Shahid Syed Nazrul Islam Medical College

Background:Bronchiolitis remains the commonest acute lower respiratory tract infection in younger children globally. Bronchiolitis is often misdiagnosed as World Health Organization (WHO)-classified pneumonia due to closely related clinical manifestations. Our primary objective was to assess the prevalence of viral bronchiolitis among WHO-classified pneumonia, and the secondary objective was to evaluate their management. Methods:This was a prospective observational study. Infants (aged <2 years) suffering from WHO-classified pneumonia attending the country's largest academic paediatric hospital 'Bangladesh Shishu Hospital and Institute', Dhaka, during July 2020 through June 2021 were enrolled (n = 60) following systematic sampling (every second child). We revalidated all infants meeting the inclusion criteria (cough, fast breathing and/or chest in-drawing) for bronchiolitis assessment using clinical, radiological, haematological, biochemical, and microbiological analyses. Nasopharyngeal aspirate (NPA) was subjected to polymerase chain reaction (PCR) assay for respiratory syncytial virus (RSV), influenza A, and influenza B viruses. Clinical features, treatment modalities, mode of discharge, and length of hospital stay (LOS) were subjected to differentiate bronchiolitis from WHO-classified pneumonia. Results:PCR of NPA of 60 WHO-classified pneumonia cases yielded RSV in 41 (68%) who had pertinent clinical symptoms and signs suggestive of bronchiolitis, attested by benign chest radiography (85%). Further, their mean (x̄) and standard deviation (SD) complete blood count (x̄ = 15,488; SD = 1874/cm) with x̄ = 36% (SD = 11) neutrophil) and C-reactive protein (x̄ = 4.49 (5.88) mg/L cut off reference value >5 mg/L) were indicative more as non-bacterial infections favouring RSV bronchiolitis. In contrast, all 19 non-RSV cases did not differ in clinical findings, as attested by haematological, microbiological and radiographical features, suggesting bronchiolitis-like illness, further supported by disease outcome, discharge pattern and LOS (x̄ = 4.7; SD = 2.29) days). Nevertheless, antibiotics were given in 95% of all 60 cases. Conclusions:There was a high proportion of bronchiolitis among WHO-classified pneumonia, and antimicrobials were prescribed to treat those cases. The findings need the attention of policymakers to address the overlap between WHO-classified pneumonia and bronchiolitis and minimise the potential overuse of antibiotics.

Since the first detection of dengue in 2000, Bangladesh has been facing an increasing number of dengue patients and related deaths every year. This situation warrants the importance of quickly identifying severe dengue patients to expedite necessary medical interventions which could potentially reduce the adverse consequences. The aim of this study was to identify clinical features and laboratory parameters of the severe dengue patients in the 2023 dengue outbreak in Bangladesh. This hospital based cross-sectional study included the demographic, clinical and laboratory data of 1313 Dengue patients from several secondary and tertiary hospitals across Bangladesh from August 2023 to December 2023. According to the 2009 WHO classification, dengue cases were classified into severe dengue and non-severe dengue (with and without warning signs). Chi-square test, Fischer’s exact test and multiple logistic regression analyses were conducted to identify potential risk factors associated with severe dengue cases. Of the 1313 patients included in this study, nearly 20

Background: Chronic kidney disease (CKD) is one of the leading causes of mortality and morbidity all over the world. On the other hand, metabolic syndrome has been reported to be associated with adverse renal outcomes. Among the components of metabolic syndrome, diabetes and hypertension are established causes of renal impairment. However, the association of Triglycerides (TGs), High density lipoprotein (HDL), and Waist Circumference (WC) with renal function independently remains understudied. Objectives: The objective of this study was to determine the association of triglycerides, HDL, waist circumference with estimated glomeruar filtration rate (eGFR). Materials and Methods: This cross-sectional study enrolled 100 subjects attending as outpatient in Ibn Sina Diagnostic Centre, Uttara from July 2023 to December 2023. Renal impairment was measured by estimated glomerular filtration rate (eGFR). The eGFR was calculated using the modified modification of diet in renal disease (MDRD) equation. Statistical analyses were performed by using SPSS 25.0 (Statistical Package for Social Science, Inc., Chicago, IL, USA). Continuous variables were expressed as means±standard deviation, and categorical variables as frequencies and proportions. The relationships between renal function with triglycerides, HDL and WC were assessed by correlation coefficient. A p-value <0.05 was considered significant. Results: Among 100 subjects the overall incidence of renal impairment is 13 (13%). Waist Circumference (WC) and high Triglyceride (TG) have inverse relation with eGFR means significant association in developing renal impairment. Conclusion: This study suggests triglyceride and central obesity progress with renal impairment. Therefore, early monitoring and management of triglycerides and central obesity in CKD patients may help in decreasing the progression of the disease and, hence, mortality in CKD patients. EWMCJ Vol. 12, No. 1&2, January-July 2024: 4-8

Introduction: Lockdown measures in response to the COVID-19 pandemic had an appreciable impact on the education of all medical, dental and non-medical healthcare professional students. These included the closure of universities necessitating a rapid move to e-learning and a new practical approach to conducting teaching-learning classes. However, initially, there was a lack of knowledge and expertise regarding e-learning approaches and the affordability of internet bundles and equipment. Materials and Methods: We conducted two pilot studies to assess such current challenges, replaced by a two-stage approach including a full investigation involving 32 private and public universities during the early stages of the pandemic, followed by a later study assessing the current environment brought about by the forced tops. Results: The top challenges at the start of the pandemic included a lack of familiarity with the e-learning approaches, the cost of the internet, a lack of IT equipment and the quality of the classes. To address identified challenges, universities offered support to staff and students. Since then, e-learning approaches have widened the possibilities for teaching and learning at convenient times. However, challenges remain. Conclusions: There were considerable challenges at the start of the pandemic. Several key issues have been addressed with hybrid learning here to stay. The remaining challenges include a lack of ICT equipment. However, new innovations will continue.

Background: Detection of aberrancies in newly diagnosed Acute Myeloid Leukaemia (AML) patients by flow cytometry is of diagnostic and prognostic importance. This study assessed the frequency of expression of aberrant Immunophenotype in newly diagnosed AML patients. Objectives: To assess the frequency of expression of aberrant immunophenotype in patients with acute myeloid leukaemia. Method: This observational cross-sectional study was conducted in the Department of Haematology, BSMMU, Dhaka, for 12 months duration following ethical approval. Total 100 newly diagnosed AML patients were analysed by multiparametric flow cytometry using a panel of monoclonal antibodies. Antigen expression was rated as positive when the percentage of positive blast cells was ?20%. Result: Aberrant lymphoid markers were found in 56% AML cases, wherein 26% had B-cell markers only, 23% had T-cell markers only and 7% had presence of both T-cell and B-cell markers. CD7 (23%) was the most common aberrant marker, followed in decreasing order CD10 (22%), CD19 (11%), CD4 (6%), CD2 (4%) and CD20 (1%). Conclusion: More than half of AML patients had aberrant lymphoid phenotypes. Though aberrance of B-cell markers and T-cell markers are almost same, CD7 was the most common aberrant immunophenotype expressed in AML patients. Further study can be undertaken to correlate prognostic and therapeutic response with these aberrancies.