A systematic review of knowledge, attitude, practice and health impacts of self-medication among COVID-19 affected people in South Asia

The objective of this study was to assess the knowledge, attitude and practice of self-medication and its health impact among South Asian people. This systematic review was conducted at the Department of Public Health, under the Faculty of Health Sciences of University of Sunderland, United Kingdom (UK) during December 2020 to December 2022.For this study, a comprehensive literature review was conducted on the knowledge, attitudes, and behaviors of self-medication among COVID-19-affected adults aged 18 and older in South Asian nations The design of this review was completed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA). Critical Appraisal Skills Programme (CASP)-2019 were used to identify the methodological problems in each individual study report. In this systematic review ten qualifying studies were examined with a total of (n=5137) study subjects. Among the study subjects, 2211 (43.04%) COVID 19 afflicted People had enough knowledge of self- medication followed 2001 (38.95%) COVID19 affected people in South Asia had a favorable attitude toward self-medication, 2906 (56.56%) people had performed self-medication and 206 (4.01%) had adverse impacts on their health. Bangladesh and India had the greatest and lowest rates of self-medication, 88.3% and 17.9%, respectively. In addition, the greatest rate of self-medication was seen among medical students in Pakistan (83%). This study investigated that during the COVID-19 Pandemic, self-medication was very common, with over half of the study population engaging in it. Therefore, it is vital to enhance the public awareness about the adverse effects of self-medication without having proper knowledge.

Expression of isocitrate dehydrogenase-1 in glioblastoma, Bangladesh perspective

Background: Glioblastoma is the most frequent malignant brain tumor in adults. Various studies have identified IDH (isocitrate dehydrogenase) mutation as a hallmark genetic alteration in glial tumors. The World Health Organization (WHO) has classified glioblastoma based on IDH mutation status, including IDH-mutant glioblastoma, IDH-wildtype glioblastoma along with its variants and glioblastoma, NOS (not otherwise specified) (where IDH mutation status cannot be evaluated). Methods: It was a cross-sectional observational study, conducted on 35 histologically diagnosed cases of glioblastoma, within the period of March, 2018 to December 2019. Results: Among the 35 glioblastoma cases, 6 (17.14%) were found to be IDH-mutant (positive for IDH1 immunostain), while the remaining 29 cases were negative for IDH1 immunostain (therefore designated as IDH-wildtype glioblastoma). In the IDH-mutant group, 3 out of 6 patients were in the younger age group (?40 years). On the other hand, IDH-wildtype glioblastoma was more common in elderly and most frequent was in the age group of 51-60 years (11 out of 29 cases). Conclusions: In this study, IDH1 expression was observed in 17.14% of all glioblastoma cases (designated as IDH-mutant glioblastoma). Whereas, most (~82.86%) of the glioblastoma cases did not express IDH1 (designated as IDH-wildtype).

Urothelial carcinoma of urinary bladder with histologic grading: a study in a tertiary care hospital, Bangladesh

Background: Urinary bladder cancer is one of the most common forms of all cancers in the world. It is the ninth leading cause of death from cancer among men. The incidence of urinary bladder cancer in Bangladesh is increasing day by day. The aim of the study was to evaluate different clinic-pathological parameters of urothelial carcinoma of urinary bladder with the grade of the tumor. Methods: This study was a cross sectional study done over a period of two years, from March 2018 to February 2020 at the department of pathology, Dhaka medical college, Dhaka. Total 73 samples were collected, fixed overnight in 10% buffered formalin and stained with hematoxylin and eosin staining. Pathological grading was confirmed and different clinic-pathological parameters were evaluated. Results: Most of the cases (22 cases, 30.1%) were found in the fifth decade (51-60). Mean age of the patients was found to be 60.85 (±12.72) years, 58 (79.5%) cases were male and 15 (20.5%) cases were female with male to female ratio of 3.9:1. Most of the cases (49 cases, 67.1%) were smokers. Most common clinical presentation was hematuria (91.8% cases), most frequent tumor location was the lateral wall of the urinary bladder and 75.3% cases were reported as high-grade urothelial carcinoma. Conclusions: Different clinic-pathological parameters with histologic grading were evaluated in this study which may have a significant impact in epidemiology, diagnosis and assessment of biological behavior of urothelial carcinoma.

Evaluation of mucin histochemistry in relation to p63 expression in nodular hyperplasia and adenocarcinoma of prostate

Background: Prostate cancer is a leading cause of death in men. Nodular hyperplasia and adenocarcinoma are common causes of prostatic enlargement. Diagnosis of these lesions on routine biopsies can be difficult for pathologists. Immunohistochemical stain p63 can help, but it is costly and not widely available. The present study aimed to evaluate the usefulness of mucin histochemistry in relation to p63 expression in differentiating nodular hyperplasia and adenocarcinoma of prostate. Methods: This study was conducted in the department of pathology at Dhaka medical college from July 2018 to June 2020. 50 cases of prostatic lesions (25 NHP and 25 adenocarcinoma) were examined using histomorphology. The sections were stained with periodic acid Schiff (PAS) to identify neutral mucins and Alcian blue (2.5 pH) to identify acidic mucins. Additionally, p63 antibody was used in immunohistochemistry. Results: NHP showed positivity for neutral mucin (96% with PAS stain) but not for acidic mucin (Alcian blue stain), while prostatic carcinoma showed positivity for both neutral mucin (28%) and acidic mucin (44%). The grade group 1 tumors of prostatic carcinoma showed 100% positivity for acid mucin, with a decrease in Alcian blue staining as the grade increased. P63 was positive in 100% of NHP cases and negative in 100% of prostatic carcinoma cases. Conclusions: Positivity for acidic mucins with Alcian blue stain can be a helpful diagnostic tool to differentiate well differentiated adenocarcinomas from benign lesions where facility for p63 immuno-stain is not available and poor people who cannot afford the cost of immunohistochemistry.

Diagnosis of cervical lesion by colposcopy, VIA, pap smear tests, and their correlation with histopathology in a tertiary level laboratory in Chattogram, Bangladesh

Background: Cervical carcinoma is one of the most common causes of mortality among women. This mortality rate can be reduced by early detection of cervical neoplasm by different screening tests. The main objective of this study was to diagnose cervical diseases by colposcopy, by pap smears for cytological examination as well as correlate these findings as screening tests with histopathological diagnosis. Methods: In this cross-sectional observational study, total 143 cases were included. History was taken and clinical examination was done. Colposcopy and VIA test was done, pap smear sample was collected and reporting was made. Cytological findings were correlated with histopathology. Results: Mean age of the study cases was 41.2±11.5 years. VIA test was positive in 98 study cases (68.5%). On colposcopy, most of the cases show neoplastic proliferation (80 cases, 55.9%). Among them, most cases were diagnosed as cervical intraepithelial neoplasia-I (CIN-I). Sixty-three (63) cases (44.1%) were non-neoplastic. Most of the biopsies was diagnosed histopathologically as cervical intraepithelial neoplasia-I (CIN-I) (20 cases, 14.0%). Association of colposcopy findings with histopathological diagnosis was done which was significant. Sensitivity of diagnosis of cervical malignancy by colposcopy was 33.33% and specificity was 98.57%. Conclusions: The study provides good cyto-histopathology correlation in detecting different cervical lesions and malignancy with colposcopy. Although colposcopy sensitivity was low but it can be increased by adequate training and avoiding technical errors. Bethesda system is strongly recommended for adequacy of sampling to minimize inconsistency. Early and regular screening should be advised for reduction of mortality rates from cervical carcinoma.

Assessment of Arsenic (As), Lead (Pb) and Chromium (Cr) Accumulation in Different Organs of Commercially Important Fish Species Collected from Chattogram Coastal Region of Bangladesh.

Aims: The purpose of this study was to evaluate whether there are any significant toxic effects of the widely exposed metals on different organs (gill, liver, kidney, and muscle) of some commercially important marine fish species (Herpodon nehereus, Pampus chinensis and Hilsa ilisha). Study Design: The collection of the samples was done from January to March 2018 from Bay of Bengal near Chattogram city of Bangladesh. The study is based on randomly collected samples from the intended sampling sites (Randomized Block Design) to ensure the evenness and unbiases of the collected samples. Methodology: Analyses were performed for metals such as arsenic (As), lead (Pb) and chromium (Cr) using Atomic Absorption Spectrophotometer (AAS). During each month, five individuals each with three replications from the three targeted species were collected, with a total of 135 (45*3) fishes in the study period. Results: The concentrations of the metals found in the fishes varied in the following ranges: As: 0.029-0.071 ppm, Pb: 0.008-0.083 ppm and Cr: 0.0001-0.03 ppm. The obtained result revealed the highest concentrations of all three metals were recorded in H.nehereus fish. The organ wise lead concentration was recorded highest in kidneys and gills of examined fishes with significant variation in muscles and liver. The scenario depicted quite differently in case of chromium where concentration in gills was found to be the highest with insignificant variation in accumulation in other three organs. In case of Arsenic, kidneys and livers were the most exposed two organs in comparison to significant exposure to muscles and gills. The obtained values of arsenic accumulation were considered critical for human consumption as it was higher than the recommended values stated by WHO and FAO; but the concentration of lead and chromium were found to be safe for human consumption. The values recorded for lead were increasingly approached to the safety values. Conclusion: So, crucial steps should be taken regarding safety and environmentally friendly discharge of arsenic and lead; high levels of pollution will not only affect aquatic life but will also invite socio-economic disasters.

A Comparative Study of Oral Ivermectin and Topical 5% Permethirn Cream in the Treatment of Scabies in Patient Suffering from Diabetes Mellitus.

Scabies is one of the commonest diseases among all age groups. Topical permethrin is a widely used treatment option for scabies. Ivermectin is a newer oral agent for the treatment of scabies. This study was done to compare the efficacy of permithrin and oral Ivermectin in the treatment of Scabies in patient suffering from Diabetes mellitus. This comparative clinical trial was carried out in the outpatient department of Dermatology & Venereology, Diabetic Association Medical College Hospital (DAMCH), Faridpur from January 2012 to December 2012. A total 60 cases were enrolled purposively and divided into 2 groups. Group I received 2 doses oral Ivermectin and group II treated with 5% permethirn cream. Patients were followed up at the 3rd and 4th week. Total 86.6% patients of Ivermectin group and 90% of permethrin group were cured. Though permethrin showed somewhat more effective, the difference was not statistically significant. The study found that both ivermectin and permethrin were similarly effective in the treatment of scabies in patients suffering from Diabetes Mellitus.

Association of dietary fiber with high sensitivity C-reactive proteinin type 2 diabetes mellitus.

Introduction: Hs-CRP is a nonspecific marker of the inflammatory response has been associated with development of type 2 diabetes mellitus. Cardiovascular disease is a major consequence of diabetes. DM confers a 2-4 fold rise in cardiovascular risk compared with general population. One of the many modifiable risk factors for both cardiovascular disease and diabetes is diet. Fiber is an important dietary factor that may modify the risk of both diseases. Material & methods: The current study is an attempt to explore the association of dietary fiber on inflammatory marker, hs-CRP in type2 diabetic subjects. Total 80 diabetic subjects were included in this study of which 40 were taking more dietary fiber and 40 were taking relatively low dietary fiber. Serum hs-CRP was measured by chemiluminescent immunometric assay (DPC Biermann Gmbh., Germany). Nutrient information was calculated using a pretested food recall questionnaire prepared by nutritionists for usual Bangladeshi food articles. Results: Hs-CRP was significantly higher in subjects taking low dietary fiber. There was significant negative correlation between CRP of subjects taking high and low intake of dietary fiber. Conclusion: So, low dietary fiber consumption maybe a possible causal factor of raised CRP. Type 2 diabetic patients who took less dietary fiber in their diets had elevated blood CRP levels.

Outcome of management of differentiated thyroid carcinoma.

A prospective study was done on 93 cases of differentiated thyroid carcinoma to find out the outcome of management according to the protocol followed in the Department of ENT-Head and Neck Surgery of Bangabandhu Sheikh Mujib Medical University Hospital. Here Papillary carcinoma is more common (76.35%) than follicular carcinoma. Papillary carcinoma affected in the younger patients more commonly than the follicular carcinoma with a mean age of 34.37years (SD=12.81) for papillary carcinoma and 44.93 years (SD=16.01) for follicular carcinoma; but age as a risk factor showed no significant difference between two histological types (p>0.05). Female was the predominant sex with a ratio of 3.04:1. In this series majority of patients were categorized as high risk group (75.27%). There is strong association between histological type & risk group (P<0.05). High risk group is more common in follicular carcinoma (95.45% Vs 69.01%). There was a significant differences between the two histological types for extrathyroidal extention and distant metastasis as risk factors (p<0.01 and p<0.001); but tumour size and lymphatic metastasis showed no significant difference (p>0.05). All low risk patients were treated by hemithyriodectomy followed by life long thyroxine. All high risk cases were treated with total thyroidectomy with (35.71%) or without (62.86%) different types of neck dissection (according to the degree of lymph node involvement) followed by radioiodine ablasion and lifelong thyroxine therapy routinely. Overall rate of complication of thyroid surgery was 23.08%. The commoner complications were vocal cord palsy (5.5%), hypoparathyroidism (5.5%) and haemorrhage (4.4%). Less common complications were laryngeal oedema (2.2%), wound infection (2.2%), tracheal injury (1.1%) and death (2.2%). Many cases lost to follow up. Sixty seven cases (73.64%) responded well for follow-up. Mean duration of follow up was 3.40 years (SD=1.41). There was recurrence in thyroid remnant in 9.09% of hemithyroidectomy cases and were treated by completion thyroidectomy followed by radioiodine ablasion. Regional lymphatic metastasis was seen in six cases and was treated by different types of neck dissection. Recurrence at distal site was seen in 4 cases (18.18% of follicular carcinoma). These were treated by radioiodine ablation; two of them died during the period of follow-up.

Prevalence of psychiatric ailments among patients with sexually transmitted disease.

A cross-sectional descriptive study conducted on 250 sexually transmitted disease patients was carried out in two teaching institutes and their tertiary hospitals. These subjects constitute a special group of population for psychiatric diagnosis by using Structured Clinical Interview for Diagnostic and Statistical Manual IIIR. The study was done in the dermatology and venereology outpatient department of two tertiary hospitals of Dhaka, between January 1998 and January 1999. The findings show that 34% of total sexually transmitted disease patients had psychiatric disorders. Anxiety disorders (11.2%) were found to be the most common disorder among these psychiatric patients; this was followed by depressive disorder (8.4%), psychoactive substance use disorder (6.8%), sexual dysfunction (6.8%), bipolar mood disorder (0.4%), and schizophrenia (0.4%). Four percent of anxiety disorder was associated with psychoactive substance use disorder and sexual dysfunction. Similarly 3.6% of depressive disorder was found with psychoactive substance use disorder and sexual dysfunction while 1.6% of sexual dysfunction was associated with substance use disorder. Most of the patients in the sexually transmitted disease population recruited in the present study had both anxiety disorder and depressive disorder though majority of them were undetected and untreated. These findings underscore that special attention needs to be given to the mental health component of our health care delivery system.

Intravesical adjuvant therapy using mitomycin C.

Bladder cancer is mostly superficial at first diagnosis. High incidence of recurrence is the major problem after initial management with transurethral resection (TUR) of bladder tumor. Adjuvant chemotherapy has been advocated to reduce the incidence of recurrence. A study was carried out to observe the efficacy of intravesical adjuvant therapy with single immediate versus delayed multi-dose regimen of Mitomycin C (MMC) in preventing recurrence of superficial bladder cancer. One hundred Patients having intermediate risk superficial bladder cancer were randomized into two equal groups. All patients were followed carefully. Total duration of follow-up was minimum 12 months, maximum 36 months, mean 29 months. No recurrence was seen on 3(rd), 6(th) and 9(th) month of intravesical therapy. As much as 94% and 96% of recurrence free rate was observed in immediate single and delayed multi-dose group respectively on 12(th) month; 86% and 84% on 18(th) month; 74% and 72% on 24(th) month; 70% and 68% on 36(th) month of follow-up cystoscopy respectively. Efficacy of post transurethral resection of bladder tumour (TURBT) MMC single immediate dose was found similar to that of MMC delayed multi-dose regimen in preventing the recurrence of intermediate risk superficial bladder transitional cell carcinoma (TCC) in the study. The difference between the two groups insignificant (p>0.05).

Trend of selected risk factors for hepatitis B infection among the drug addicts in Bangladesh: a five year statistics.

The present retrospective study was conducted by review of records of last five years from 1996 to 2000, among 1497 drug addicts, admitted in a selected drug addicts treatment centre in Dhaka, with an aim to find out the trend of occurrence of hepatitis B infection among the drug addicts, as well as the trend of the risk factors. It was found from the study that during the period of five years, among the total drug addicts, sixty-nine addicts were found to be hepatitis B positive as determined by HBsAg status. The main contributing risk factors were found to be history of exposure to the commercial sex workers (CWS), injecting drug use (IDUs) and needle sharing. It was also found that the trend of hepatitis B infection was gradually falling down among the drug addicts probably due to reduction of the risk factors, especially the injection of drugs. It can be recommended that as a considerable portion of (NUDS) have shown evidence of hepatitis B infection, especially those who were using and sharing needles with others. Therefore, for protecting them from this dreadful infection, drug addicts should be counseled to avoid the above high risk behavior.

Necessity of antibiotics prophylaxis during extracorporeal shock wave lithotripsy.

A total of 360 patients with renal and ureteral calculi who had sterile urine before extracorporeal shock wave lithotripsy (ESWL) and did not have any increased risk of infection received Tab.Ciprfloxacin (500 mg) 12 hourly for the next 5 days or no prophylaxis were included in this prospective study. Patients were followed by urinalysis and culture together with clinical evaluations. In antibiotic prophylactic group 10 (6.4%) had post ESWL urine culture positive while in without prophylaxis 13 (8.8%) had positive urine culture. The incidence of urinary tract infection after ESWL is extremely low, provided that patients have sterile urine before the procedure.

A case report on Klinefelter syndrome.

An 18 year old boy presented with small genitalia, failure of eruption of secondary sex hairs, female like voice with eunachoid body habitus, bilateral gynecomastia, infantile external genitalia, small testes and poorly developed musculature. He was diagnosed as a case of 47XXY Klinefelter syndrome on the basis of hormone assay and karyotyping. He has given androgen replacement therapy with the aim to relieve symptoms of androgen deficiency, to reproduce physiological levels of plasma testosterone and to prevent long term consequences of androgen deficiency.

Tuberous sclerosis.

Tuberous sclerosis - also called tuberous sclerosis complex (TSC) - is a rare, multi-system genetic disorder affecting cellular differentiation & proliferation, which results in hamartoma formation in many organs. The classic triad of clinical features comprises mental retardation, epilepsy & skin lesion, but these three features are not always present. Mrs. Jahanara Khatun, a 30 years old lady presented with maculo-papular skin lesions over the face, neck, shoulder since her six years of age, a lump in the right lumber region for four years, pain in the right lumber region associated with passage of blood clot in urine for 15 days. Her family history was very characteristic. One of her elder brother had developed same type of skin lesions. Again her 13 years old daughter had developed same type of skin lesions since seven years of age & she was mentally retarded. Clinical examination revealed normal mentation, pin head sized yellowish red translucent discrete waxy papules situated in the face, neck, shoulder. A large tender firm irregular mass in the right lumber region, which was ballotable & moved with respiration. USG revealed bilateral retroperitoneal masses with the involvement of right kidney & formation of renal artery aneurysm. The patient undergone right sided nephrectomy & histopathology of the specimen showed features suggestive of renal angiomyolipoma. The patient was diagnosed as a case of definite tuberous sclerosis complex as she had two major feature of revised diagnostic criteria - facial angiofibromas & renal angiomyolipoma.

Colonic perforation due to necrotizing amoebic colitis.

A seriously ill woman with the history of fever for 14 days and severe pain in abdomen with frequent passage of blood and mucous mixed loose stool for 11 days was admitted in the Surgery Unit-3 of Mymensingh Medical Collage Hospital. On examination the patient was toxic, moderately anaemic and dehydrated and there was diffuse abdominal tenderness with a palpable tender cystic intra abdominal lump in right lower abdomen. Fluidthril was present with absent bowel sound. Digital rectal examination revealed bulged anterior rectal wall. X-ray abdomen revealed multiple gas and fluid leveled loops of intestine with increased haziness of the film. On emergency laparotomy it revealed huge amount of faecal matter with fluid in peritoneal cavity. The greater omentum was adherent to caecum with multiple friable necrotic areas in the caecum, transverse and splenic flexure of the colon with multiple small perforations, Subtotal colectomy and end to end anastomosis was done. Histopathological examination of the resected gut revealed features compatible with amoebic ulcer perforations. On 13th post operative day the patient was discharged without any post operative complication and in the 1st follow up after one month the patient was found without any complication.

Branchial cleft anomalies--a study of 20 cases.

Preauricular sinus, branchial cyst, branchial sinus and branchial fistula are the result of incomplete obliteration of branchial clefts. Classically these lesions have particular sites and nature. The aim of this three years retrospective study was to see the prevalence of these conditions as well as the outcome of the conventional surgery. Twenty cases of branchial cleft anomalies were reported, of which 60% had with preauricular sinus. One case with preauricular sinus had recurrence during postoperative follow-up.