Association of plasma fibrinogen level with the severity of obstructive sleep apnoea patients in a tertiary care hospital

Background: Obstructive sleep apnoea syndrome (OSAS) is a common sleep-related breathing disorder of multi-risk factorial pathogenesis and is characterized by recurrent, partial or complete upper airway obstruction resulting in intermittent hypoxia during sleep. It has been implicated in both cardiovascular and cerebrovascular diseases. Objective of the study was to determine the association of Plasma Fibrinogen levels with the severity of OSA patients in a tertiary care hospital. Methods: This cross-sectional observational study with group comparison was conducted among all the patients attending in the Department of Respiratory Medicine, BSMMU with suspicion of OSA within one year after the clearance of institutional review board (IRB) using STOP-BANG questionnaire and Epworth sleepiness scale (ESS) and confirmed by polysomnography. Plasma fibrinogen was measured in all OSA and non-OSA patients. Data were analyzed with the help of statistical package for the social sciences (SPSS) version 26. Results: Sociodemographic analysis found no significant differences in age, gender, area, occupation, or smoking between OSA and non-OSA groups (p>0.05). However, witnessed apnoea (p=0.002), breathlessness (p=0.005), higher ESS (p<0.001), and STOP-Bang scores (p<0.001) were associated with OSA. Plasma fibrinogen levels were significantly higher in OSA (319.2±63.7 mg/dl versus 242.5±20.33 mg/dl, p<0.001), positively correlating with AHI (r=+0.876, p=0.001). Positive correlations were also found between fibrinogen levels and daytime sleepiness (r= +0.393, p=0.002), waist circumference (r =+0.346, p=0.007), and BMI (r =+0.297, p=0.021) in OSA patients. Conclusions: In conclusion, this study establishes a notable connection between plasma fibrinogen levels and the severity of OSA. Elevated fibrinogen levels correlate with increased OSA severity, indicating a link between OSA, inflammation and coagulation.

Association of serum alpha-1 antitrypsin level with the severity of COPD

Background: Alpha-1 antitrypsin deficiency (AATD) is a hereditary disorder linked to early onset COPD, notably the emphysema variety, but often goes undetected. Low serum AAT levels may impact lung function and correlate with COPD severity. The aim of the study was to detect possible associations of serum AAT level with the severity of COPD patients on the basis of post bronchodilator FEV1 in Bangabandhu Sheikh Mujib Medical University (BSMMU). Methods: A cross-sectional study was conducted at the Department of Respiratory Medicine, BSMMU, Dhaka, from October 2022 to September 2023. Adult patients (?18 years) of both genders diagnosed with COPD based on spirometry were included. COPD was defined per GOLD guidelines, with a post-bronchodilator FEV1/FVC ratio <70%. Severity was categorized based on post-bronchodilator FEV1% predicted. Association between serum AAT level and COPD severity was analyzed using SPSS version 26, with significance set at p <0.05. Results: The study involved 80 COPD patients, with 1.25% showing low serum AAT levels and 98.75% normal. No significant differences in age, sex, or smoking status were observed among severity groups. Mean serum AAT levels varied across severity groups but were not statistically significant (p=0.377). Smoking was prevalent (66.3%), with common comorbidities like hypertension (26.3%), IHD (16.3%), and diabetes mellitus (15.0%). Shortness of breath (95.0%) and cough (92.5%) were common symptoms, with most patients having moderate disease severity (42.5%). Conclusions: The study indicates a weak association between serum AAT levels and COPD severity, with only 1.25% of 80 patients exhibiting low AAT levels.

Association of obesity with the clinical severity of COVID-19 among hospitalized patients in a tertiary care hospital in Bangladesh

Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is increasingly drawing worldwide attention. Among multiple risk factors, obesity is one of the factors that can influence the disease severity. This study aimed to explore the impact of obesity on the severity of COVID-19 infection. Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka from September 2020 to February 2021. The Adult (Aged ?18 years) patients of both genders, who were COVID-19 positive, were included in this study. Ninety-one COVID-19 patients with BMI?25 kg/m2 were set as case and another ninety-one patients with BMI<25 kg/m2 were selected as control. The patient's BMI and waist circumference (WC) were recorded. Disease severity was evaluated by the management of COVID-19 disease guidelines by the World Health Organization (WHO) 2020. Results: The maximum patients were male (65.38%), in the sixth and seventh decades. The proportion of severe illness was higher in the obese group 69.2% compared to the non-obese 47.3%. Patients with obesity require more ICU support (15.4% versus 5.5%) and invasive mechanical ventilation (9.9% versus 2.2%) compared to non-obese patients. In multivariate logistic regression analysis, after adjusting age, diabetes mellitus, and hypertension, obesity (BMI>25 kg/m2) was an independent risk factor for severe illness. Conclusions: Obese patients are associated with severe COVID-19 pneumonia. As BMI increases, disease severity increases, needs more ICU support, and needs more invasive mechanical ventilation.

Usefulness of pleural fluid cholesterol in the diagnosis of tuberculous pleural effusion

Background: Tuberculous pleural effusion (TPE) is the most common etiology of exudative pleural effusion in high tuberculosis burden countries like Bangladesh. The usefulness of pleural fluid cholesterol for the diagnosis of TPE is not evaluated yet. This study aimed to assess the usefulness of pleural fluid cholesterol for the diagnosis of TPE. Methods: This cross-sectional study was conducted at the department of respiratory medicine at Bangabandhu Sheikh Mujib medical university. A total of thirty-five TPE was included in this study. Pleural fluid aspiration followed by cytological (total count, differential count), and biochemical (protein, glucose, lactate dehydrogenase, adenosine deaminase, and cholesterol) investigations were done. At the same time, blood was sent for biochemical (protein, glucose, and lactate dehydrogenase) investigation. Pleural biopsy followed by a histopathological examination was done to confirm TPE. Ethical clearance was obtained from the institutional review board (IRB) prior to starting this study. Results: In our study, the mean age of the participants was 35.54±14.13 years, and male predominant (74.3%). The mean pleural fluid cholesterol was 99.87±23.82 mg/dl. With a cut of value 69.85, the sensitivity, specificity, and accuracy were 97.14%, 57.14%, and 77.14% respectively. Conclusions: Pleural fluid cholesterol has significant diagnostic usefulness for the diagnosis of tuberculous pleural effusion.

A study on demographical, clinical-radiological, and histopathological profile of bronchial carcinoma in a tertiary care hospital in Bangladesh

Background: Bronchial carcinoma has different demographical, clinico-radiological, and histopathological profiles depending on the environment, gender, and racial group. The purpose of this study was to explore the sociodemographical, clinical, radiological, and histopathological patterns of bronchial carcinoma in Bangladesh. Methods: This cross-sectional descriptive study was conducted at the respiratory medicine department of Bangabandhu Sheikh Mujib Medical University (BSMMU). The study period was one year from January 2021 to December 2021. Our study documented socio-demographic patterns, smoking habits, history of COPD, clinical features, radiological findings, histopathological patterns of the tumor, and participants' performance status. Results: One hundred histopathologically confirmed patients with bronchial carcinoma were included in this study. The mean age of the participants was 59.57±10.41 years. The majority of the participants were in the 5th and 6th decade, 35% and 34% respectively. Smokers were 80% in our study. The presenting complaints were cough (87%), shortness of breath (61%), and chest pain (58%). Mass lesions (83%) followed by collapse (8%) were the most common imaging findings. Adenocarcinoma (48%) and squamous cell carcinoma (35%) were the predominant histological types. Conclusions: The histopathological profiles of bronchial carcinoma are changing and adenocarcinoma is becoming the predominant type in Bangladesh.

PCR for mecA Gene of Methicillin Resistant Staphylococcus Aureus.

The study was under taken to detect mecA gene of methicillin resistant Staphylococcus aureus (MRSA) by PCR. It was carried out in the department of Microbiology, Mymensingh Medical College in collaboration with the Department of Medicine under the Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh between the periods from July 2006 to June 2007. A total of 40 S. aureus strains were used in this study. Isolates of S. aureus were identified by standard microbiology technique and their antimicrobial susceptibility test was done by disk diffusion method according to NCCLS. Minimum inhibitory concentration (MIC) of oxacillin was determined for all isolates by standard agar plate dilution method. All strains were tested for mecA gene by PCR. Out of 40 S. aureus strains 15(37.5%) were detected as MRSA by disk diffusion and agar dilution method but 10(25%) yielded mecA gene by PCR. Detection rate of MRSA by disk diffusion and agar dilution test showed significant difference to that by PCR (p<0.001).

A case of renal transplantation.

A 12-year-old boy was admitted in paediatric nephrology unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) with massive proteinuria, hypertension, respiratory distress and anaemia and diagnosed as nephrotic syndrome. Percutaneous needle biopsy was consistent with diffuse endocapillary proliferative glomerulonephritis and initially managed conservatively with injection methyl prednisolone, cyclophosphamide, lisinopril etc. without any improvement. Living-related renal transplantation was done successfully from paternal uncle. Two episodes of acute rejection occurred, one immediately after transplantation and another after one month. These were managed with IV methyl prednisolone for 3 days. At present, he is on oral prednisolone, cyclosporine, azathioprine and antihypertensives with normal haemoglobin and stable serum creatinine level (pre-transplant level 12.5mg/dl to post-transplant level 1.5mg/dl). He has been maintaining his normal life including schooling for last few months. It is concluded that a patient with uncommon presentation of nephrotic syndrome should be confirmed by renal biopsy and renal transplantation may be considered if conservative measures fail.

Impact of etiology of chronic renal failure on growth in children.

A prospective study was carried out in the Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from October, 2001 to October, 2003 to find out the impact of different etiology of chronic renal failure on growth in children. Fifty children of both sexes under 15 years of age with clinical and biochemical evidence of chronic renal failure (CRF) with creatinine clearance (Ccr) of <75 ml/min/1.73m2 were included in the study. On the basis of underlying causes of CRF, the children were divided into congenital (n=30) and acquired (n=20) groups. All patients' height, weight, radiographs of different bones was obtained to evaluate the presence of renal osteodystrophy (ROD) and for assessment of bone age. Serum intact parathormone (iPTH) level was also assayed in all patients. These parameters were evaluated in two groups. CRF children due to congenital anomalies had stunting and wasting in 23 (76.7%) and 20 (66.7%) cases respectively and the difference between two groups was highly significant (P<0.001). Alkaline phosphatase (467.70+/-218.55 U/L) and iPTH (91.43+/-33.42 pg/ml) were also significantly higher in the congenital group (P<0.001 and P<0.05 respectively). Radiographic features of ROD were present in 15 (50%) cases in congenital group in comparison to 4 (20%) in acquired group and the growth zone lesion was the commonest type of ROD in congenital group (66.7%). CRF should be diagnosed as early as possible to maintain growth potential.

Diagnosis of human rotavirus in stool specimens: comparison of different methods.

A total of 345 stool specimens of hospitalized children below 5 years of age with acute gastroenteritis were tested for the presence of rotavirus by Polyacrylamide gel electrophoresis (PAGE), a monoclonal antibody based enzyme immunoassay (EIA) and a latex agglutination test (LAT). Detection rate for PAGE and EIA were 24.9% (345/86) and 20.9% (345/70) respectively. Using PAGE as the standard, the sensitivity and specificity of EIA were 75.6% and 98.1% respectively. The sensitivity of LAT was 70.9% with 100% specificity (LAT was done in only PAGE positive specimens). LAT appeared as the simplest and economic for both bed side and field use.

Electrophoretic patterns of human rotavirus strains prevailing among hospitalized children with acute gastroenteritis.

Polyacrylamide gel electrophoresis (PAGE) and silver staining was applied to detect rotavirus dsRNA from acute diarrheic stool of 365 hospitalized children below 5 years of age. The study was conducted at Mymensingh and Sunamgonj districts, Bangladesh from January 2002 to February 2003. Among 345 stool specimens tested, 86 (24.9%) were positive by PAGE. The rate of infection was highest in 0-12 months of age and declined significantly with increasing age. Males were slightly more infected than females and infection rate was more in winter. Twelve different electropherotypes were identified, of them eight were long and four were short. RNA profiles of the analyzed specimens, 88.6% were long and 11.4% were short patterns. Two of these long patterns (2F N 1 L, 2F N 3(U) L) circulated through out the study period and a single type was predominant (2F N 1 L). Mixed electropherotypes were also detected. Electropherotyping technique can be applied routinely to study the prevalence and epidemiological features of rotavirus infection. It is an excellent method for studying genomic variation, tracing mixed infections, detecting atypical rotaviruses lacking group-antigen and characterizing virus strains in outbreaks.