IntroductionChikungunya is an arthropod-borne virus endemic to Africa, Southeast Asia and India that causes acute febrile polyarthralgia and arthritis. In this short case series, we discuss six Bangladeshi patients with chikungunya fever. Though Bangladesh is in endemic zone, it is not common here, hence it demands attention for proper diagnosis and management.Case presentationThe six cases of chikungunya we report occurred in native Bangladeshi women with ages ranging from 20 to 50 years and all having a middle class family background. Three women had severe incapacitating arthralgia as well as a maculo-papular rash and a high fever. The other three had a high grade fever and arthralgia only, but no rash. They were tested for chikungunya immunoglobulin M antibody and found to be positive in all cases. They were treated symptomatically with non-steroidal anti-inflammatory drugs and found responsive in most cases.ConclusionFrom this case series, it is evident that chikungunya is not that uncommon in Bangladesh. But the concomitant presence of other arthropod-borne infections with similar courses of illness makes most physicians less aware of this infection. An awareness and clinical knowledge are necessary to diagnose chikungunya infection properly.

Abstract.From April to September 2017, Bangladesh experienced a huge outbreak of acute Chikungunya virus infection in Dhaka. This series describes the clinical and laboratory features of a large number of cases (690; 399 confirmed and 291 probable) suffered during that period. This observational study was carried out at Dhaka Medical College Hospital, Bangladesh. The median age of the patients at presentation was 38 years (IQR 30–50) with a male (57.3%) predominance. Hypertension and diabetes were the most common comorbidities. The mean (±SD) duration of fever was 3.7 (±1.4) days. Other common manifestations were arthralgia (99.2%), maculopapular rash (50.2%), morning stiffness (49.7%), joint swelling (48.5%), and headache (37.6%). Cases were confirmed by anti-chikungunya IgG (173; 43.3%), IgM (165; 42.3%), and reverse transcription polymerase chain reaction (44; 11.0%). Important laboratory findings include high erythrocyte sedimentation rate (156; 22.6%), raised serum glutamic pyruvic transaminase (73; 10.5%), random blood sugar (54; 7.8%), leukopenia (72; 10.4%), thrombocytopenia (41; 5.9%), and others. The oligo-articular (453; 66.1%) variety of joint involvement was significantly more common compared with the poly-articular (237; 34.5%) variety. Commonly involved joints were the wrist (371; 54.1%), small joints of the hand (321; 46.8%), ankle (251; 36.6%), knee (240; 35.0%), and elbow (228; 33.2%). Eleven cases were found to be complicated with neurological involvement and two of them died. Another patient died due to myocarditis. Public health experts, clinicians, and policymakers could use the results of this study to construct the future strategy tackling chikungunya in Bangladesh and other epidemic countries.

Introduction: The outbreak of COVID-19 is taking an unprecedented mental toll on health workers worldwide. So it comes as no surprise that the mental well-being of health care workers of Bangladesh too is in serious jeopardy. This survey was aimed to assess the immediate psychological impact on doctors working in largest Covid-19 dedicated facility in Bangladesh, Dhaka Medical College Hospital. Methods: This cross sectional study was conducted in a single-centre with response received from participating doctors between 31st May to 3rd June, 2020. Mental health variables were assessed via the Athens Insomnia Scale (AIS) and Hospital Anxiety Depression Score (HADS). Results: We received 192 completed questionnaires (response rate, 64.43%) among whom around 50% of the participating doctors reportedly have depression and anxiety symptoms respectively. Among them 104 doctors (54.17%) responded to have insomnia. Around 56% of the responding subjects perceived the highly contagious nature of the SARS-CoV-2 as the most striking threat of COVID-19. Conclusion: Agonizing disease process, high death toll, highly contagious nature of the responsible virus is taking a serious mental toll on physicians in the background of their heightened concern about personal health and family health, scarcity in PPE and adequate hospital facility. Psychological protective measures implemented by the hospital could be helpful. J Bangladesh Coll Phys Surg 2020; 38(0): 50-55

Background: Diabetes mellitus is responsible for significant morbidity and mortality around the world though there is huge development regarding its treatment. Many studies showed that functional health literacy has a great impact on diabetes outcome. The study assessed the relationship between functional health literacy and glycemic control in a sample of urban diabetic patients. Materials and methods: A cross-sectional study was conducted in Bangladesh University of Health and Science Hospital, Jurain, Dhaka from January to December 2014 that included adult diabetic patients on the basis of defined selection criteria following the purposive sampling method. Functional health literacy was assessed with the short form Test of the Functional Health Literacy in Adults (s-TOFLA). Recent HbA1c was used as a measure of glycemic control and categorized into tight, fair and inadequate glycemic control. Regression models were controlled for demographic data, diabetes duration, treatment regimen, diabetes knowledge and assistance for taking medications. Results: Following the s-TOFLA scale, 60.5% of the diabetic patients had inadequate functional health literacy of them, 89.3% had inadequate glycemic control (HbA1c>8%). And those who had adequate functional health literacy (24%) of them 68.8% had tight glycemic control (HbA1c≤7%). Overall 63.0% of the respondents had inadequate glycemic control. In linear regression model low s-TOFLA scores, longer diabetes duration and lack of assistance for taking medications were associated with higher levels of HbA1c. In fully adjusted model s-TOFLA score was the variable which was more strongly associated with HbA1c (β = -0.60, P<0.001). Conclusions: The study found that low health literacy is consistently associated with inadequate glycemic control. J MEDICINE JUL 2019; 20 (1) : 19-24

Objective: To assess associations between codon 72 polymorphisms (Pro or B and Arg or b alleles) of the TP53 gene and lung cancer risk among Bangladeshis. Materials and Methods: The distribution of the BB, Bb, and bb genotypes and the frequencies of the B and b alleles were determined by PCR-RFLP method using DNA extracted from leucocytes of 50 confirmed lung cancer patients and 50 age-matched controls and the data were analysed. Results: The ratio of BB, Bb, and bb genotypes were in Hardy-Weinberg equilibrium except for the male patients (χ2=4.6). The B allele is overrepresented among all patients (OR=2.0, p=0.02) and the female patients (OR=4.1, p≤0.01) compared to the controls. The BB/bb ratio was also higher among the patients (OR=3.0, p=0.03). The relative risk of cancer for having BB over bb genotype was 1.8 (p=0.04) but no effect was observed for the Bb genotype. The B allele was overrepresented among patients with adenocarcinomas (OR=2.4, p≤0.01) and squamous cell carcinomas (OR=2.7, p≤0.01) over the controls but the difference was not significant for those with small cell lung carcinomas (OR=1.1, p=0.66). The B allele was overrepresented among patients age 50 or younger (OR=2.7, p≤0.01), but not for older patients (OR=1.7, p=0.07), and among smokers compared to the controls (OR=1.8-10.0, p≤0.01-0.03). However, no correlation between increasing pack-years and lung cancer was observed. Conclusions: The Pro/Pro (BB) genotype and the B allele are risk factors for lung cancer among Bangladeshis, particularly for people under age 50, women and smokers.