Evaluation of Serum CA 19-9 as a Diagnostic Marker for Pancreatic Malignancy.

In biliary-pancreatic malignancy, the serum CA 19-9 is considered as a tumor marker. Its high level may indicate the presence of a malignant disorder, but it can also be raised in benign conditions and also in malignancies from other organs. The value may be normal even in malignant condition. This comparative study was conducted in the Department of Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from 1st June 2016 to 31st May 2017 to determine the sensitivity and specificity of CA 19-9 as a tumor marker in pancreatic malignancy in our perspective and to establish a cut-off value of CA 19-9 which might prove as a definitive indication of pancreatic malignancy. We found that when the cut off value of CA 19-9 is 38 U/ml (according to ROC curve), the sensitivity, specificity, PPV and NPV were 77.8%, 77.8%, 77.8%, 77.8% respectively. And if the serum CA 19-9 threshold was raised to 100 and 120 to diagnose pancreatic cancer, sensitivity became 72.2% and 66.7% and NPV 76.2% and 73.9% respectively. However, the specificity increased to 88.9% and 94.4% and the PPV increased to 86.7% and 92.3% respectively.

Knowledge, Attitude and Practice of Undergraduate Medical Students of Bangladesh Regarding COVID-19 and its Vaccination.

Medical students are one of the socially active, reliable, and persuading population of information, prevention and control, and incentive of vaccination to stop the current pandemic situation. Consequently, knowing the status of medical students' knowledge, about symptoms, and transmission of disease, prevention of COVID-19 and their attitudes towards a vaccine is important. This multi-center cross-sectional descriptive study was one of the first ones in Bangladesh among the undergraduate medical students who completed pathology, microbiology, and pharmacology. The study was conducted from March to April 2021, using a convenience sampling method in twelve government and non-government medical colleges. Among 1132 who completed the questionnaire, and 15 students from different centers were excluded from the pre-testing and face validation. The age of the 1117 respondents were 22 to 23 years, of which the majority of the respondents were female 749 (67.0%), and 368 (33.0%) were male. Almost all participants had correct knowledge (84.1%) about the symptoms of COVID-19. But 59.2% had wrong knowledge about transmission of disease by an afebrile person. Above 60.0 % of the participants have worn a facial mask when contacting people, refrained from shaking hands, washed hands, avoided people with signs and symptoms suggestive of COVID-19, and avoided crowded places as a practice of prevention. 37.6% of medical students showed positive attitudes about the participation of management of a COVID-19 patient. Most of the participants' decided to have a vaccine depending on its availability. But 31.5% had trust in natural immunity rather than vaccination. Most undergraduate Medical college students understood the basic information, possessed a positive attitude, and presented good practice towards the COVID-19 and vaccination. They play a crucial role in motivation and acceptance of vaccines among the general citizen to fight back against the pandemic in the country with limited resources.

Cryptocurrency and stock market: bibliometric and content analysis.

This study conducted a systematic review regarding the association between cryptocurrency and the stock market. This study used bibliometric and content analysis covering 151 articles from 2008 to November 2021. Using VOSviewer software, we explored the influential aspects of the literature, such as the prominent institutions, authors, countries, and journals. Additionally, we performed co-authorship, bibliographic coupling, and co-occurrence of keywords to understand the network. Furthermore, in the content analysis, we discussed key findings of four major research streams that we identified. Finally, we present seven research questions that can be explored in the future. The findings have a number of implications for the present state of the literature on cryptocurrency and the stock market, including study gaps and potential future research initiatives.

A comparison of traditional diarrhoea measurement methods with microbiological and biochemical indicators: A cross-sectional observational study in the Cox's Bazar displaced persons camp.

BACKGROUND: Water, Sanitation, and Hygiene (WASH) systems aim to reduce the spread of enteric pathogens, particularly amongst children under five years old. The most common primary outcome of WASH trials is carer-reported diarrhoea. We evaluate different diarrhoea survey instruments as proxy markers of enteric pathogen presence in stool. METHODS: We recruited 800 community-based participants from the Cox's Bazar Displaced Person's Camp in Bangladesh, split evenly between the rainy (July/August 2020) and dry (November/December 2020) periods. Participants were randomized evenly into either a standard survey asking carers if their child under five years old has had diarrhoea in the past fortnight, or a pictorial survey asking carers to pick from a pictorial chart which stools their child under five years old has had in the past fortnight. We collected stools from a random sub-sample of 120. Stools were examined visually, and tested for proteins associated with enteric infection and 16 enteric pathogens. We calculated sensitivities and specificities for each survey type, visual examination, and proteins with respect to enteric pathogen presence. FINDINGS: The sensitivity of the standard survey for enteric pathogen presence was 0.49[95%CI:0.32,0.66] and the specificity was 0.65[0.41,0.85]. Similar sensitivities and specificities were observed for pictorial survey, visual inspection, and proteins. INTERPRETATION: While diarrhoea is an important sign in clinical practice it appears that it is a poor proxy for enteric pathogen presence in stool in epidemiological surveys. When enteric infection is of interest, this should be measured directly. FUNDING: The project was funded by the National Institutes for Health Research Global Health Research Unit on Improving Health in Slums (16/136/87) and by the University of Warwick.

High prevalence of plasmid-mediated quinolone resistance (PMQR) among E. coli from aquatic environments in Bangladesh.

Fluro(quinolones) is an important class of antibiotic used widely in both human and veterinary medicine. Resistance to fluro(quinolones) can be acquired by either chromosomal point mutations or plasmid-mediated quinolone resistance (PMQR). There is a lack of studies on the prevalence of PMQR in organisms from environmental sources in Bangladesh. In this study, we investigated the occurrence of PMQR genes in E. coli from various water sources and analysed associations between multi-drug resistance (MDR) and resistance to extended spectrum ß-lactam antibiotics. We analysed 300 E. coli isolates from wastewaters of urban live-bird markets (n = 74) and rural households (n = 80), rural ponds (n = 71) and river water samples (n = 75) during 2017-2018. We isolated E. coli by filtering 100 ml of water samples through a 0.2µm cellulose membrane and incubating on mTEC agar media followed by identification of isolated colonies using biochemical tests. We selected one isolate per sample for detection of PMQR genes by multiplex PCR and tested for antibiotic susceptibility by disc diffusion. Clonal relatedness of PMQR-positive isolates was evaluated by enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR). About 66% (n = 199) of E. coli isolates harbored PMQR-genes, predominantly qnrS (82%, n = 164) followed by aac(6')-lb-cr (9%, n = 17), oqxAB (7%, n = 13), qnrB (6%, n = 11) and qepA (4%, n = 8). Around 68% (n = 135) of PMQR-positive isolates were MDR and 92% (n = 183) were extended spectrum ß-lactamase (ESBL)-producing of which the proportion of positive samples was 87% (n = 159) for blaCTX-M-1' 34% (n = 62) for blaTEM, 9% (n = 16) for blaOXA-1, blaOXA-47 and blaCMY-2, and 2% (n = 4) for blaSHV. Further, 16% (n = 32) of PMQR-positive isolates were resistant to carbapenems of which 20 isolates carried blaNDM-1. Class 1 integron (int1) was found in 36% (n = 72) of PMQR-positive E. coli isolates. PMQR genes were significantly associated with ESBL phenotypes (p≤0.001). The presence of several PMQR genes were positively associated with ESBL and carbapenemase encoding genes such as qnrS with blaCTXM-1 (p<0.001), qnrB with blaTEM (p<0.001) and blaOXA-1 (p = 0.005), oqxAB and aac(6')-lb-cr with blaSHV and blaOXA-1 (p<0.001), qnrB with blaNDM-1 (p<0.001), aac(6')-lb-cr with blaOXA-47 (p<0.001) and blaNDM-1 (p = 0.002). Further, int1 was found to correlate with qnrB (p<0.001) and qepA (p = 0.011). ERIC-PCR profiles allowed identification of 84 of 199 isolates with 85% matching profiles which were further grouped into 33 clusters. Only 5 clusters had isolates (n = 11) with identical ERIC-PCR profiles suggesting that PMQR-positive E. coli isolates are genetically heterogeneous. Overall, PMQR-positive MDR E. coli were widely distributed in aquatic environments of Bangladesh indicating poor wastewater treatment and highlighting the risk of transmission to humans and animals.

A Comparative Study of Thermal Aging Effect on the Properties of Silicone-Based and Silicone-Free Thermal Gap Filler Materials.

Thermal conductive gap filler materials are used as thermal interface materials (TIMs) in electronic devices due their numerous advantages, such as higher thermal conductivity, ease of use, and conformity. Silicone is a class of synthetic materials based on a polymeric siloxane backbone which is widely used in thermal gap filler materials. In electronic packages, silicone-based thermal gap filler materials are widely used in industries, whereas silicone-free thermal gap filler materials are emerging as new alternatives for numerous electronics applications. Certainly, characterization of these TIMs is of immense importance since it plays a critical role in heat dissipation and long-term reliability of the electronic packages. Insubstantial studies on the effects of various chemical compounds on the properties of silicone-based and silicone-free TIMs has led to this study, which focuses on the effect of thermal aging on the mechanical, thermal, and dielectric properties of silicone-based and silicone-free TIMs and the chemical compounds that cause the changes in properties of these materials. Characterization techniques such as dynamic mechanical analysis (DMA), thermomechanical analysis (TMA), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), and broadband dielectric spectroscopy (BbDS) are used to study the mechanical, thermal, and dielectric characteristics of these TIMs, which will guide towards a better understanding of the applicability and reliability of these TIMs. The experiments demonstrate that upon thermal aging at 125 °C, the silicone-free TIM becomes hard, while silicone-based TIM remains viscoelastic, which indicates its wide applicability to higher temperature applications for a long time. Though silicone-based TIM displays better mechanical and thermal properties at elevated temperatures, dielectric properties indicate low conductivity for silicone-free TIM, which makes it a better candidate for silicone-sensitive applications where higher electric insulation is desired.

Identifying predictors of antimicrobial exposure in hospitalized patients using a machine learning approach.

AIMS: Analysis and tracking of antimicrobial utilization (AU) are crucial in antimicrobial stewardship efforts which are used to find effective interventions for controlling antimicrobial resistance. In antimicrobial stewardship, standard risk adjustment models are needed for benchmarking appropriate AU and for fair inter-facility comparison. In this study we identify patient- and facility-level predictors of antimicrobial usage in hospitalized patients using a machine learning approach, which can be used to inform a risk adjustment model to facilitate assessment of AU. To our knowledge, this is the first time machine learning has been applied for this purpose. METHODS AND RESULTS: Patient admission records were retrieved from the Duke Antimicrobial Stewardship Outreach Network which include clinical data for 27 community hospitals in the southeastern United States. Candidate features (predictors) were then generated from these records. The number of features was reduced using a statistical approach, and missing values of the reduced feature set were imputed using bootstrapping and expectation-maximization algorithm. Finally, support vector regression (SVR) and cubist regression (CB) models were applied to find root-mean-square error values which were used to evaluate the selected feature set. The performance of the SVR and CB models was found to be better than that of linear null and negative binomial null models, thereby demonstrating the effectiveness of our selected features. CONCLUSIONS: Relevant patient- and facility-level predictors of antimicrobial usage in days of therapy were obtained and evaluated. The potential predictor set can be used in risk adjustment strategies for benchmarking antimicrobial use. SIGNIFICANCE AND IMPACT OF THE STUDY: One reason for the rapid emergence of antimicrobial resistance is inappropriate use of antibiotics in hospitalized patients. Identifying predictors of antimicrobial exposure using a machine learning technique can improve the use of AU, enhance patient health outcomes, and reduce the infection spread caused by antimicrobial-resistant organisms.

Capreomycin resistance prediction in two species of Mycobacterium using a stacked ensemble method.

AIMS: Predicting bacterial resistance provides valuable information that can assist in clinical decisions. With recent advances in whole genome sequencing technology, the detection of antibiotic resistance (AR) proteins directly from genomic data is becoming feasible. AR genes/proteins can be identified using best-hit methods that work by comparing candidate sequences with known AR genes in public databases. However, these approaches may fail to detect resistance genes with sequences that differ significantly from known sequences. Our goal is to develop a machine learning technique to accurately predict capreomycin resistance in Mycobacteria with low false discovery rates. METHODS AND RESULTS: We present a stacked ensemble learning model as an alternative to traditional DNA sequence alignment-based methods using optimal features generated from the physicochemical, evolutionary and secondary structure properties of protein sequences. We train logistic regression, C5.0 and support vector machine (SVM) algorithms as our base classifiers, and our stacked ensemble predictors combine the results from the base classifiers to achieve higher accuracy. Compared with our most accurate base classifier (SVM), our most accurate stacked ensemble predictor increases training accuracy by 2·43%. Our stacked ensemble predictors achieve test accuracy up to 81·25%. CONCLUSIONS: We developed a stacked ensemble model to predict capreomycin resistance for Mycobacteria with an accuracy >80% using protein sequences with sequence similarity ranging between 10% and 70%. This performance cannot be achieved with best-hit methods due to differences in sequence similarity. SIGNIFICANCE AND IMPACT OF THE STUDY: Today an estimated one-half million cases of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) occur annually worldwide at a great cost. Because capreomycin is a second-line drug used to treat drug-resistant TB, the ability to use a machine learning approach to classify capreomycin-resistant TB in a timely manner is crucial for the successful treatment of MDR or XDR TB.

Why Abortion is Illegal? Comparison of Legal and Illegal Abortion: A Critical Review.

Abortion is the termination of pregnancy that occurs spontaneously or purposely. In the most developed world, abortion is legally allowed for women seeking safe termination of pregnancies. Particularly, when access to legal abortion is restricted, abortion is the resort to unsafe methods. The aim of this review is to necessitate safe abortion and to accentuate the consequences of illegal abortion in case of legal prohibition. We used Pubmed, MedLine and Scopus databases to review previous literatures of safe, unsafe, legal and illegal abortions. Research work and reports from organizations such as World Health Organization (WHO), World Bank (WB) and United Nations (UN) were included. Snowball sampling was used to obtain relevant journals. Abortion is conventional whether it is safe, unsafe, legal or illegal. The intention of the antiabortion policy was to reduce the number of abortions globally. However, instead of decreasing rates, evidences show significant increase in abortions. When abortion is legal, the preconditions to be ensured are availability, accessibility, affordability and acceptability for the safe abortion facilities. When abortion is illegal, risk reduction strategies are needed to decrease maternal morbidity and mortality. We can reduce abortion related morbidity and mortality, whether it is legal or illegal if we can ensure the appropriate access to health care, including abortion services, education on sexuality, access to contraceptives, post abortion care, and suitable interventions and liberalization of laws. The paper reviewed the Mexico City Policy and the US foreign aid strategies and highlighted the evidence based analysis for policy reform. The liberalized abortion law can save pregnant women from abortion related complications and death.

Moebius syndrome with Taussig-Bing anomaly.

We report a 6 years old male child, presented with difficulty in swallowing, crying and smiling from early infancy and recurrent episodes of cyanosis on exertion for about 2 years. He had facial dysmorphism, clubbing and polydactyly and right sided lower motor neuron type of facial nerve palsy. On examination and relevant investigations findings were consistent with Moebius syndrome and Taussig-Bing anomaly. Moebius syndrome comprises of congenital facial nerve palsy with or without palsy of the other cranial nerves and the associated organ system malformations. Taussig-Bing anomaly is a rare congenital heart malformation consisting of a transposed aorta, a large pulmonary artery which arises primarily from the right ventricle and ventricular septal defect. Simultaneous occurrence of Moebius syndrome and Taussig-Bing anomaly has not yet been reported in the past.

Improvement in reporting skills of radiology residents with a structured reporting curriculum.

RATIONALE AND OBJECTIVES: Radiology residents must acquire dictation and reporting skills to meet Accreditation Council for Graduate Medical Examination requirements and provide optimal patient care. Historically, these skills have been taught informally and vary between institutions and among radiologists. A structured curriculum improves resident report quality when using a quantitative grading scheme. This study describes the implementation of such a curriculum and evaluates its utility in tracking resident progress. MATERIALS AND METHODS: We implemented a three-stage reporting curriculum in our diagnostic radiology residency program in 2009. Stages 1 and 2 involve instruction and formative feedback composed of suggestions for improvement in a 360° format from faculty, peers, and others within the resident's sphere of influence. The third stage involves individual, biannual, written feedback with scored reports specifically assessing four categories: succinctness, spelling/grammar, clarity, and responsible referral. Biannual scores were collected from 2009 to 2013, sorted by year of residency training (R1 to R4), and average training level scores were statistically compared. RESULTS: Review of 1500 reports over a 4-year period yielded a total of 153 scores: 54, 36, 29, and 34 from R1, R2, R3, and R4 residents, respectively. The mean (standard deviation) scores for R1, R2, R3, and R4 residents were 10.20 (1.06), 10.25 (0.81), 10.5 (0.74), and 10.75 (0.69), respectively. Post hoc analysis identified significant differences between R1 and R4 residents (P = .012) and R2 and R4 residents (P = .009). CONCLUSIONS: Residents' reporting scores showed significant improvement over the course of their residency training. This indicates that there may be a benefit in using an organized reporting curriculum to track resident progress in producing reports that may improve patient care.

Serum transaminase level changes in dengue fever and its correlation with disease severity.

It was observed that liver enzymes are elevated in dengue fever. In this study our aims were to determine the changes in serum transaminases in dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) and to find out the relation of transaminase level changes with the disease severity. This cross sectional, prospective hospital based observational study was carried out in the department of Gastrointestinal Hepatobiliary and Pancreatic diseases and Internal Medicine department of BIRDEM Hospital, Dhaka. Patients are classified into 3 groups depending on clinical & laboratory findings: Group 1 dengue fever (DF), Group 2 dengue hemorrhagic fever & Group 3 dengue shock syndrome. A total of 240 cases were taken in this study who fulfilled the selection criteria. Out of whom 125 male and 115 female patients. DF was 157(65.4%) & DHF was 83(34.6%). Aminotransferases [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] were significantly raised in DHF cases compared to those of classical dengue fever (AST 84.5±42.4 in DF vs. 507±106.8 IU/L in DHF and ALT 59.9±31.3 in DF vs. 234±30.6 IU/L in DHF). The rise of AST is far greater than ALT in both DF and DHF. Dengue fever is usually associated with mild to moderate elevations of aminotransferase levels. The increase in aminotransferases, mainly AST has been associated with disease severity and serves as an early indicator of dengue infection.

Association of thromboangiitis obliterans with cigarette and bidi smoking in Bangladesh: a case-control study.

BACKGROUND: In addition to cigarettes, bidi, made of unprocessed and low-grade tobacco, is being smoked widely in Bangladesh and in other south Asian countries. The cause-and-effect relationship is established between thromboangiitis obliterans (TAO) and smoking. However, type of smoking material(s) most strongly related to TAO is not yet determined. METHODS: We conducted a hospital-based case-control study in Rajshahi, Bangladesh, to examine the relationship of type of smoking materials (cigarette versus bidi) with TAO on 103 pairs of cases and controls matched by age and sex during the period 1995 to 1996. The inclusion criteria for cases were newly diagnosed TAO and current smoker, while those for controls were current smokers admitted to the hospital due to non-cardiovascular diseases. RESULTS: Among the cases 35.0% and 65.0% were cigarette and bidi smokers, while among the controls 69.9% and 30.1%, respectively. Using logistic regression approach, considering cigarette smoking approximately 10 per day as reference, bidi smoking >20 per day (odds ratio [OR] = 34.76, 95% CI: 6.11-197.67) and 11-20 per day (OR = 7.12, 95% CI: 2.35-21.63) had greater risk of TAO after adjusting confounding factors. Respective OR for bidi smoking approximately 10 per day, cigarette smoking 11-20 per day and cigarette smoking >20 per day, were 2.18 (95% CI: 0.64-7.51), 3.81 (95% CI: 1.37-10.57) and 6.88 (95% CI: 1.87-25.30). CONCLUSION: Within the limits inherent to case-control study, our findings suggest that bidi smoking may well play a more important role in causing TAO than cigarettes. It leads to the speculation that unprocessed and low-grade tobacco used for producing bidi might play a more potent role to initiate TAO than cigarettes.

Uncooked rice powder in oral rehydration solution: an alternative to glucose or cooked rice powder.

Glucose-based or rice-based ORS is the standard treatment in acute dehydrating diarrhoea. However, glucose may not be easily available in remote villages and the rice needs to be cooked for rice-based ORS. We embarked on a study to examine whether uncooked rice powder could be used as an alternative to glucose or cooked rice powder in ORS. Initially, 50 adult male patients (aged 18 to 55 yr) were randomized to receive glucose-ORS or uncooked rice ORS, in two equal groups. Subsequently, 20 male children (aged 3 to 12 yr) were also enrolled in the study and received either WHO-ORS or study ORS. All the adult patients and the children could be successfully rehydrated with ORS containing uncooked rice powder. As compared to WHO-ORS, the study ORS significantly reduced stool output (6.60 +/- 1.24 vs. 5.88 +/- 1.34 l), ORS intake (9.17 +/- 1.54 vs 8.24 +/- 1.69 l) and duration of diarrhoea (45.68 +/- 6.91 vs 41.32 +/- 6.03 h). In children also similar results were obtained. No clinical complication (e.g., vomiting, abdominal pain etc.) or abnormality in serum electrolyte concentrations was encountered either in the adults or in the children. Uncooked rice powder containing ORS can be considered as an alternative to glucose-based ORS or rice-based ORS.

Epidemic of Vibrio cholerae 0139 in Calcutta.

As one of large outbreaks of cholera-like illness in the Indian subcontinent, Calcutta and its neighbouring areas experienced an unprecedented epidemic due to a new strain of V. cholerae non-01, designated as V. cholerae 0139 Bengal, since January 1993. This epidemic predominantly affected the adult population of Calcutta as evidenced by the hospitalization of more adults at the Infectious Disease Hospital, Calcutta (IDH), which bore the main brunt of the epidemic in and around Calcutta. During the peak of the epidemic about 180 to 300 diarrhoea patients were admitted daily at the IDH. Of the 807 patients screened, 407 were positive for V. cholerae 0139 and majority (82.8%) of the cases were > 10 yr of age. Severe dehydration was recorded in 85.5 per cent of the cases.

Acute diarrhoea caused by Vibrio mimicus in Calcutta.

Out of 539 acute diarrhoea cases studied, Vibrio mimicus was isolated as a sole pathogen in the faeces of 7 (1.3%) cases. The chief clinical presentations of the seven cases were watery diarrhoea and vomiting. Bloody diarrhoea was observed in 2 (28.5%), abdominal pain in 2 (28.57%) and fever in one (14.29) cases. All cases could be effectively treated with ORS except 3 (42.85%) cases who required IV Ringer's lactate. All V. mimicus strains isolated in the study were uniformly susceptible to tetracycline, chloramphenicol, norfloxacin and ciprofloxacin.

Serovar, biotype, phage type, toxigenicity & antibiotic susceptibility patterns of Vibrio cholerae isolated during two consecutive cholera seasons (1989-90) in Calcutta.

Characteristics of V. cholerae isolated from patients of acute secretory diarrhoea admitted to the Infectious Diseases Hospital, Calcutta during two consecutive cholera seasons (1989 and 1990), with special emphasis on biotyping and toxigenicity, were investigated. The isolation rates of V. cholerae during 1989 and 1990 were 78 and 85.1 per cent respectively, with Inaba serotype dominating in 1989 and Ogawa in 1990. All the V. cholerae 01 strains isolated in this study belonged to biotype Eltor with phage type 4 dominating (48.8%). Most of the strains of V. cholerae were resistant to 10 and 150 micrograms/ml of 0/129 vibriostatic agent. Similarly, majority of the V. cholerae strains were resistant to furazolidone (95.7%), cotrimoxazole (83%) and tetracycline (63.1%) and several resistance patterns were encountered. All the V. cholerae 01 strains examined produced cholera toxin (CT) in amounts ranging between greater than 70 pg/ml and greater than 2.5 ng/ml. In contrast, all but one of the non-01 strains isolated in this study did not produce CT. Further studies are required to elucidate the mechanism involved in the pathogenesis of non-01 V. cholerae mediated diarrhoea.