Publications by authors named "Liaquat Ali"

101 Publications

Thoracic Epidural Versus General Anaesthesia For Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

J Ayub Med Coll Abbottabad 2022 Apr-Jun;34(2):279-282

Department of Surgery, Fauji Foundation Hospital, Rawalpindi, Pakistan.

Background: Laparoscopic cholecystectomy is one of the most commonly performed surgeries worldwide. Aim of our study was to compare the effectiveness of thoracic epidural anaesthesia with general anaesthesia for Laparoscopic cholecystectomy in terms of changes in blood pressure during surgery, postoperative pain, respiratory complications and average length of hospital stay. It was a randomized controlled trial conducted from 1stOctober 2018 to 31st October 2019.

Methods: Eightytwo patients planned to undergo elective laparoscopic cholecystectomy were randomly divided into two groups, T and G. In Group T all patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia with 12 ml of 0.25% bupivacaine and 1% lignocaine plain whereas in group G all patients underwent surgery under general anaesthesia. Intra-operative mean arterial pressure (MAP) and postoperative opioid consumption in first 24hrs were recorded as primary outcomes whereas presence or absence of respiratory complication and duration of hospital stay as secondary outcome..

Results: Out of 82 patients, 41 patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia and 41 patients had surgery under general anaesthesia. Mean arterial pressure was lower in Group T and the difference was statistically significant. The average time of first complaint of postoperative pain in Group T was 5.4±1.26 hours as compared to less than 0.79±0.25 hours in Group G. Patients in group T required lower doses of opioid analgesia in first twenty-four hours as compared to patients in group G. Mean hospital stay in group T was 1 day as compared to 3 days in group G.

Conclusions: Thoracic epidural anaesthesia provides a better alternative to general anaesthesia for Laparoscopic cholecystectomy with lower intraoperative mean arterial blood pressure, 24 hours postoperative consumption of opioids, respiratory complications and length of hospital stay.
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http://dx.doi.org/10.55519/JAMC-02-9071DOI Listing
May 2022

Acute Neurological Manifestations of COVID-19 Patients From Three Tertiary Care Hospitals in Qatar.

Cureus 2022 Mar 14;14(3):e23150. Epub 2022 Mar 14.

Neurosciences, Hamad General Hospital, Doha, QAT.

Introduction Worldwide, there are more than 424 million confirmed cases of COVID-19. Most of the hospitalized critical COVID-19 patients manifested neurological signs and symptoms and higher mortality. The majority of COVID-19 fatalities occurred mostly in patients with advanced age and underlying medical comorbidities. This is the first local retrospective study in Qatar, which reported neurologic manifestations (48.5%) of hospitalized COVID-19 patients. The primary objective of this study is to evaluate acute neurological manifestations in COVID-19 hospitalized patients in the country. Methods This is a retrospective, observational study of 413 hospitalized COVID-19 patients. They were admitted to three different COVID-19 designated hospitals (Hazm Mebaireek, Ras Laffan, and Cuban tertiary care Hospitals) under the Hamad Medical Corporation, Qatar from 1st January 2020, to 31 January 2021. We evaluated electronic medical records of these patients and data were collected while their neurological manifestations were confirmed by two trained neurologists. These neurologic manifestations were categorized into three major groups: central nervous system (CNS), peripheral nervous system (PNS), and neuromuscular system. Results Of 413 patients, 94% (389) were male and 6% (24) were female; the mean age was 52 years. Among all different nationalities of COVID-19 patients, 20.3% (84) were Indian, 12.5% (52) were Bangladeshi, 10.1% (42) were Qatari and 9.2% (38) were Nepali. The most common symptoms at the onset of COVID-19 illness were as follows: 77.5% (321) had a fever, 67.4% (279) experienced cough, 58.7% (243) experienced shortness of breath and 26.1% (108) developed a sore throat. Overall 48.5% (201) patients developed different neurologic manifestations. The most common neurologic symptoms were myalgia (28%; 116), headache (10.4%; 43), dizziness (5.8%; 24) and hemiparesis due to strokes (5.3%; 22). In this study, the most common risk factors were hypertension (47.6%), diabetes (46.9%), obesity (21%), chronic kidney disease (10%), ischemic heart disease (9.7%), and smoking (6.8%). About 45.2% (187) patients were admitted to MICU and 8.5% (35) died due to COVID-19 complications. Significant other extrapulmonary multiorgan system involvement were skeletal muscle injury (39.4%), kidney injury (36.7%), liver injury (27.5%), myocardial injury (23.9%), rhabdomyolysis (15.7%) heart failure (11.4%) and acute pancreatitis (11.1%). Discussion The most common neurologic signs and symptoms were myalgia, headache, dizziness, and strokes, mainly due to large vessel thrombosis, lacunar, and posterior circulation strokes. Conclusions Patients with COVID-19 are at high risk of developing neurological manifestations. The most common COVID-19-related acute neurological manifestations were myalgia, headache, dizziness, and acute ischemic stroke. Prompt recognition, early diagnosis, and appropriate management of these manifestations could potentially lead to better patient outcomes in COVID-19 patients.
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http://dx.doi.org/10.7759/cureus.23150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9007182PMC
March 2022

The great imposter: A case report of IgG4-RD hypertrophic pachymeningitis with skull lytic lesion and pulmonary nodules.

Clin Case Rep 2022 Apr 4;10(4):e05470. Epub 2022 Apr 4.

Neurology Section Al Khor Hospital Hamad Medical Corporation Doha Qatar.

Immunoglobulin G4-related disease (Ig4RD) is an inflammatory condition with unique clinical, serological, and pathological features. In this study, we report a challenging diagnostic clinical case of Ig4RD diagnosed based on histopathology. This unique imitating nature reinforces that it is crucial to consider the diagnosis of IgG4-RD in those presenting with pachymeningitis.
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http://dx.doi.org/10.1002/ccr3.5470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8978985PMC
April 2022

Emerging Super-specialty of Neurology: Intraoperative Neurophysiological Monitoring (IONM) and Experience in Various Neurosurgeries at a Tertiary Care Hospital in Doha, Qatar.

Cureus 2021 Dec 15;13(12):e20432. Epub 2021 Dec 15.

Department of Neurosurgery, Neuroscience Institute, Hamad General Hospital, Doha, QAT.

Introduction Intraoperative neurophysiological monitoring (IONM) helps in better patient outcomes by minimizing risks related to the functional status of the nervous system during surgical procedures. An IONM alert to the surgical team during the surgery can help them identify the cause and take immediate corrective action. IONM confers possible benefits, including improved surgical morbidity and mortality, better patient care, minimal neurological deficits, reduced hospital stay, medical costs, and litigation risk. In addition, a highly skilled IONM team will make a better patient outcome. Methods We retrospectively reviewed 62 consecutive patients who underwent intracranial and spinal neurosurgical procedures. Multimodality IONM was utilized, including somatosensory evoked potentials, transcranial electrical motor evoked potential, spontaneous and triggered electromyography, electroencephalography, electrocorticography, cortical sensory mapping, and direct electrical cortical stimulation. Of a total of 62 patients, two patients revealed neurotonic EMG discharges during IONM, and most patients woke up without any new neurological deficit. Results Sixty-two patients were included, ranging from age 5 to 77 years (mean 43.5 years), with 54.8% men and 45.2% female. Multimodality IONM was used in all patients. Two EMG alerts were recorded during IONM, during a brain tumor resection, and right acetabular hip surgery with postoperative right foot drop. Conclusion Multimodality IONM is the gold standard of care for any surgical services and is used as real-time monitoring of functional integrity of neural structures at risk. If utilized by trained and expert teams, numerous surgeries may benefit from multimodality intraoperative neurophysiologic monitoring.
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http://dx.doi.org/10.7759/cureus.20432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8759984PMC
December 2021

Acute Myocardial Injury and Rhabdomyolysis in COVID-19 Patients: Incidence and Mortality.

Cureus 2021 Oct 19;13(10):e18899. Epub 2021 Oct 19.

Neurology, Hamad General Hospital, Doha, QAT.

Background Myocardial injury has been defined as an elevated troponin level. The frequency of acute myocardial injury of hospitalized coronavirus disease 2019 (COVID-19) patients ranges from 7% to 36%. COVID-19 patients with cardiovascular disease (CVD) have a four-fold higher risk of mortality (odds ratio, 4.33; CI 95%, 3.16-5.94). In COVID-19 hospitalized patients' study showed mortality rate was 18.5%. Rhabdomyolysis is considered as muscle necrosis and the release of intracellular muscles elements and enzymes into blood. In one of retrospective cohort study of COVID-19 hospitalized patients, incidence of rhabdomyolysis was 16.7%. Materials and methods This retrospective observational study consisted of 413 COVID-19 hospitalized patients. Patients with rhabdomyolysis was defined as creatine kinase level greater than 1,000 U/L and acute myocardial injury was defined as serum high-sensitivity troponin-T for males greater than 30 ng/l and for female greater than 20 ng/l. The primary outcome was in-hospital mortality of COVID-19 patients with acute myocardial injury and rhabdomyolysis.  Results The incidence of acute myocardial injury and rhabdomyolysis in hospitalized COVID-19 patients was 23.9% (99) and 15.7% (65), respectively. The mortality rate of in hospitalized COVID-19 patients who developed acute myocardial injury (28.3%) was significantly higher in comparison to patients who developed rhabdomyolysis (13.8%). Discussion The binding of SARS-CoV-2 virus to the angiotensin-converting enzyme 2 (ACE2) is a critical step in the pathophysiology in patients with COVID-19. There may be diverse direct and indirect mechanisms of acute myocardial injury in COVID-19 including ischemic injury, hypoxic injury (MI type 2), direct viral myocarditis, stress cardiomyopathy and systemic cytokine storm. Musculoskeletal injury may be caused by direct viral myositis or indirectly by host immune hyperinflammatory cytokine storm response that leads to skeletal muscle fiber proteolysis and fibrosis. Conclusions Acute myocardial injury and rhabdomyolysis were underreported in COVID-19 patients. The incidence and mortality of acute myocardial injury are higher than that of rhabdomyolysis in COVID-19 hospitalized patients. The outcome was worse in COVID-19 patients with severe acute myocardial injury. Patients with acute myocardial injury and rhabdomyolysis may get benefits from rehabilitation programs.
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http://dx.doi.org/10.7759/cureus.18899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8599434PMC
October 2021

COVID-19-Associated Acute Transverse Myelitis: A Case Series of a Rare Neurologic Condition.

Cureus 2021 Oct 6;13(10):e18551. Epub 2021 Oct 6.

Neurology, Hamad General Hospital, Doha, QAT.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection is not confined to the respiratory system, but has also shown extra-pulmonary invasion including the nervous system. About 36.4% of hospitalized patients in China with confirmed coronavirus disease 2019 (COVID-19) infection had neurological manifestations. SARS-CoV-2 virus enters the human body through angiotensin converting enzyme-2 (ACE-2) receptors on the surface of human cells and causes disease. ACE2 receptors are also expressed on the surface of spinal cord cells. More rare neurologic conditions have been reported in the literature to be associated with COVID-19 such as acute transverse myelitis (ATM), Guillain Barre syndrome, acute flaccid myelitis, etc. We report two cases of confirmed COVID-19 who presented four to five days of their COVID-19 symptoms and progressive bilateral lower limb weakness and urinary retention. ATM is an acquired spinal cord disorder. ATM is a relatively common neurological complication of COVID-19, accounting for 1.2% of all neurological complications associated with COVID-19. The mechanism by which COVID-19 causes ATM is not completely understood but has been assumed to be due to the structural resemblance of RNA viruses. Entrance of SARS-CoV-2 to the nervous system can take place through two pathways, either directly or indirectly. The direct pathway is through trans-synaptic transmission from the peripheral nervous system or by hematogenous spread into the blood-brain barrier through ACE-2, while the indirect pathway is through a systemic immune response.
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http://dx.doi.org/10.7759/cureus.18551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8571429PMC
October 2021

Bilateral Acute Optic Perineuritis Associated With COVID-19 in a Patient With Seronegative Myelin Oligodendrocyte Glycoprotein (MOG) Antibody.

Cureus 2021 Sep 24;13(9):e18234. Epub 2021 Sep 24.

Neurology, Hamad General Hospital, Doha, QAT.

Severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) may cause various neuro-ophthalmologic manifestations including optic perineuritis. Optic perineuritis is a rare form of orbital inflammatory disease in which optic nerve sheath is inflamed and nonspecific fibrotic thickening with classic radiological finding is a perineural enhancement of optic nerve sheath. A 45-year-old gentleman with known diabetes mellitus, hypertension and dyslipidemia was admitted with a critically ill COVID-19 infection. During the recovery period, the patient developed sudden onset of painless loss of vision. MRI head and orbit with gadolinium was suggestive of optic perineuritis. Other secondary causes of autoimmune or vasculitis myelin oligodendrocyte glycoprotein (MOG) antibody disease and other common central nervous system (CNS) infection were excluded. The patient had dramatic response with steroids. This is the first rare case report of COVID-19-related optic perineuritis in critically ill COVID-19 patients with seronegative MOG antibody. Optic perineuritis is a rare orbital inflammatory disease and underlying mechanisms may arise from systemic response to COVID-19 infection as well as direct effects of the virus via angiotensin-converting enzyme 2 (ACE-2) receptors on ocular tissues. Optic perineuritis is a rare disease with inflammation restricted to the optic nerve sheath. Neuroimaging of the brain and orbit is the most important modality of choice for visualizing optic nerve sheath and optic nerve. Delay in the diagnosis of COVID-19-related optic perineuritis, may result in permanent optic nerve injury and irreversible vision loss.
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http://dx.doi.org/10.7759/cureus.18234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542256PMC
September 2021

Acute Thromboembolic Ischemic Stroke From Complex Aortic Arch Plaque.

Cureus 2021 Aug 7;13(8):e16977. Epub 2021 Aug 7.

Neurology, Hamad Medical Corporation, Doha, QAT.

Atherosclerosis is a systemic pathologic process, may involve aorta and is important cause of systemic embolization. The risk of embolism is increased for mobile and complex aortic plaques that are >4 mm thick. The most common manifestations are stroke, transient ischemic attack (TIA) and peripheral embolization. Imaging modalities used include transesophageal echocardiogram (TEE), CT angiography and magnetic resonance angiography (MRA). The mainstays of medical treatment are antiplatelets and statin. The role of anticoagulation is reserved for plaques with thrombotic component. There were two patients who presented with large acute ischemic stroke with high grade, floating aortic arch thrombus and complex aortic arch plaques. In one of cases, after 10-day follow-up CT aortic angiography showed completely resolved thrombus after being treated with IV tissue plasminogen activator (TPA) followed by low molecular weight heparin (LMWH). The risk of embolism depends on size of aortic plaques and mobility. TEE is modality of choice for thoracic aortic plaques. Aortic plaques >4 mm are independent predictors of recurrent ischemic stroke. There are limited data available for off-label use of intravenous thrombolysis and mechanical thrombectomy (MT) in presence of aortic arch thrombus in acute ischemic strokes. These two case reports help in recognition of aortic arch complex plaques as independent risk factor for recurrent stroke. The right patients may consider about the use of intravenous alteplase and MT performed via trans-brachial access after excluding aortic dissection and aneurysm. In future, multicenter, randomized controlled trials will be required for safety of IV TPA and MT.
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http://dx.doi.org/10.7759/cureus.16977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423320PMC
August 2021

Health-related quality of life among people with type 2 diabetes mellitus - A multicentre study in Bangladesh.

Diabetes Metab Syndr 2021 Sep-Oct;15(5):102255. Epub 2021 Aug 19.

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.

Aims: This study aimed to explore the health-related quality of life and the various demographics and clinical characteristics associated with it among people with type 2 diabetes mellitus in Bangladesh.

Methods: A total of 1253 participants with type 2 diabetes were recruited from a cross-sectional and retrospective study conducted in Bangladesh in 2017. Participants were recruited from six rural and urban diabetes hospitals. The health-related quality of life of the participants was assessed using the validated EuroQol-5D-5L scale and EuroQol-VAS score. Information was collected via face-to-face interviews and existing medical records. Data was analysed using univariate and multivariable regression analyses with bootstrap resampling.

Results: The average health-related quality of life was 0.64 (±0.20) for EQ-5D-5L score and 61.69 (±34.98) for EQ-VAS score. Old age, low income, low education level, residing in an urban area, longer duration of diabetes, being physically inactive, the presence of macro- and/or micro-vascular complications, impaired cognitive function, being depressed and having anxiety were related to poor health-related quality of life.

Conclusion: The health-related quality of life among people with type 2 diabetes in Bangladesh is low, and various socio-demographic and psychological factors and diabetes-related complications are associated with it. This finding will help reform treatments and enforce lifestyle modifications to ensure that the burden of diabetes on people's quality of life is minimal.
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http://dx.doi.org/10.1016/j.dsx.2021.102255DOI Listing
January 2022

Proportion and predictors of SMBG use among type 2 diabetic subjects in three tertiary care hospitals in Dhaka City.

Heliyon 2021 Jul 16;7(7):e07619. Epub 2021 Jul 16.

Pothikrit Institute of Health Studies, Sangskriti Bikash Kendra Bhaban, 1/E/1, Paribagh, Dhaka 1000, Bangladesh.

Aims: The aim was to find out the proportion of Self-monitoring of Blood Glucose (SMBG) Users and factors affecting the nonuse in three large hospitals of Dhaka city.

Methods: Under an observational cross-sectional design 598 type 2 diabetic subjects were recruited (convenient sampling) from the OPDs of 3 large tertiary care hospitals [one public hospital (PUBH), one Not-for-profit Hospital (NFPPH), and one For-profit private hospital (FPPH)] in Dhaka City. Data were analyzed by both univariate and multivariate analysis as appropriate.

Results: Overall 71% of subjects were SMBG Nonusers (PUBH 86%, NFPPH 67%, and FPPH 46%). Monthly income status and advice showed the highest impact (OR 4.66 and 3.74 respectively) on the use. Physicians (54%), relatives (34%), and friends (8.2%) were the major sources of advice. Irregular diabetes check-up and distrust of results were also among the major reasons for not using SMBG among the Nonusers.

Conclusion: Nearly three-fourth of type 2 diabetic patients in Dhaka city do not use SMBG and the proportion is especially high in public hospitals. Poor income status of patients, lack of coordinated advice/motivation by Caregivers, irregularity in diabetes checking, and distrust on results are major predictors for not using SMBG by the patients.
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http://dx.doi.org/10.1016/j.heliyon.2021.e07619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321936PMC
July 2021

Comparative antioxidant and analgesic effect of sesame oil, fish oil and their combination in experimental animal model.

Pak J Pharm Sci 2021 Mar;34(2):499-506

Department of Pharmacology, Faculty of Pharmacy & Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan.

Natural oils are rich in polyunsaturated fatty acids (PUFs) like omega 3, omega 6 and other nutrients that boost physical and mental health. Traditionally these oils have been used to treat joint pain associated with several inflammatory conditions. In this study, we investigated the antioxidant and analgesic properties of the sesame oil (SO), fish oil (FO) and combination of these two oils (SO+FO). Different concentrations of the SO, FO and SO+FO combination 0.02-4mg/ml were used for assessing the free radical scavenging activity by DPPH method and the IC50 value was calculated. Acetic acid-induced abdominal writhing test, tail immersion and hot plate models were used to determined analgesic effect. Results showed that both oils were well tolerated as no signs of toxicity or death were noticed during the observational study period. SO+FO combination showed the best antioxidant properties as shown by DPPH assay. Similarly in analgesic models, SO and FO significantly reduced the number of abdominal contractions (p<0.05) however, SO+FO (1:1) exhibited highly significant results (p<0.001) in writhing reflex test. Furthermore, SO and FO both increased the reaction time on a hot plate as well as in tail flick test (p<0.05) whereas, SO+FO significantly increased reaction time (p<0.001) in hot plate and in tail flick test as compared to SO and FO single treatments. Conclusively, our results suggest that the combination of both oils (SO+FO) exhibited significant antioxidant and analgesic potential that it could be considered as one of the active combinations for relieving pain in adjunctive treatment for joint pain associated with rheumatoid arthritis.
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March 2021

Prevalence of non-communicable disease risk factors among nurses and para-health professionals working at primary healthcare level of Bangladesh: a cross-sectional study.

BMJ Open 2021 03 19;11(3):e043298. Epub 2021 Mar 19.

Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Objective: To determine the prevalence of non-communicable disease (NCD) risk factors among nurses and para-health professionals (PHPs) working at primary healthcare centres in Bangladesh. In addition to this, we also investigated the association of these risk factors with the categories of health professions.

Design: Cross-sectional study and the sampling technique was a census.

Setting: The study site was a medical university of Bangladesh where the study population was recruited by NCD Control Programme of Directorate General of Health Services to participate in a 3-day training session from November 2017 to May 2018.

Participants: A total of 1942 government-employed senior staff nurses (SSNs) and PHPs working at Upazila Health Complexes.

Primary And Secondary Outcome Measures: The data were collected using a modified STEPwise approach to NCD risk factors surveillance questionnaire of the World Health Organisation (V.3.2). The prevalence of NCD risk factors was presented descriptively and the χ² test was used to determine the association between NCD risk factors distribution and categories of health professions.

Results: The mean age of the participants was 37.6 years (SD 9.5) and most of them (87.6%) had a diploma in their respective fields. Physical inactivity (86.9%), inadequate fruits and/vegetable intake (56.3%) and added salt intake (35.6%) were the most prevalent behavioural risk factors. The prevalence of central obesity, overweight, raised blood glucose and raised BP were 83.5%, 42.6%, 19.2% and 12.8% respectively. Overall, the NCD risk factors prevalence was higher among PHPs compared with SSNs. A highly significant association (p<0.001) was found between risk factors and the categories of health professions for tobacco use, alcohol intake, added salt intake and physical inactivity.

Conclusion: High NCD risk factors prevalence and its significant association with SSNs and PHPs demand an appropriate risk-reduction strategy to minimise the possibility of chronic illness among them.
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http://dx.doi.org/10.1136/bmjopen-2020-043298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986941PMC
March 2021

Maternal and Fetal Outcome of Pregnant Patients Having Preexisting Cardiovascular Disease.

Cureus 2020 Aug 5;12(8):e9563. Epub 2020 Aug 5.

Family Medicine, Dr. Ruth Pfau Hospital, Karachi, PAK.

Introduction Cardiovascular disease is common in woman of all age, including child bearing age. In this study, we aim to compare maternal and fetal outcome in pregnant woman with and without preexisting cardiovascular disease. Methods This case control single center study was conducted by Obstetrics & Gynecology department and Cardiology department Shaikh Zayed Medical College/Hospital Rahimyar Khan from 1 March 2020 to 30 June 2020. Results Pregnant woman with preexisting cardiovascular disease had more preterm births and newborn with lower birth weight. Maternal and fetal deaths were numerical higher in pregnant women with preexisting cardiovascular disease but statistically non-significant compared to woman without preexisting cardiovascular disease. Conclusion It is important to identify underlying cardiovascular disease in pregnant woman. Proper counselling throughout pregnancy is needed and efforts should be made to minimize risk of maternal and fetal complications.
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http://dx.doi.org/10.7759/cureus.9563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473608PMC
August 2020

Health-related quality of life and its predictors among the type 2 diabetes population of Bangladesh: A nation-wide cross-sectional study.

J Diabetes Investig 2021 Feb 3;12(2):277-285. Epub 2020 Aug 3.

Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.

Aims/introduction: We aimed to assess the health-related quality of life (HRQoL) and identify its predictors among type 2 diabetes patients of Bangladesh.

Materials And Methods: This nationwide cross-sectional study assessed HRQoL among 1,806 type 2 diabetes patients using the EuroQol-5 Dimensions Questionnaire (EQ-5D-5L), and the responses were further translated into a single summary crosswalk index score using the UK time trade-off value set. The predictors were determined using multinomial logistic regression analysis.

Results: The mean EQ-5D-5L index score was 0.62 (standard deviation 0.25), and men scored better than women. More than half of the study participants (53.4%) were ranked as "average" HRQoL. Overall, 64% of respondents had a "problem" at least in one of the dimensions of the EQ-5D-5L, and the burden of reported "problems" was higher among women (70%). Among the five dimensions, the highest reported "problem" was 79.8% for anxiety/depression, 77.7% for pain/discomfort and 60.1% for mobility. However, younger participants (aged <30 years) showed a higher burden of anxiety/depression (95%) compared with the rest of the population. The specific predictors of average/good HRQoL (odds ratio >1) were being men, living in a rural area, married, literate, a monthly income >19,488 BDT, absence of comorbidity and had a duration of diabetes ≤5 years.

Conclusions: The majority of Bangladesh's type 2 diabetes patients had an "average" HRQoL based on the EQ-5D-5L index score. In broad terms, the identified predictors were sex, place of residence, marital status, literacy, monthly income, comorbidity and duration of diabetes.
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http://dx.doi.org/10.1111/jdi.13331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7858106PMC
February 2021

The influence of mobile phone-based health reminders on patient adherence to medications and healthy lifestyle recommendations for effective management of diabetes type 2: a randomized control trial in Dhaka, Bangladesh.

BMC Health Serv Res 2020 Jun 8;20(1):520. Epub 2020 Jun 8.

Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany.

Background: In 2017, 80% of 425 million adults with diabetes worldwide were living in low and middle-income countries. Diabetes affected 6.9 million adults in Bangladesh and accounted for 3% of the country's total mortality. Proper management of diabetes is the key to positive health outcomes. This study investigated how mobile phone-based health intervention could increase patient adherence and thereby improve the disease outcomes for diabetes type 2 in Bangladesh.

Methods: A mobile phone-based health project (including mobile phone reminders and 24/7 call center) was implemented in Dhaka District, Bangladesh from January to December 2014. A randomized control trial was carried out, recruiting randomly in intervention and control groups among the patients receiving treatment for type 2 diabetes at the Bangladesh Institute of Health Sciences Hospital, Dhaka, Bangladesh. A total of 320 patients from both groups at baseline and 273 at endline were interviewed.

Results: A significant improvement in patient adherence to diet, physical exercise, the cessation of use of tobacco and betel nut, and blood glycaemic control was found in the intervention group, whereas no such significant improvement was found in the control group. Cost and other co-morbidities were found to be the main reasons for non-adherence.

Conclusion: A mobile-health intervention should be considered as an additional option for non-communicable disease programs.
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http://dx.doi.org/10.1186/s12913-020-05387-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282058PMC
June 2020

Community clinics in Bangladesh: A unique example of public-private partnership.

Heliyon 2020 May 11;6(5):e03950. Epub 2020 May 11.

Department of Health Promotion and Health Education, Bangladesh University of Health Sciences (BUHS), Bangladesh.

Background: Bangladesh has established more than 13,000 community clinics (CCs) to provide primary healthcare with a plan of each covering a population of around 6,000. The inception of CCs in the country has revolutionized the healthcare delivery to reach the doorstep of people. The provision of healthcare through CCs is truly participatory since the community people donate land for building infrastructure and also involve in management process. The study was conducted to assess pattern of public private partnership in healthcare delivery through participation of community people in establishment, management, monitoring and utilization of community clinics.

Methods: This quantitative study involving descriptive cross sectional design included 63 healthcare providers, 2,238 service-users and 3,285 community people as household members. Data were collected by face-to-face interview and reviewing records of CCs with the help of semi-structured questionnaire and checklist respectively. The public private partnership was assessed in this particular study by finding community participation in different activities of CCs. Data were analysed using descriptive statistics.

Results: Almost all (96.9%) CCs are located in easy-to-reach areas and have good infrastructure. Lands of all CCs are donated by the respective communities. The security of most of the CCs (93.7%) is maintained by community people. Cleanliness of the CCs is maintained by the cleaners or ayas who are appointed by local communities. Community Groups (CGs) of 88.9% and Community Support Groups (CSGs) of 96.8% CCs are found to be active. In most of the CCs (98.4%), monitoring is done by analysis of monthly reports. All CCs provide referral services for pregnant women. Health care delivery is found to be 'good' in more than three-fourths while health education service is 'good' in 96.7% of CCs. All CCs showed an increased trend in the utilization of services and conduction of normal child deliveries. Benefits of CCs as perceived by service users included free drugs (82.1%), free treatment (81.2%), easy access (76.3%), need-based health services (75.0%), and immunization services (68.6%). Almost all (99.0%) of the CC service users opined that CGs are involved in management of CC activities.

Conclusion: In resource-poor settings of developing countries, public private partnership in primary healthcare delivery through community clinics may play crucial role in sustainable development of community health by providing quality health care. The study recommends public-private partnership for strengthening CCs including establishment, maintenance, utilization, monitoring and supply of essential drugs and logistics.
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http://dx.doi.org/10.1016/j.heliyon.2020.e03950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218291PMC
May 2020

Validation of a food frequency questionnaire as a tool for assessing dietary intake in cardiovascular disease research and surveillance in Bangladesh.

Nutr J 2020 05 14;19(1):42. Epub 2020 May 14.

School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia.

Background: Cardiovascular disease (CVD) has emerged as a major public health concern in Bangladesh. Diet is an established risk factor for CVD but a tool to assess dietary intake in Bangladesh is lacking. This study aimed to validate a food frequency questionnaire (FFQ) using the 24-h dietary recall method and corresponding nutritional biological markers among rural and urban populations of Bangladesh.

Method: Participants of both genders aged 18-60 years were included in the analysis (total n = 146, rural n = 94 and urban n = 52). Two FFQs of 166 items were administered three-months apart, during which time three 24-h dietary recalls were also completed. Participants were asked to recall their frequency of consumption over the preceding 3 months. Urine and blood samples were collected for comparison between FFQ-estimates of nutrients and their corresponding biomarkers. Methods were compared using unadjusted, energy-adjusted, de-attenuated correlation coefficients, 95% limits of agreement (LOA) and quartile classification.

Results: Fair to moderate agreement for ranking energy, macro and micronutrients into quartiles was observed (weighted k value ranged from 0.22 to 0.58; p < 0.001 for unadjusted data) except for vitamin D (weighted k - 0.05) and zinc (weighted k 0.09). Correlation coefficients of crude energy, macronutrients and common micronutrients including vitamin E, thiamine, riboflavin, niacin, pyridoxine, folate, iron, magnesium, phosphorus, potassium, and sodium were moderately good, ranging from 0.42 to 0.78; p < 0.001 but only fair for vitamin A, β carotene and calcium (0.31 to 0.38; p < 0.001) and poor for vitamin D and zinc (0.02 and 0.16; p = ns, respectively). Energy-adjusted correlations were generally lower except for fat and vitamin E, and in range of - 0.017 (for calcium) to 0.686 (for fat). De-attenuated correlations were higher than unadjusted and energy- adjusted, and significant for all nutrients except for vitamin D (0.017) to 0.801 (for carbohydrate). The Bland Altman tests demonstrated that most of the coefficients were positive which indicated that FFQ provided a greater overestimation at higher intakes. More than one in three participants appeared to overestimate their food consumption based on the ratio of energy intake to basal metabolic rate cut points suggested by Goldberg. Absolute intake of macronutrients was 1.5 times higher and for micronutrients it ranged from 1.07 (sodium) to 26 times (Zinc). FFQ estimates correlated well for sodium (0.32; p < 0.001), and vitamin D (0.20; p = 0.017) with their corresponding biomarkers and iron (0.25; p = 0.003) with serum ferritin for unadjusted data. Folate, iron (with haemoglobin) and total protein showed inverse association; and fat and potassium showed poor correlation with their corresponding biomarkers for unadjusted data. However, folate showed significant positive correlation (0.189; p = 0.025) with biomarker after energy adjustment.

Conclusion: Although FFQ showed overestimation for absolute intake in comparison with 24-h recalls, the validation study demonstrated acceptable agreement for ranking dietary intakes from FFQ with 24-h recall methods and some biomarkers and therefore could be considered as a tool to measure dietary intake for research and CVD risk factors surveillance in Bangladesh. The instrument may not be appropriate for monitoring population adherence to recommended intakes because of the overestimation.
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http://dx.doi.org/10.1186/s12937-020-00563-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227307PMC
May 2020

A comparative neurobehavioral study of sesame oil and fish oil on experimental animals.

Pak J Pharm Sci 2020 Mar;33(2):511-521

Saidu Medical College, Swat, Khyber Pakhtunkhwa, Pakistan.

Natural oils are enriched with polyunsaturated fatty acids (PUFAs) which are important for our health. Recent experimental data explained that PUFAs might have a beneficial effect on various brain functions such as anxiety, dementia, epileptic seizures, depression or bipolar and other neurobehavioral diseases. The objective of the current research work was to evaluate the effect of sesame oil, fish oil and mixture of both oils (1:1) on neurobehavioral changes and cognition. For this purpose shark fish oil and sesame oil were extracted out and there poly unsaturated and saturated fatty acids were analyzed by using GCFID that exposed the presence of different PUFs in shark fish oil, sesame oil and mixture of both oils. Neurobehavioral changes were seen after 5ml/kg/day sesame oil, 5ml/kg/day shark fish oil and 1:1 combination of both oil 5ml/kg/day administration on open field, cage crossing, light and dark, stationary rod, forced swimming induced depression test and water maze test. Our GCFID results showed sesame and fish oil enriched with higher amount of PUFs and showed significant anxiolytic and antidepressant like effect after 30 days of treatment (P<0.05) however combination of these both oils exhibited greater efficacy (P<0.01) in reducing anxiety and depression as imipramine standard drug. Results showed that combination of both oils (sesame oil and fish oil) could be a better option to treat neurobehavioral problems as compared to alone.
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March 2020

Risk of diabetic foot ulcer and its associated factors among Bangladeshi subjects: a multicentric cross-sectional study.

BMJ Open 2020 02 28;10(2):e034058. Epub 2020 Feb 28.

Biochemistry and Cell Biology, Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Objective: To assess the risk of diabetic foot ulcer (DFU) and find out its associated factors among subjects with type 2 diabetes (T2D) of Bangladesh.

Design, Setting And Participants: This cross-sectional study recruited 1200 subjects with T2D who visited 16 centres of Health Care Development Project run by Diabetic Association of Bangladesh.

Primary And Secondary Outcome Measures: Risk of DFU was assessed using a modified version of International Working Group on the Diabetic Foot (IWGDF) Risk Classification System. The modified system was based on five parameters, namely peripheral neuropathy (PN), peripheral arterial diseases (PAD), deformity, ulcer history and amputation. The risks were categorised as group 0 (no PN, no PAD), group 1 (PN, no PAD and no deformity), group 2A (PN and deformity, no PAD), group 2B (PAD), group 3A (ulcer history) and group 3B (amputation). The associated factors of DFU risk were determined using multinomial logistic regression for each risk category separately.

Results: Overall, 44.5% of the subjects were found 'at risk' of DFU. This risk was higher among men (45.6%) than women and among those who lived in rural areas (45.5%) as compared with the urban population. According to IWGDF categories, the risk was distributed as 55.5%, 4.2%, 11.6%, 0.3%, 20.6% and 7.9% for group 0, group 1, group 2A, group 2B, group 3A and group 3B, respectively. The associated factors of DFU (OR >1) were age ≥50 years, rural area, low economic status, insulin use, history of trauma, diabetic retinopathy and diabetic nephropathy.

Conclusion: A significant number of the subjects with T2D under study were at risk of DFU, which demands an effective screening programme to reduce DFU-related morbidity and mortality.
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http://dx.doi.org/10.1136/bmjopen-2019-034058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050319PMC
February 2020

Seasonal Variations in Physical Activity Domains among Rural and Urban Bangladeshis Using a Culturally Relevant Past Year Physical Activity Questionnaire (PYPAQ).

J Environ Public Health 2019 13;2019:2375474. Epub 2019 Oct 13.

School of Science and Health, Western Sydney University, Sydney 2751, Australia.

While the effect of weather and seasons on physical activity (PA) is well documented for leisure-time physical activities in western countries, scant information is available for developing countries where lifestyle PA is the major source of energy expenditure (EE). In Bangladesh, the traditional calendar divides the year to six seasons that last two months each: summer, rainy, autumn, late autumn, winter, and spring. We developed the Past Year Physical Activity Questionnaire to record culturally relevant physical activities and to help assess the seasonal variation in total and domain-specific PA in Bangladesh. We have applied this tool to 162 men and women aged 18-60 years residing in Dhaka city and in the northern rural district of Thakurgaon. Repeated measures analysis of variance (RMANOVA) was used to test for evidence of variation in PA between place and seasons. The age- and gender-adjusted model revealed significantly lower levels of EE in urban residents compared to rural residents across all seasons and domains. We also found evidence of seasonal variations in moderate-to-vigorous physical activity (MVPA) MET-min/weekamong rural participants only; for total PA (ranging from 3192 in autumn to 4124 in winter; = 0.0001) and for two domains: the occupation domain (ranging from 935 in autumn to 1645 in winter; = 0.0001) and the leisure time domain(ranging from 229 in late autumn to 272 in rainy season; = 0.005). Seasonality in gardening was also noted (ranging from 2.46 in late autumn to 29.28 in rainy season; = 0.0001). There were no seasonal differences of total and domain-specific MVPA in urban except household-related PA. Among rural participants, PA was higher in the summer, rainy, and winter seasons and lower in autumn and late autumn. The most common leisure-time physical activities were walking, bicycling, and swimming with higher participation in the rural area. Leisure-time physical activity needs to be promoted to urban residents all year long but more focused on autumn, late autumn, and spring in rural areas.
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http://dx.doi.org/10.1155/2019/2375474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815625PMC
March 2020

Type 2 diabetes mellitus in Bangladesh: a prevalence based cost-of-illness study.

BMC Health Serv Res 2019 Aug 27;19(1):601. Epub 2019 Aug 27.

Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Rd., Level 4, Melbourne, VIC, 3004, Australia.

Background: The economic burden of type 2 diabetes has not been adequately investigated in many low- and lower middle-income countries, including Bangladesh. The aim of this study was to estimate the cost-of-illness of type 2 diabetes and to find its determinants in Bangladesh.

Methods: A cross-sectional study was conducted in 2017 to recruit 1253 participants with type 2 diabetes from six diabetes hospitals, providing primary to tertiary health care services, located in the northern and central regions of Bangladesh. A structured questionnaire was used for face-to-face interviewing to collect non-clinical data. Patients' medical records were reviewed for clinical data and hospital records were reviewed for hospitalisation data. Cost was calculated from the patient's perspective using a bottom-up methodology. The direct costs for each patient and indirect costs for each patient and their attendants were calculated. The micro-costing approach was used to calculate direct cost and the human capital approach was used to calculate indirect cost. Median regression analysis was performed to identify the determinants of average annual cost.

Results: Among the participants, 54% were male. The mean (±SD) age was 55.1 ± 12.5 years and duration of diabetes was 10.7 ± 7.7 years. The average annual cost was US$864.7 per patient. Medicine cost accounted for 60.7% of the direct cost followed by a hospitalisation cost of 27.7%. The average annual cost for patients with hospitalisation was 4.2 times higher compared to those without hospitalisation. Being females, use of insulin, longer duration of diabetes, and presence of diabetes complications were significantly related to the average annual cost per patient.

Conclusions: The cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalisation costs. Optimisation of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost.
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http://dx.doi.org/10.1186/s12913-019-4440-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712789PMC
August 2019

Burden of macro- and micro-vascular complications of type 2 diabetes in Bangladesh.

Diabetes Metab Syndr 2019 Mar - Apr;13(2):1615-1622. Epub 2019 Mar 8.

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address:

Objective: The aim was to estimate the burden of macro- and micro-vascular complications on hospitalisation and healthcare cost among people with type 2 diabetes mellitus in Bangladesh.

Methods: A cross-sectional study was carried out in 2017. A total of 1253 patients were recruited from six hospitals. Information related to cost and complications of type 2 diabetes were collected. Multiple logistic and non-parametric regression analyses were performed to evaluate the effect of complications on hospitalisation and average annual cost.

Results: Overall, 63.4% of the participants had complications of which 14.8% and 20.7% had macro- and micro-vascular complications respectively and 27.9% had both. Use of insulin, presence of both hypertension and dyslipidaemia, coronary artery diseases, stroke, nephropathy, and retinopathy were significantly associated with hospitalisation. Further, use of oral hypoglycaemic agent with a combination of insulin, presence of coronary artery diseases, stroke, nephropathy, and retinopathy increased the average annual cost.

Conclusion: The prevalence of macro- and micro-vascular complications were very high in Bangladesh and majority of them are key drivers for hospitalisation and increased healthcare cost. An improvement of primary prevention strategy for complications is urgently needed which in turn will reduce the long-term healthcare cost for type 2 diabetes in Bangladesh.
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http://dx.doi.org/10.1016/j.dsx.2019.03.001DOI Listing
December 2019

Glycaemic Control for People with Type 2 Diabetes Mellitus in Bangladesh - An urgent need for optimization of management plan.

Sci Rep 2019 07 15;9(1):10248. Epub 2019 Jul 15.

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.

Aims: The objective of this study was to identify the determinants of glycaemic control among people with type 2 diabetes mellitus in Bangladesh. A cross-sectional study was carried out during March to September 2017, and 1253 adult patients with type 2 diabetes mellitus were recruited from six hospitals. Data were collected from patients via face-to-face interview, and their medical records were reviewed. Multiple logistic regression analysis was performed. Among the participants, 53.2% were male. Mean (±SD) age was 54.1 (±12.1) years and mean (±SD) duration of diabetes was 9.9 (±7.2) years. About 82% participants had inadequate glycaemic control (HbA1c ≥ 7%) and 54.7% had very poor control (HbA1c ≥ 9%). Low education level, rural residence, unhealthy eating habits, insulin use, infrequent follow up check-ups and history of coronary artery diseases found associated with inadequate and very poor controls. Being female and smokeless tobacco consumer appeared to be associated with inadequate control however cognitive impairment was associated with very poor control only. Prevalence of inadequate glycaemic level was very high in Bangladesh. Having understood relatable lifestyle modification factors, demographics and co-morbidities among people with type 2 diabetes, health care providers in conjunction with patients should work together to address the glycaemic control.
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http://dx.doi.org/10.1038/s41598-019-46766-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6629620PMC
July 2019

Atherogenic index of plasma and its association with cardiovascular disease risk factors among postmenopausal rural women of Bangladesh.

Indian Heart J 2019 Mar - Apr;71(2):155-160. Epub 2019 May 3.

Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences (BUHS), 125/1 Darus Salam, Mirpur-1, Dhaka 1216, Bangladesh. Electronic address:

Objectives: There is absolute lacking of evidences on atherogenic index of plasma (AIP) and its association with cardiovascular disease (CVD) risk factors among postmenopausal women of Bangladesh. This prompted us to investigate this association between AIP and CVD risk factors among postmenopausal women in a rural setting.

Methods: This cross-sectional study recruited 265 postmenopausal women aged 40-70 years who visited a primary health-care center of Bangladesh. We used modified STEP-wise approach for the Surveillance of Noncommunicable diseases risk factors questionnaire of the World Health Organization to collect data on sociodemographic and behavioral risk factors. Physical measurements were carried out following the method described in the 'noncommunicable disease risk factors survey Bangladesh 2010'. AIP was determined by the logarithmic transformation of triglyceride to high-density lipoprotein ratio, and association with CVD risk factors were examined by multiple linear regression analysis.

Results: Overall 35.5% respondents had a high risk level of AIP with a mean of 0.16 ± 0.25. After adjusting the confounders, CVD risk factors including duration of menopause (β = 0.606, p = 0.043), waist-hip ratio (β = 0.165, p = 0.003), 2-h plasma glucose (β = 0.118, p = 0.04), total cholesterol (β = 1.082, p < 0.001), low-density lipoprotein cholesterol (β = -1.044, p < 0.001), and metabolic equivalent of tasks (β = -0.171, p = 0.003) showed a significant association with AIP.

Conclusion: High AIP and its significant association with CVD risk factors demand proper lifestyle intervention for postmenopausal women of Bangladesh.
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http://dx.doi.org/10.1016/j.ihj.2019.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620423PMC
January 2020

Agreement between 2017 ACC/AHA Hypertension Clinical Practice Guidelines and Seventh Report of the Joint National Committee Guidelines to Estimate Prevalence of Postmenopausal Hypertension in a Rural Area of Bangladesh: A Cross Sectional Study.

Medicina (Kaunas) 2019 Jun 26;55(7). Epub 2019 Jun 26.

Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, 125/1 Darus Salam, Mirpur-1, Dhaka-1216, Bangladesh.

Justification for application of 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines to detect hypertension (HTN) among Bangladeshi population is understudied. This prompted us to examine the level of agreement between 2017 ACC/AHA and Joint National Committee 7 (JNC 7) guidelines to detect postmenopausal HTN in a rural area of Bangladesh. This cross-sectional study recruited 265 postmenopausal women of 40-70 years of age who visited a rural primary health care centre of Bangladesh. HTN was diagnosed based on two definitions: the JNC 7 guidelines (SBP ≥ 140 or DBP ≥ 90 mmHg), and the 2017 ACC/AHA guidelines (SBP ≥ 130 mmHg, or DBP ≥ 80 mmHg). The prevalence of postmenopausal HTN, its sub-types and stages were reported and compared using frequency and percentage. Agreement was evaluated using Cohen's Kappa (κ), Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) and First-order Agreement Coefficient (AC1). The prevalence of postmenopausal HTN was 67.5% and 41.9% using 2017 ACC/AHA and JNC 7 guidelines respectively. Among the HTN sub-types and stages, the new 2017 ACC/AHA guideline classified higher proportion of respondents as having isolated systolic hypertension (ISH) (42.6%) and stage 2 HTN (35.8%) compared to JNC 7 (28.7% and 6.8% respectively). On the other hand, the JNC 7 guideline identified more respondents as pre-hypertensive (32.5%) when compared with the 2017 ACC/AHA guideline (3.8%). Between two guidelines, highest agreement was observed for ISH (86.03%) and those had pre-hypertension/elevated blood pressure (71.3%). Similarly, Landis & Koch's approach detected highest agreement for ISH (κ = 0.74, substantial; PABAK = 0.76, substantial; AC1 = 0.84, excellent; p < 0.001) and pre-hypertension/elevated blood pressure (κ= 0.12, slight; PABAK = 0.42, moderate; AC1 = 0.83, excellent; p < 0.001). The 2017 ACC/AHA HTN guideline reported high agreement and detected more participants as hypertensive when compared with JNC 7 guideline for Bangladeshi postmenopausal women that demands further large-scale study in general population to clarify the current findings more precisely.
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http://dx.doi.org/10.3390/medicina55070315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681048PMC
June 2019

Concordance between two versions of world health organization/international society of hypertension risk prediction chart and framingham risk score among postmenopausal women in a rural area of Bangladesh.

Indian J Public Health 2019 Apr-Jun;63(2):101-106

Honorary Professor, Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Background: Prevention of cardiovascular disease (CVD) among postmenopausal women with limited resource is a great challenge for a country like Bangladesh.

Objectives: This study aimed to evaluate the level of agreement among different risk prediction tools to find out the cost-effective and suitable one that can be applied in a low-resource setting.

Methods: This was a cross-sectional study conducted from February through December 2016 among 265 postmenopausal women of 40-70 years age. Data were collected from the outpatient department of a rural health-care center situated in the village Karamtola of Gazipur district, Bangladesh. The CVD risk was estimated using the World Health Organization/International Society of Hypertension (WHO/ISH) "with" and "without" cholesterol risk charts and the Framingham Risk Score (FRS). Concordance among the tools was evaluated using Cohen's kappa (κ), prevalence-adjusted bias-adjusted kappa (PABAK), and first-order agreement coefficient (AC1).

Results: The "without" cholesterol version showed 79% concordance against the "with" cholesterol and 75.4% concordance against the FRS. In between the WHO/ISH risk charts, slight-to-substantial levels of agreement (κ = 0.14, PABAK = 0.58, and AC1 = 0.72; P = 0.023) were observed. With FRS, the "without" cholesterol version showed higher agreement (κ = 0.38, fair; PABAK = 0.50, moderate; and AC1 = 0.60, moderate; P = 0.000) compared to "with" cholesterol version (κ = 0.13, slight; PABAK = 0.30, fair; and AC1 = 0.44, moderate; P = 0.013). Predictability of CVD risk positive (≥10%) cases was similar for both the versions of WHO/ISH risk charts.

Conclusion: In a low-resource setting, the "without" cholesterol version of WHO/ISH risk chart is a good option to detect and target the population with high CVD risk.
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http://dx.doi.org/10.4103/ijph.IJPH_178_18DOI Listing
December 2019

Prevalence of cardiovascular disease risk factors: A community-based cross-sectional study in a peri-urban community of Kathmandu, Nepal.

Indian Heart J 2018 Dec 10;70 Suppl 3:S20-S27. Epub 2018 Mar 10.

Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Background: As a low-income country, Nepal is experiencing cardiovascular diseases as an emerging health problem. However, studies are lacking on the risk factors of cardiovascular diseases in peri-urban communities; where the socio-demographical transition is in progress. Therefore, this study aimed to identify the prevalence and socio-demographic distribution of cardiovascular disease risk factors in one of the peri-urban communities in Kathmandu, Nepal.

Methods: We conducted a cross-sectional study in Sitapaila Village Development Committee, Kathmandu from February 2014 to February 2015. Altogether, 347 adults from 18 to 70 years of age were selected randomly. Data were collected through modified WHO STEPS questionnaire for non-communicable disease (NCD) risk factors survey and analyzed in SPSS V.16.0 software.

Results: Mean age of the participant was 42.5 ± 13.2 years. Majority of them were female (n = 206; 59.4%), one-third (34%) represented Brahman and Chetri, and over a quarter (29.1%) did not attend school. Cardiovascular disease risk factors included smoking (17.6%), alcohol consumption (29.4%), insufficient fruit and vegetables intake (98%), insufficient physical activity (21.0%), obesity (15.3%), hypertension (34.4%), diabetes (10.5%), and high triglyceride levels (10.8%). They were significantly associated with different socio-demographic characteristics: smoking with gender, age groups and education level; alcohol consumption was with gender, age groups, ethnicity and occupation; insufficient physical activity with gender, age groups and occupation; hypertension with gender, age groups, ethnicity, education level and occupation.

Conclusion: A high prevalence of cardiovascular disease risk factors and their disproportional distribution among the study population indicated an inevitable risk of cardiovascular events in near future.
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http://dx.doi.org/10.1016/j.ihj.2018.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309148PMC
December 2018

Physical activity levels and associated cardiovascular disease risk factors among postmenopausal rural women of Bangladesh.

Indian Heart J 2018 Dec 19;70 Suppl 3:S161-S166. Epub 2018 Sep 19.

Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences (BUHS), 125/1 Darus Salam, Mirpur-1, Dhaka, 1216, Bangladesh. Electronic address:

Objectives: The role of physical inactivity in relation to cardiovascular disease (CVD) among postmenopausal women is understudied. The main objective of this study was to measure the physical activity levels (PALs) and evaluate its relation to other CVD risk factors among postmenopausal rural women of Bangladesh.

Methods: A cross-sectional study was conducted among 265 postmenopausal women aged 40-70 years who visited the outpatient department of a primary health-care center situated in the village Karamtola of Gazipur district. A pretested modified questionnaire of STEP-wise approach to Surveillance (STEPS) of noncommunicable disease risk factors was used to collect data on sociodemographic and lifestyle factors. PAL was determined by the Estimated Energy Requirement (EER) equation of the Dietary Reference Intakes (DRIs) Committee, and association with CVD risk factors was examined by Spearman's rank correlation.

Results: More than half (58.1%) of the postmenopausal women were identified as sedentary with high prevalence of central obesity (73.2%) among them. CVD risk factors including age (r = -0.228, p < 0.01), age at menopause (r = -0.129, p < 0.05), duration of menopause (r = -0.183, p < 0.05), 2-h plasma glucose (r = -0.148, p < 0.05), total cholesterol (r = -0.138, p < 0.05), low-density lipoprotein cholesterol (r = -0.122, p < 0.05), and triglyceride (r = -0.168, p < 0.01) showed a significant as well as inverse association with Metabolic Equivalent of Task (MET) of physical activity.

Conclusion: Low PAL and significant inverse correlation with various CVD risk factors demand interventions to maintain higher PAL among postmenopausal women of Bangladesh.
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http://dx.doi.org/10.1016/j.ihj.2018.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309711PMC
December 2018

Developing a frame of reference for fisheries management and conservation interventions.

Fish Res 2018 Dec;208:296-308

Department of Zoology, University of Oxford, Oxford, UK.

Effective implementation of management interventions is often limited by uncertainty, particularly in small-scale and developing-world fisheries. An effective intervention must have a measurable benefit, and evaluation of this benefit requires an understanding of the historical and socio-ecological context in which the intervention takes place. This context or 'frame of reference' should include the baseline status of the species of interest, as well as the most likely counterfactual (a projected scenario indicating what would have occurred in the absence of the intervention), given recent trends. Although counterfactuals are difficult to estimate and so are not widely specified in practice, an informative frame of reference can be developed even in data-poor circumstances. We demonstrate this using a case study of the Bangladesh hilsa () fishery. We combine qualitative and some quantitative analyses of secondary datasets to explore ecological trends in the hilsa fishery, as well as patterns of social, economic, institutional, and physical change relevant to its management over the last ∼50 years. We compile all available information on the key parameters that determine hilsa abundance and distribution (movement, reproduction, growth, and mortality), as well as all available information on stock status. This information is used to produce a baseline and qualitative counterfactual which can be used to guide decision-making in this complex, data-poor fishery. A frame of reference provides a systematic way to break down potential drivers of change in a fishery, including their interactions, reducing the potential for unexpected management outcomes. Critical evaluation of contradictions and commonalities between a set of potential counterfactuals, as well as the reliability of sources, allows the identification of key areas of uncertainty and information needs. These can then be incorporated into fisheries management planning.
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http://dx.doi.org/10.1016/j.fishres.2018.08.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179125PMC
December 2018

Evaluating the ecological and social targeting of a compensation scheme in Bangladesh.

PLoS One 2018 13;13(6):e0197809. Epub 2018 Jun 13.

Department of Zoology, University of Oxford, Oxford, United Kingdom.

Conservation payments are increasingly advocated as a way to meet both social and ecological objectives, particularly in developing countries, but these payments often fail to reach the 'right' individuals. The Government of Bangladesh runs a food compensation scheme that aims to contribute to hilsa (Tenualosa ilisha) conservation by improving the socioeconomic situation of households affected by hilsa sanctuary fishing bans. Analysing data from a household survey of compensation recipients and non-recipients, we identify the current correlates of compensation distribution and explore perceptions of fairness in this distribution. We find that distribution is largely spatial rather than based on the household characteristics that are supposed to determine eligibility for compensation, indicating political influence in the distribution process. We also find the compensation scheme is widely perceived to be unfair, which could be undermining its potential to compensate vulnerable fishers while improving compliance with fishing bans. The spatial distribution of compensation would shift substantially under alternative targeting scenarios that are likely to improve the cost-effectiveness of the scheme, such as targeting those who are most dependent on fishing for their livelihood. This study highlights a challenge for conservation payment schemes that aim to achieve the dual objectives of poverty reduction and ecological sustainability, particularly large-scale public schemes, and suggests that more effective targeting and transparency about the basis of payment distribution are prerequisites for schemes to be both cost-effective and socially acceptable.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197809PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999081PMC
December 2018
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