by considering gross domestic product (GDP). As a result, India adopted economic liberalization in 1991 with the new policy support, and there appeared to be an increase in foreign direct investment in the country. The augmented Dickey–Fuller (ADF) test suggests the quantile regression (QR) method using time series data from 1975 to 2021. Moreover, the results indicate that gross domestic product and the current account balance have a positive impact on FDI. Because of the large volume of trade in India, the government should focus on the balance of payments and current account as a determinant of FDI. However, this study added value to existing literature with the best magnitude on foreign direct investment and international trade policy.

Cognitive behavioural therapy (CBT) has heightened the need for internet-delivered intervention for depression with chronic diseases than a traditionally-based treatment procedure, and the need for CBT as an internet-delivered intervention has increased because it scales down the stigma of proceeding to a therapist, saves travel time from different geographical areas, and increases access to the service. This study aimed to evaluate the contemporary evidence for the effectiveness of internet-delivered cognitive behavioural therapy (CBT) as a treatment option for depression with chronic illness (CVD, diabetes, chronic pain, cancer, and chronic obstructive pulmonary disease (COPD)) among adult populations in high-income countries. A systematic search strategy was devised based on selecting search terms, inclusion and exclusion criteria, and refinement processes. Electronic searches were conducted using databases related to healthcare and containing peer-reviewed literature: the Cumulated Index to Nursing and Allied Health Literature (CINAHL), the Excerpta Medica Database (Embase), the Medical Literature Analysis and Retrieval System Online (Medline), and PsycINFO. Key search terms were applied to all databases and combined using Boolean operators to maximise the efficiency of the search. This review included randomised controlled trials (RCTs) evaluating the adult population aged ≥18 years published from 2006-2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was employed to guide the review process. The initial search yielded 134 studies across all databases, which were refined, leading to 18 studies in the final review data set. This review suggests that internet-based CBT is an effective strategy for reducing depressive symptoms in patients with comorbid depression and chronic diseases.

Introduction: In reality, many Muslims have an intense spiritual urge to participate in fasting, even those who could get an exemption. There are many cultural variations in the Muslim population in different parts of the world, even in the same country with different social and family backgrounds. Thus, persons with diabetes should seek medical advice before planning to fast or proceed to fast during Ramadan. Materials: This was a narrative, non-systematic review of the international literature from the major medical online database (PubMed and Google Scholar) in 2023. The term “Ramadan fasting” and “Diabetes” was used to search, and the relevant literature was captured and narrated in a concise thematic account. Results: Practically, there are certain risks associated with fasting for patients with diabetes, which might exacerbate their existing illnesses. Along with the globally increasing prevalence of diabetes, there is an increased number of the population who intend to or fast. The article captured a wide array of topics related to Ramadan fasting by patients with diabetes, including its epidemiology, risk stratification, lifestyle modification, assessment of safety and efficacy profiles of pharmacotherapies, hypo or hyperglycemia, and the impact of diabetes education. Conclusion: Fasting with diabetes poses a range of risks and thus pre-Ramadan risk stratification is essential. Particular attention should focus on the patient’s current risk factors, complications, comorbidities, and the roles of newer antihyperglycemic medicines and advanced technology for safer fasting practices to mitigate the risks of hypoglycemia and or hyperglycemic crises. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 41-57

Introduction Diarrhoea is one of the leading causes of under-5 childhood mortality and accounts for 8% of 5.4 million global under-5 deaths. In severely malnourished children, diarrhoea progresses to shock, where the risk of mortality is even higher. At icddr,b Dhaka Hospital, the fatality rate is as high as 69% in children with severe malnutrition and fluid refractory septic shock. To date, no study has evaluated systematically the effects of inotrope or vasopressor or blood transfusion in children with dehydrating diarrhoea (eg, in cholera) and severe acute malnutrition (SAM) or severe underweight who are in shock and unresponsive to WHO-recommended fluid therapy. To reduce the mortality of severely malnourished children presenting with diarrhoea and fluid refractory shock, we aim to compare the efficacy of blood transfusion, dopamine and epinephrine in fluid refractory shock in children who do not respond to WHO-recommended fluid resuscitation. Methods and analysis In this randomised, three-arm, controlled, non-masked clinical trial in children 1–59 months old with SAM or severe underweight and fluid refractory shock, we will compare the efficacy of dopamine or epinephrine administration versus blood transfusion in children who failed to respond to WHO-recommended fluid resuscitation. The primary outcome variable is the case fatality rate. The effect of the intervention will be assessed by performing an intention-to-treat analysis. Recruitment and data collection began in July 2021 and are now ongoing. Results are expected by May 2023. Ethics and dissemination This study has been approved by the icddr,b Institutional Review Board. We adhere to the ‘Declaration of Helsinki’ (2000), guidelines for Good Clinical Practice. Before enrolment, we collect signed informed consent from the parents or caregivers of the children. We will publish the results in a peer-reviewed journal and will arrange a dissemination seminar. Trial registration number NCT04750070 .

Objective: There is a lack of established biological, psychological, social, and digital markers for the prediction, identification, and stratification of patients with major depressive disorder (MDD). We therefore aimed to evaluate serum nerve growth factor (NGF) in MDD patients. Methods: In this case-control study, we recruited MDD patients and age- and sex-matched healthy controls (HCs). A qualified psychiatrist evaluated study participants according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Serum NGF levels were analyzed using a commercially available enzyme-linked immunosorbent assay kit. Results: We analyzed data from 106 MDD patients and 88 HCs. Mean serum NGF concentrations were significantly higher in MDD patients (104.70 ± 6.43 pg/mL) than in HCs (72.09 ± 7.69 pg/mL). Receiver operating characteristic curve analysis revealed the good diagnostic performance of serum NGF in MDD. Conclusions: Higher serum NGF levels might be involved in MDD pathophysiology, and altered NGF levels may be an early warning sign of depression. The present findings will aid in the development of new and improved therapies for depressive patients. Further interventional studies are recommended to explore the underlying mechanisms, risk factors, disease course, and treatment responses of NGF in MDD.

Introduction: Tuberculosis (TB) is highly prevalent in Bangladesh. The affection of the central nervous system(CNS) is one of the most dangerous manifestations of extrapulmonary tuberculosis. This may take the form of either tubercular meningitis (TBM), tuberculoma, or spinal arachnoiditis. CNS tuberculosis (CNS-TB) carries high morbidity and mortality among all forms of TB. The diagnosis is difficult and often delayed due to the varied and non-specific presentation. Aside from clinical indicators, cerebrospinal fluid (CSF) diagnostic indicators include mononuclear pleocytosis, low sugar levels, and high protein concentrations. It is possible to confirm Mycobacterium tuberculosis in CSF using staining, culture methods, and molecular analysis, but it is difficult. Advanced radiological imaging techniques can often be very helpful in making presumptive diagnoses, but they do not always yield confirm diagnoses. Aim: In our case series, we aimed to highlight the spectrum of presentation of CNS tuberculosis, diagnostic challenges, and initial response to anti-TB drugs. Material and Methods: We report a case series of six patients with CNS tuberculosis admitted to the neurology department between 2022 and 2023. Four of them were prospectively reviewed and two retrospectively. Data on presentation, diagnostic workup, and treatment were analyzed. Result: We presented six cases of CNS TB from 2022 to 2023. Four cases among six had only TBM, two cases had concomitant intracranial tuberculoma and two cases had tuberculosis in the extracranial site. The most common presentation were fever, altered consciousness level, and constitutional symptoms. CSF study was done and revealed increased total protein in all six cases, lymphocytic pleocytosis in 66.67% of cases, a low sugar level in 50% of cases, and raised ADA level in 66.67% of cases. MTB was detected in a polymerase chain reaction (PCR) in one case and was none positive for AFB stain and culture. MRI with contrast showed meningeal enhancement in all six cases, hydrocephalus in 66.67% of cases, and infarction and tuberculoma in 33.33 % of cases. Brain biopsy for histopathological confirmation was not done. All of them had an anti-tubercular therapy and reported good clinical responses at 21-day-follow up. Conclusion: CNS TB should be diagnosed primarily based on compatible clinical features, morphological findings on brain MRI, and CSF findings. In Bangladesh, CNS TB should always be considered an important differential diagnosis in patients with prolonged fever and headache, as well as altered consciousness level, and treatment should be initiated immediately on the basis of strong clinical suspicion, rather than waiting for laboratory confirmation.

Background Universal screening for neonatal hyperbilirubinemia risk assessment is recommended by the American Academy of Pediatrics to reduce related morbidity. In Bangladesh and in many low- and middle-income countries, there is no screening for neonatal hyperbilirubinemia. Furthermore, neonatal hyperbilirubinemia may not be recognized as a medically significant condition by caregivers and community members. We aimed to evaluate the acceptability and operational feasibility of community health worker (CHW)-led, home-based, non-invasive neonatal hyperbilirubinemia screening using a transcutaneous bilimeter in Shakhipur, a rural subdistrict in Bangladesh. Methods We employed a two-step process. In the formative phase, we conducted eight focus group discussions with parents and grandparents of infants and eight key informant interviews with public and private healthcare providers and managers to explore their current knowledge, perceptions, practices, and challenges regarding identification and management of neonatal hyperbilirubinemia. Next, we piloted a prenatal sensitization intervention and home-based screening by CHWs using transcutaneous bilimeters and evaluated the acceptability and operational feasibility of this approach through focus group discussions and key informant interviews with parents, grandparents and CHWs. Results Formative findings identified misconceptions regarding neonatal hyperbilirubinemia causes and health risks among caregivers in rural Bangladesh. CHWs were comfortable with adoption, maintenance and use of the device in routine home visits. Transcutaneous bilimeter-based screening was also widely accepted by caregivers and family members due to its noninvasive technique and immediate display of findings at home. Prenatal sensitization of caregivers and family members helped to create a supportive environment in the family and empowered mothers as primary caregivers. Conclusion Adopting household neonatal hyperbilirubinemia screening in the postnatal period by CHWs using a transcutaneous bilimeter is an acceptable approach by both CHWs and families and may increase rates of screening to prevent morbidity and mortality.

Frozen shoulder, also known as adhesive capsulitis, is a condition featured by stiffness and pain in shoulder joint. In this report, we present a case of 58 years old diabetic male patient with the history of coronary artery bypass grafting (CABG) 06 months back. He presented with persistent right shoulder pain for 05 months. Clinical examinations reveal restriction of the right shoulder joint movement in all directions and wasting of the right supraspinatus, infraspinatus and trapezius muscles. Both active and passive range of motions was restricted with painful right shoulder joint. Pain free abduction range was about 40 degrees in right shoulder. Plain X-ray of right shoulder joint and other relevant investigations show normal findings. Considering the clinical and laboratory findings decision was taken to treat the patient with exercise, pain killer and ultrasound therapy which were found to be optimistic.

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by abdominal pain and altered bowel movements. This disorder affects up to 10–23% of people globally and can affect both children and adults. Therefore, it is important to uncover early and novel therapeutic biomarkers and also reveal the pathobiology mechanisms of IBS. The main goal of this study is to investigate the hub genes and putative molecular mechanisms in IBS. Firstly, we identified 73 mutual differentially expressed genes (DEGs) from three RNA-seq databases. Then, functional gene annotation and pathway analysis of these common DEGs were enriched with interferon signaling, interferon gamma signaling, antigen processing-cross presentation, adaptive immune system, cytokine signaling in immune system, type II interferon signaling (IFNG), notch signaling pathway, MAPK signaling pathway, and IL-4 signaling pathway. In addition, a total number of 9 hub genes discovered as candidates of potential therapeutic biomarkers of IBS pathogenesis. Furthermore, transcription factors and regulatory protein kinases were identified as key signature molecules linked with IBS pathobiology. Taken together, this current study provided a novel understanding of biological mechanisms of IBS and may provide promising therapeutic targets.