Enam Medical College & Hospital (EMCH) (Bengali: এনাম মেডিকেল কলেজ ও হাসপাতাল) is a private medical school in Bangladesh, established in 2003. It is located in Savar, Dhaka. It is affiliated with University of Dhaka as a constituent college.
Background:Multidrug-resistant tuberculosis (MDR-TB) remains a major public health challenge in South Asia, which bears a disproportionate global burden. Comprehensive, longitudinal analyses of MDR-TB mortality trends, stratified by country and sex, with forward-looking projections are limited. Methods:We conducted a retrospective analysis using data from the Global Burden of Disease Study 2023 to examine age-standardized mortality rates (ASMR) attributable to MDR-TB in South Asia and its countries (Bangladesh, Bhutan, India, Nepal, Pakistan) from 1990 to 2023. Trends were assessed by sex, and estimated annual percentage changes (EAPC) were calculated via log-linear regression. Seasonal Autoregressive Integrated Moving Average (SARIMA) models were employed to forecast ASMR through 2050, with 95% prediction intervals. Results:Regional ASMR rose from 0.25 per 100,000 (95% UI: 0.03-0.88) in 1990 to a peak of 6.34 (95% UI: 2.56-13.56) in 2010, declining to 3.63 (95% UI: 0.54-9.80) by 2023, driven predominantly by India and Pakistan. Nepal exhibited consistent declines (EAPC: -2.44%; 95% CI: -3.21 to -1.66), while Pakistan showed the highest increase (EAPC: 6.16%; 95% CI: 3.21-9.19). Males consistently had higher ASMR across all settings. Forecasts suggest continued declines toward near-elimination in Bangladesh, Bhutan, and Nepal, but potential substantial rebounds in India, Pakistan, and regionally, with upper prediction intervals exceeding 20-40 per 100,000 by 2050 in high-burden scenarios. Conclusion:Despite progress in some countries, MDR-TB mortality remains elevated in populous nations, with persistent male excess. Projections highlight risks of resurgence without intensified interventions. These findings underscore the urgent need for tailored, gender-sensitive strategies and enhanced regional collaboration to achieve End TB targets in South Asia.
OBJECTIVE:This study was conducted to evaluate lasmiditan efficacy and cardiovascular (CV) safety in patients with CV risk factors, and provide an updated synthesis of observational evidence on long-term triptan-related CV outcomes. BACKGROUND:Approximately 20% of patients with migraine have CV contraindications to triptans. Lasmiditan, a selective 5-hydroxytryptamine (5-HT)1F receptor agonist without vasoconstrictive properties, may offer a safer alternative to triptans for these patients. METHODS:In this systematic review and meta-analysis, we systematically searched MEDLINE, Embase, Scopus, and Cochrane CENTRAL from inception to June 2025 following a retrospectively registered International Prospective Register of Systematic Reviews protocol (CRD420251208584). Primary outcomes were pain freedom at 2 h (efficacy; randomized controlled trials) and major adverse CV events (observational studies). Random-effects meta-analyses used odds ratios (ORs) for binary efficacy outcomes and hazard ratios for time-to-event safety data. Rare cardiac adverse events were analyzed using Peto ORs. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. RESULTS:Sixteen studies were included (six lasmiditan studies involving three randomized controlled trials [two phase 3 and one phase 2] enrolling 5126 participants, two post hoc analyses, one open-label extension, and 10 triptan CV safety studies). In the meta-analysis of three independent randomized controlled trials (eight dose-specific comparisons), lasmiditan significantly increased pain freedom at 2 h versus placebo (OR, 2.09; 95% confidence interval [CI], 1.66-2.63, p < 0.001; heterogeneity statistic (I2) = 58.9%; GRADE: high certainty), with clear dose-dependent effects (50 mg OR ≈ 1.50; 100 mg OR ≈ 2.0; 200 mg OR ≈ 2.60; subgroup p < 0.001) and number needed to treat of 4.1-15.4. Most bothersome symptom freedom was similarly improved (OR, 1.79; 95% CI, 1.45-2.22, p < 0.001; I2 = 54.5%; GRADE: high certainty). Observational triptan safety data (14 comparisons from 10 studies) showed apparent CV protection (hazard ratio, 0.82; 95% CI, 0.73-0.92), although certainty was very low due to confounding by indication, inconsistency (I2 = 82.4%), and comparator indirectness. Cardiac treatment-emergent adverse events were rare with lasmiditan (<1%; Peto OR, 3.14; 95% CI, 1.10-8.98, based on 14 total events; GRADE: low certainty), with zero vasoconstrictive CV events across all trials. Common adverse events included dizziness (risk ratio [relative risk] [RR], 5.71), somnolence (RR, 2.68), and paresthesia (RR, 5.02), all dose-dependent. CONCLUSIONS:Lasmiditan demonstrated efficacy and favorable CV safety in CV-risk populations, with no vasoconstrictive events detected across 5126 participants. Common central nervous system adverse effects, particularly dizziness, require careful patient counseling. The recent voluntary market withdrawal of lasmiditan underscores the need for continued development and evaluation of non-vasoconstrictive acute migraine treatments for patients with CV contraindications to triptans.
Anatomical changes during Head and Neck Cancer (HNC) radiotherapy can compromise target volume dose coverage and Organs at Risk (OARs) sparing. This study evaluated the volumetric, dosimetric, clinical, and cost-effectiveness impacts of Adaptive Radiotherapy (ART) in HNC patients treated with Three-Dimensional Conformal Radiotherapy (3D-CRT) and Con-Current Chemo-Radiotherapy (CCRT) in resource-limited settings. Fifteen patients with advanced HNC were treated using 3D-CRT with CCRT to a total dose of 70 Gray (Gy) in 35 fractions. A repeat Computed Tomography (re-CT) simulation was performed at 44 Gy due to anatomical changes such as weight loss and tumor shrinkage during the treatment. Adaptive plans were generated using the re-CT images. Pre- and re-CT simulation images were fused, and Planning Target Volumes (PTVs) from the initial and adaptive plans were compared to evaluate the volumetric changes. Adaptive plans were then compared with the initial plans using Dose-Volume Histograms (DVHs), and dosimetric variations in Gross Tumor Volume (GTV), Clinical Target Volume (CTV), and PTV were evaluated. Target coverage deterioration observed with 3D-CRT was mitigated by ART, resulting in improved coverage for both high- and low-dose target volumes compared with the accumulated planned dose. The mean body weight ratio was 0.88 (12
Background and Aims:Garment workers are exposed to long working hours, high output demands, and limited social support that increase vulnerability to psychological distress. However, their mental health conditions remain underexplored in Bangladesh. This study aimed to estimate the rates of depression, anxiety, and stress among Bangladeshi garment workers and sociodemographic and occupational factors associated with these outcomes. Methods:A cross-sectional study was conducted in Savar, Bangladesh, between March 2023 and December 2025. Data were collected through face-to-face interviews using a structured questionnaire from 281 adult garment workers. Psychological distress was assessed using the Bangla version of the Depression, Anxiety, and Stress Scale-21 (DASS-21). Bivariate and multivariate logistic regression analyzes were performed to identify factors associated with depression, anxiety, and stress. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and a p-value < 0.05 was considered statistically significant. Results:Overall, 58.7% of participants reported depressive symptoms, 73.6% reported anxiety symptoms, and 19.9% reported stress. Female workers had higher rates than males for all three outcomes. In multivariate analyzes, female sex was independently associated with higher odds of depression (AOR = 2.98) and anxiety (AOR = 2.90). Older age, longer duration of work, and higher monthly income were significantly associated with depression and anxiety. Stress was independently associated with older age, longer job tenure, substance abuse (AOR = 3.03), and higher income. Conclusion:Depression, anxiety, and stress are highly prevalent among garment workers in Bangladesh, with women and older, long-tenured workers disproportionately affected. The findings highlight the urgent need for workplace-based mental health screening, gender-sensitive interventions, stigma reduction, and accessible psychosocial support services to improve worker well-being and productivity.
Background: Hypertension is a major global health concern with significant perioperative implications. White coat hypertension (WCH) and coincidental hypertension (CH) are undiagnosed blood pressure patterns that affect surgical outcomes, sometimes causing unnecessary interventions or delays. This study determined the prevalence of WCH and CH during preoperative assessment at the BMU and associated clinical factors. Methods: This cross-sectional study was conducted at the department of anesthesia, analgesia and intensive care medicine, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from April 2024 to March 2025 among 2,084 adults who underwent elective surgery at the preoperative assessment unit (PAU). Patients ≥18 years were purposively sampled, blood pressure was measured, and patients were classified as known hypertensive, normotensive, or undiagnosed. Undiagnosed cases were followed up to pre-induction and categorized as white coat or coincidental hypertension. Data were analyzed using SPSS version 27.0. Results: Among the 2,084 preoperative patients, 445 (21.4%) were hypertensive, 1,561 (74.9%) were normotensive and 78 (3.7%) had previously undiagnosed hypertension, including 26 (33.3%) with white-coat hypertension and 52 (66.7%) with coincidental hypertension. Patients with coincidental hypertension were older, had more comorbidities, experienced more surgical cancellations (11.5% versus 0%; p=0.049), and had significantly higher systolic and diastolic blood pressure throughout the follow-up than those with white coat hypertension (all p<0.05). Conclusions: Undiagnosed hypertension is common in the preoperative setting, with coincidental hypertension being more prevalent than white coat hypertension and associated with higher perioperative risk and surgical postponement.
