Syndrome In Bangladesh Research Articles

Identifying the Risk Factors for Metabolic Syndrome in Bangladesh: Documented from a Nationwide Survey

Summary Metabolic syndrome is a complex of interrelated health conditions that pose a significant risk of developing cardiovascular disease, stroke, and type 2 diabetes. Resistance to insulin, genetic predisposition, high blood pressure, inflammation, and excess abdominal fat are the main stimuli of this syndrome. Metabolic syndrome is becoming more widespread due to fast and unplanned urbanization causing changes in lifestyle, such as poor dietary habits and sedentary behavior, that decrease the metabolic rate in the human body. A developing South Asian country like Bangladesh is most vulnerable to components of metabolic syndrome such as obesity, hypertension and diabetes. Consequently, it has become one of the major public health concerns. Prediction of disease status is a key component of community and health service policymaking. A nationally representative cross-sectional survey, the Bangladesh Demographic and Health Survey (BDHS), is used to find statistically significant variables for metabolic syndrome. BDHS datasets do not contain any direct data regarding metabolic syndrome. A binary variable is generated by utilizing the available data on blood pressure, blood glucose level, and body mass index (BMI). Overall, 34.33% of the population has metabolic syndrome. Primarily, bivariate analysis is performed using chi-square testing to find variables that are correlated with metabolic syndrome. Results of binary logistic analysis are presented in terms of coefficients and odds ratios (OR) with 95% confidence intervals (CI). Age, gender, education, division (province), occupation type, and wealth index are found to be important covariates for the syndrome. Age especially is seen as one of the most influential factors, since the prevalence of metabolic syndrome is only 12.17% for the age group younger than 18 years, while for the group older than 65 years it is 62.18%. Residents of Barishal have the highest rate of metabolic syndrome (38.58%). The rate in the country’s capital Dhaka is 34.48%. Individuals whose employment primarily involves manual labor are 11.1% less likely to suffer from metabolic syndrome than those doing non-manual work.

Electrophysiological variations of Guillain-Barre syndrome in Bangladesh- Hospital based study

Introduction: Guillain-Barre syndrome (GBS) is an immune mediated disorder of peripheral nerves which usually presents by rapidly evolving ascending weakness & mild sensory loss and hypo- or areflexia. Electrodiagnostic study (EDS) is the basis for classification of different subtypes of the disease. EDS also has a crucial role in diagnosis, ruling out of some differential diagnosis like myopathic and motor neuron disorders and confirming the neuropathic nature of GBS. The benefit of immunotherapy is greatest when introduced early. In addition, electrophysiological characteristic can predict the prognosis of patients with GBS. This study was conducted to determine the predominant subtype and electrophysiological pattern of GBS in the context of Bangladesh. Objectives: Objective of this study was to compare the electrophysiological variations among different electrophysiological subtypes of GBS. Methods: It is an observational cross sectional study conducted in Department of Medicine and Neurology, Sir Salimullah Medical College & Mitford Hospital and National Institute of Neuroscience (NINS), Dhaka, over a period of one year & four months. Total 30 patients were selected by purposive sampling technique. Demographic data were collected from the patients and recorded in structured case report form. Clinical examination and relevant investigations were done meticulously. Collected questionnaire were checked to identify any error in data. Data was analyzed with SPSS version 21 software. Result: In this study, maximum numbers of patients 53% were between 21-30 years of age group with mean value 27.47±8.1 years. Male to female ratio was 1.7:1. Frequency of Guillain-Barre syndrome is predominance at middle age group. Commonest presentation was limb weakness (parapledgia or quadripledgia) in 60% patients, paresthesias & numbness (40%), pain (100%) and deviation of mouth (63%) of GBS patients. Cerebrospinal fluid shows a mild pleocytosis (5 to 50 cells/µl) in majority of cases was found in 76% of patients. Whereas elevated CSF Protein (>45 mg/dl) was seen in all GBS patient. Increased distal motor latency (DML) was found in 93% patients, whereas 7% patients had normal DML. In the case of the lower limbs, increased distal motor latency was predominant. Decreased amplitude of sensory nerve action potential (SNAP) was seen in 83% patients while 16% patients had normal. Slowing of motor conduction velocities, decreased amplitude as well as increase in distal motor latencies were observed, being more pronounced in the lower limbs. F-wave was completely absent in 20.0% patients while 20% patients showed decreased conduction velocity with prolonged latency. Sensory nerve action potential revealed that decreased sensory conduction velocity (SCV) was seen in 26%, absent SCV in 10% and normal SCV in 63% patients. Present study demonstrated that Acute inflammatory demyelinating polyneuropathy (AIDP) was the commonest type of Guillain-Barré syndrome, present in 56% of patient. Around 30% of the patients belonged to acute motor axonal polyneuropathy (AMAN) and 13% were acute motor sensory axonal polyneuropathy (AMSAN). Conclusion: In this study AIDP was the most frequent subtype. The characteristic findings supportive of AIDP include prolonged distal motor latencies, reduced conduction velocities, conduction blocks at non-entrapment sites, temporal dispersion and prolonged F wave latencies. J MEDICINE 2024; 25: 11-16

Factors contributing to mental depression: A study among university students

Mental depression among students is a rising syndrome in Bangladesh. Recent research shows that the extent of depression, suicidal attempts, drug addictions, anxiety, and stress level have been on the rise significantly worldwide. It has become one of our critical social concerns. Unfortunately, these symptoms are more prevalent among tertiary-level students. These young people suffer from various disorders and various forms of depression. Since the young generation, like university students, are our prime strengths, their dejection and weak mental disposition are a significant loss and threat to our country. This problem is becoming more intense with time and causing vital social changes. This research investigated this issue using quantitative techniques, including a questionnaire survey. SPSS version 24 was used to determine the relationship between dependent and independent variables. The main goal is to determine the severity and variance underlying mental depression so that recommendations for improving cognitive abilities can be made. Further research can also be undertaken based on the findings of this research.

Pre-hospital delay of the patients with acute coronary syndrome in Bangladesh

Pre-hospital delay of the patients with acute coronary syndrome in Bangladesh

Prevalence and Characteristics of Women with Polycystic Ovary Syndrome in Bangladesh – A Narrative Review

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive-aged women. PCOS is not a homogeneous disease and can manifest as a range of multifaceted problems, including various reproductive, cosmetic, cardiometabolic, and psychiatric conditions. In Bangladesh, research defining the prevalence and characteristics of PCOS is not ample. This review summarizes the findings from published studies that provide consistent evidence on the prevalence and characteristics of women with PCOS in the country. The small-scale studies conducted among different subgroups of women indicate a high prevalence of the condition. Clinical presentations of PCOS in Bangladeshi women are also highly variable. A substantial portion has obesity, insulin resistance, abnormal glucose tolerance, dyslipidemia, and metabolic syndrome, which significantly threaten their cardiovascular health. Many of them have co-existent other endocrinopathies, including thyroid abnormalities. Moreover, highly prevalent psychiatric comorbidities among these women warrant routine screening for these conditions.

Factors Responsible for Prehospital Delay in Patients with Acute Coronary Syndrome in Bangladesh.

Background: Acute coronary syndrome (ACS) remains a cause of high morbidity and mortality among adults, despite advances in treatment. Treatment modality and outcomes of ACS mainly depend on the time yielded since the onset of symptoms. Prehospital delay is the time between the onset of myocardial ischemia/infarction symptoms and arrival at the hospital, where either pharmacological or interventional revascularization is available. This delay remains unacceptably long in many countries worldwide, including Bangladesh. The current study investigates several sociodemographic characteristics as well as clinical, social, and treatment-seeking behaviors, with an aim to uncover the factors responsible for the decision time to get medical help and home-to-hospital delay. Materials and Methods: A prospective cross-sectional study was conducted between July 2019 and June 2020 in 21 district hospitals and 6 medical college hospitals where cardiac care facilities were available. The population selected for this study was patients with ACS who visited the studied hospitals during the study period. Following confirmation of ACS, a semi-structured data sheet was used to collect the patient data and was subsequently analyzed. Results: This study evaluated 678 ACS patients from 30 districts. The majority of the patients were male (81.9%), married (98.2%), rural residents (79.2), middle-aged (40–60 years of age) (55.8%), low-income holders (89.4%), and overweight (56.9%). It was found that 37.5% of the patients received their first medical care after 12 h of first symptom presentation. The study found that the patients’ age, residence, education, and employment status were significant factors associated with prehospital delay. The patients with previous myocardial infarction (MI) and chest pain arrived significantly earlier at the hospital following ACS onset. Location of symptom onset, first medical contact with a private physician, distance from symptom onset location to location of first medical contact, the decision about hospitalization, ignorance of symptoms, and mode of transportation were significantly associated with prehospital delay. Conclusions: Several factors of prehospital delay of the ACS patients in Bangladesh have been described in this study. The findings of this study may help the national health management system identify the factors related to treatment delay in ACS and thus reduce ACS-related morbidity and mortality.

Prevalence and associated risk factors for mental health problems among patients with polycystic ovary syndrome in Bangladesh: A nationwide cross-Sectional study.

Polycystic ovary syndrome (PCOS) is a common female reproductive endocrine problem worldwide. The prevalence of mental disorder is increasing among PCOS patients due to various physical, psychological, and social issues. Here we aimed to evaluate the mental health and associated factors among women suffering from PCOS in Bangladesh. We performed an online cross-sectional survey among 409 participants with PCOS using Google Forms. We used structured questionnaires to collect socio-demographic information and lifestyle-related factors. Also, we applied patient health questionnaire (PHQ-9), generalized anxiety disorder (GAD-7) scale, and UCLA loneliness (UCLA-3) scale for psychometric assessment of the participants. Finally, we applied several statistical tools and performed data interpretations to evaluate the prevalence of mental health disorders and associated factors among patients with PCOS in Bangladesh. Prevalence of loneliness, generalized anxiety disorder and depressive illness among the women with PCOS were 71%, 88%, and 60%, respectively. Among the mental illness, mild, moderate, and severe cases were 39%, 18%, and 14% for loneliness; 39%, 23% and 26% for generalized anxiety disorder; and 35%, 18%, and 7% for depressive disorder. According to the present findings, obesity, financial condition, physical exercise, mealtime, food habit, daily water consumption, birth control method, and long-term oral contraceptive pills contribute to developing mental health disorders among females with PCOS in Bangladesh. According to present study results, high proportion of women suffering from PCOS experience several mental disorders in Bangladesh. Although several socio-demographic and lifestyle-related factors were found to be associated with the poor mental health of women with PCOS; however, PCOS itself is a condition that favors poor physical and psychological health. Therefore, we recommend proper treatment, public awareness, and a healthy lifestyle to promote the good mental health of women suffering from PCOS.

Draft Genome Sequences of Four Strains of Campylobacter jejuni Isolated from Patients with Axonal Variant of Guillain-Barré Syndrome in Bangladesh.

ABSTRACTFour Campylobacter jejuni strains (Z191005RS, Z191005SS, Z201020RS, and Z201020SS) isolated from the axonal variant of Guillain-Barré syndrome (GBS) were sequenced using Illumina technology. The average genome size was from 1.61 to 1.63 gb, with a very high coverage ranging from 654× to 758×, which facilitates the possibility of rare variant calling.

Prevalence and associated factors of metabolic syndrome among Bangladeshi adults: Evidence from a nation-wide survey

BackgroundMetabolic syndrome is an important risk factor for cardiovascular disease and premature mortality. This study aimed to determine the prevalence and associated factors of metabolic syndrome among Bangladeshi adults (aged 18–69 years) using a nationally representative survey: Stepwise Approach to Surveillance (STEPS). MethodsMetabolic syndrome was defined according to Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria. Design based multivariable log-binomial regression was conducted to explore the associated factors. The adjusted prevalence ratio (APR) was reported along with a 95% confidence interval (CI). FindingsIn total, 6851 samples were included. Overall, 15.5% and 16.6% of the participants had metabolic syndrome according to ATP III and IDF criteria, respectively. According to ATP III criteria, the prevalence of metabolic syndrome was higher among those aged 30–49 years (APR: 2.4; 95% CI: 1.8–3.2) and 50–69 years (APR: 3.5; 95% CI: 2.5–4.5) compared to those aged 18–29 years, being educated up to college and higher (APR: 1.6; 95% CI: 1.2–2.0) compared to those who did not receive any formal education, residence in the urban area (APR: 1.2; 95% CI: 1.0–1.4) compared to rural residents, having an abnormal waist-hip ratio (APR: 2.0; 95% CI: 1.6–2.6) compared to having normal waist-hip ratio, being overweight (APR: 1.8; 95% CI: 1.4–2.3), and obese (APR: 3.5; 95% CI: 2.8–4.4) compared to those who had normal BMI/underweight. Compared to the residents in the Dhaka Rural, residents in Mymensingh, and Rangpur division had lower odds of having metabolic syndrome. Except for the place of residence, the associated factors were similar according to IDF criteria. ConclusionAs approximately every one in six adults are suffering from the metabolic syndrome in Bangladesh, the public health prevention and promotion programs should target the high-risk groups to curtail the high burden.

Prevalence of Insulin Resistance, Dyslipidemia and Metabolic Syndrome in Infertile Women with Polycystic Ovary Syndrome

Introduction: Polycystic ovary syndrome (PCOS) affects 5-10% of reproductive age women and it is a common cause of infertility in young women. Most of the infertile women with PCOS are overweight or obese with related risks of insulin resistance, dyslipidemia and metabolic syndrome. There is ethnic variation in the prevalence of obesity and its related metabolic abnormalities in women with polycystic ovary syndrome. This study was designed to explore the prevalence of insulin resistance, dyslipidemia and metabolic syndrome in infertile women with polycystic ovary syndrome in Bangladesh. Methods: This was a cross sectional study of 126 infertile women with polycystic ovary syndrome attending the Infertility unit of the Department of Obstertrics and Gynaecology at Bangabandhu Sheikh Mujib Medical University from January 2017 to December 2017. Results: The mean BMI was 26.58±3.18 and mean waist circumference was 91.07±9.5 cm. Regarding the prevalence of obesity, 47.6% of the women were overweight (BMI 23 - 27.5 kg/m2), 39.7% was obese (BMI>27.5 kg/m2) and central obesity (waist circumference ≥80 cm) was in 80.2%. In infertile women of PCOS, the prevalence of insulin resistance was 27.8% , dyslipidemia 93.7% metabolic syndrome 42.9% .Median fasting insulin was higher than the cut off for insulin resistance specific for south Asian population. Insulin resistance measured by hyperinsulinemia was much more frequent (65.9%) than that measured by HOMA-IR (27.8%).The most common lipid abnormality was low HDL cholesterol (90.5%) followed by elevated LDL-cholesterol (79.4%). Low HDL cholesterol (90.5%) and abdominal or central obesity (80.2%) were the most common criteria of metabolic syndrome. There is increasing trend in metabolic syndrome with age. Conclusion: Screening the infertile women with polycystic ovary syndrome for insulin resistance, dyslipidemia and metabolic syndrome is important because it allows for additional counseling about long term health consequences and emphasis on weight management. J Bangladesh Coll Phys Surg 2021; 39: 225-232

Obesity in relation to clinical, endocrine and metabolic parameters in infertile women with polycystic ovary syndrome: the South Asian perspective

Background: Polycystic ovary syndrome (PCOS) affects 5-10% of reproductive age women and it is a common cause of infertility in young women. Most of the infertile women with PCOS are overweight or obese. Obesity or excess fat aggravates the endocrine and metabolic dysfunction in women with PCOS. Weight management is the first line measure advised to infertile PCOS women who are overweight or obese. The objective of the study was to explore the association of obesity with the clinical, endocrine and metabolic parameters in infertile women with polycystic ovary syndrome in Bangladesh.
 Methodology: This was a cross sectional study of 126 consecutive infertile women with polycystic ovary syndrome attending the Infertility unit of the Department of Obstetrics and Gynecology at Bangabandhu Sheikh Mujib Medical University from January 2017 to December 2017.Obesity groups were defined by BMI thresholds specific for the South Asian population.
 Results: The mean body mass index (BMI) was 26.58±3.18 kg/m2and mean waist circumference was 91.07±9.5 cm. There was highly significant association of obesity with waist circumference and fasting insulin. BMI at or above 25kg/m2 was significantly associated with acanthosis nigricans, hyperandrogenemia and hyperinsulinemia, whereas BMI at or more than 23kg/m2 was significantly associated, in addition, with insulin resistance and metabolic syndrome.
 Conclusion: Obesity is associated with hyperandrogenemia, hyperinsulinemia, insulin resistance and metabolic syndrome in infertile women with polycystic ovary syndrome.
 Bangladesh Journal of Medical Science Vol.20(4) 2021 p.864-870

Draft Genome Sequences of Three Strains of Campylobacter jejuni Isolated from Patients with Guillain-Barré Syndrome in Bangladesh.

Campylobacter jejuni is the pathogen most commonly associated with Guillain-Barré syndrome (GBS). The present work describes the draft genome sequences of 3 C. jejuni strains, BD39, BD67, and BD75, isolated from stool specimens of patients with C. jejuni-triggered GBS using Illumina technologies.

Electrophysiology of Guillain-Barré syndrome in Bangladesh: A prospective study of 312 patients

ObjectiveTo describe the electrophysiological features in relation to clinical and serological findings of Guillain-Barré syndrome (GBS) in the national neuroscience hospital in Bangladesh. This is one of the few studies that investigated GBS patients using standardized electrophysiology in low-income countries. MethodsIn a prospective and observational study, we investigated 312 GBS patients by standardized clinical, serological and electrophysiological methods. Unilateral motor and sensory nerve conduction studies (NCS) were performed within two weeks of onset of weakness. Follow up NCS were performed in 189 patients and classified according to eight sets of established GBS criteria. Serology included assessment of anti-GM1 antibodies and anti-campylobacter jejuni lipo-oligosaccharide (LOS) antibodies. ResultsDepending on the criteria used, 44–59% patients had axonal GBS with anti-GM1 antibodies being present in 55–58% and 9–42% patients had demyelinating GBS with anti-GM1 antibodies being present in 7–35%. Conduction block (CB) with demyelinative slowing in the same nerve segment was found in 24% (74/312) patients, and CB without demyelinative slowing in the same nerve segment was found in 18% (56/312) patients, of whom anti-GM1 antibodies were found in 27% and 57% patients respectively. Follow-up NCS showed a change in GBS classification in 11–26% of patients, mainly from demyelinating to axonal GBS. ConclusionsThe predominant subtype of GBS in Bangladesh is axonal but demyelinating GBS also occurs with classification being strongly dependent on the applied criteria. SignificanceThe present study demonstrates the importance of reaching international agreement on GBS criteria that should be based on the best evidence.

Validity of DCIP Method for Rapid Screening of Haemoglobin E Trait

Background: Hemoglobin E B thalassemia is the commonest thalassemia syndrome in Bangladesh. All tests for diagnosis of Hb E trait are expensive,time consuming and require sophisticated equipment. The need therefore, is a simple,low cost ,rapid and reliable test which can be used for mass screening of E trait. The present study was designed to see the validity of DCIP test as screening test for detection of E Trait.
 Methodology: A cross sectional observational study was conducted at Dhaka Shishu (Children) Hospital from December 2008 to November 2009. Total 150 subjects attending Dhaka Shishu Hospital Thalassemia centre were selected and evaluated for Hb estimation, RBC indices, Hb Electrophoresis and DCIP test. According to electrophoresis results patients were divided into 3 groups. Group I comprised of 50 subjects with Hb E trait, group II comprised 51 subjects with ß thalassemia trait and Group III comprised of 49 normal subjects. In all 3 groups DCIP test was done and in positive cases, precipitated haemoglobin was visualized by naked eye at the bottom of the test tube. Negative samples with normal electrophoresis and ß thalassemia trait were used to see the samples gave false positive result.
 Results: The test successfully detected 48 subjects among total 50 subjects of E trait. DCIP sensitivity, specificity, positive predictive value and negative predictive values were 96%,97%,94.12% and 97.97% respectively.
 Conclusion: DCIP has high sensitivity, specificity, positive and negative predictive value. So, it might be considered as a valid single screening test to detect E Trait in areas with limited laboratory facilities and economic resources.
 AKMMC J 2020; 11(2) : 113-119

Gender Differentials of Metabolic Syndrome in Bangladesh taking Menopause into Consideration

Objective:To assess the gender differences of metabolic syndrome (MetS) in Bangladesh and factors associated with it.Materials and methods: Cross sectional study was performed on 227 premenopausal women, 48 menopausal women and 217 men. The gender differentials were studied with measurement of waist circumference, blood pressure and fasting blood for triglyceride (TG), high density lipoprotein (HDL), blood sugar (FBS).Results:Premenopausal women had 22.9% (95% CI: 17.9-28.8%), menopausal women had 43.8% (95% CI: 30.7-57.7%), and the men had 53.9% (95% CI: 47.3-60.4%) prevalence of MetS giving a 1:1.7:2.1 ratio of premenopausal, menopausal women and men prevalence respectively. More than 95% of study population had low HDL irrespective of gender and menopause status. Obesity was 5.3% in premenopausal women, 14.6% in menopausal women and 54.4% in men. HTN was 10.6% in premenopausal women, 35.4% in menopausal women, and 19.4% in men. High TG was 42.5% in premenopausal women, 41.7%, in menopausal women and 62.0% in men. High FBS was 22.0% in premenopausal women, 37.5% in menopausal women and 30.4% in men.Conclusion: Compared to premenopausal women, MetS in men was two times higher and nearly two times higher in menopausal women, pulling menopausal women prevalence almost equal to men. Menopausal women had high prevalence of HTN while obesity was more prevalent in men. Dyslipidemia should be a concern for the policy makers in search of a prevention program.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 101-107

Oxidase Enzyme Activities and Their Correlations with Antioxidative Stress Biomarkers in Patients with Acute Coronary Syndrome in Bangladesh

Acute coronary syndrome (ACS) is a range of conditions associated with decreased blood flow in the coronary arteries resulting from sudden rupture of atherosclerotic plaques. Several studies have found that oxidative stress is involved in the initiation and progression of atherosclerosis. The role of oxidase enzymes and antioxidative stress biomarkers in these processes needs further attention. In this study, a total of 120 participants were enrolled which comprised 60 ACS patients and 60 control subjects. The major oxidase enzyme, xanthine oxidase, which plays a pivotal role in the generation of reactive oxygen species (ROS), showed significantly higher activities in both serum (158.03 ± 43.30 mU/mL) and red blood cells (RBC) lysate (309.07 ± 75.73 mU/mL) of the ACS patients compared to controls, 48.51 ± 13.41 mU/mL and 184.10 ± 70.14 mU/mL, respectively. The nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and myeloperoxidase, both of which are major contributors to ROS production, showed significantly higher activities in patients (14.13 ± 3.38 U/L and 10.9 ± 3.3 U/mg) than in controls, 6.90 ± 1.94 U/L and 5.9 ± 1.5 U/mg, respectively. Ceruloplasmin, an emerging biomarker of inflammation, showed significantly higher activity in patients (83.8 ± 26.2 U/L) compared to controls, 70.0 ± 18.9 U/L. The antioxidant enzyme glutathione reductase showed significantly lower activity in patients than controls, 60.7 ± 47.8 U/mL/min and 85.2 ± 49.5 U/mL/min, respectively. Evaluation of cardioprotective biomarkers nitric oxide and high-density lipoprotein-cholesterol (HDL-C) showed significantly lower values in patients. Correlation analyses between these parameters further corroborated increased oxidative stress in patients. These findings suggest that excessive productions of ROS by the oxidase enzymes cause an imbalance between oxidants and antioxidants in favor of oxidants leading to increased oxidative stress in patients with ACS.

Invasive Pneumococcal Infections in Children with Nephrotic Syndrome in Bangladesh

Children with nephrotic syndrome are susceptible to invasive bacterial infections. In this study, we aimed to: (1) determine the pathogens associated with infections in children with nephrotic syndrome and (2) describe antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae to guide evidence-based treatment and prevention policies. From June 2013 to March 2015, we collected blood and/or ascitic fluid from children hospitalized with nephrotic syndrome and suspected bacterial disease in the largest pediatric hospital of Bangladesh. We cultured all samples and performed polymerase chain reaction (PCR) and immunochromatographic test on ascitic fluid for detection of S. pneumoniae. Pneumococcal isolates were tested for antibiotic susceptibility using disc diffusion and serotyped using Quellung reaction and PCR. We identified 1342 children hospitalized with nephrotic syndrome. Among them, 608 children had suspected bacterial disease from whom blood and/or ascitic fluid were collected. A pathogen was identified in 8% (48/608) of cases, 94% (45/48) of which were S. pneumoniae. Most (73%, 33/45) pneumococcal infections were identified through culture of blood and ascitic fluid and 27% (12/45) through immunochromatographic test and PCR of ascitic fluid. In total, 24 different pneumococcal serotypes were detected; 51% are covered by PCV10 (+6A), 53% by PCV13 and 60% by PPSV23. All pneumococcal isolates were susceptible to penicillin. Because S. pneumoniae was the primary cause of invasive infections, pneumococcal vaccines may be considered as a preventive intervention in children with nephrotic syndrome. Additionally, penicillin can be used to prevent and treat pneumococcal infections in children with nephrotic syndrome in Bangladesh.

Study of Rare Cases of Congenital Myasthenic Syndrome in Bangladesh

Congenital myasthenic syndromes (CMS) comprise a heterogeneous group of rare inherited diseases in which the neuromuscular transmission in the motor plate is compromised by one or more genetic pathophysiological specific mechanisms are characterized by fatigable weakness of skeletal muscle (e.g., ocular, bulbar, limb muscles) with onset at or shortly after birth or in early childhood; rarely, symptoms may not manifest until later in childhood. The diagnosis of CMS is based on clinical findings, a decremental EMG response of the compound muscle action potential (CMAP) on low-frequency (2- 3 Hz) stimulation, absence of anti-acetylcholine receptor (AChR) and anti-MuSK antibodies in the serum, a positive response to acetylcholinesterase (AchE) inhibitors and lack of improvement of clinical symptoms with immunosuppressive therapy. Pathogenic variants in one of multiple genes encoding proteins expressed at the neuromuscular junction are currently known to be associated with subtypes of CMS. The most commonly associated genes include: CHAT, CHRNE, COLQ, DOK7, GFPT1 and RAPSN. We studied on a sibling presented with progressive fatigability and fluctuating ptosis with frequent exacerbations of muscle weakness during infections since infancy. On both cases CT scan of chest were negative for thymoma, antibodies against the acetylcholine receptor (AChR) and the muscle specific kinase (MuSK) were negative and decremental response on electrophysiological study of Repetitive nerve stimulation (RNS) and EMG were consistent with disease of neuromuscular junction (post synaptic) and they were only on pyridostigmine for long time with marked improvement of symptoms and signs. Considering all scenario both of our cases mostly fits with the autosomal recessive, post synaptic CMS associated with Rapsyn deficiency.
 Objective : As in Bangladesh, there is inadequate data on the epidemiological profile of CMS, our aim is to describe these cases for their rarity and the difficulty encountered in diagnosis as they are easily confused with Juvenile Myasthenia Gravis (JMG) and familial myopathies. As both the cases are very rare, it should be an original article.
 Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 95-103

Do Islamic banks need to earn extra profits?

PurposeThis paper aims to draw upon existing debate over “financial sector rent” (bank rent) to analyze the current pattern of financing of Bangladeshi and Indonesian Islamic banks during the period of 2011 and 2015.Design/methodology/approachThe empirical evidence through a comparative approach of analyzing the performance of Islamic banks with that of conventional banks in respective countries – two of the largest countries where majority of the population are Muslims – is drawn to demonstrate the objective.FindingsWhile Islamic banks in Bangladesh are primarily concentrating on the murabaha (mark-up contract) mode of financing, some transactions under musharaka (partnership/equity-based contract) are observed in the Indonesian Islamic banking sector. This anomaly in Indonesia can be explained by the nature of their musharaka financing which is not of the purely “participatory” financing type. As a result, we can observe the quasi-murabaha syndrome in Indonesian Islamic banking sector. The concentration of asset-based financing including consumers’ financing (hire purchase) in the credit portfolio gives Islamic banks relatively higher Islamic bank rent opportunity for protecting their “franchise value” as Sharīʿah-compliant (Islamic law-compliant) lenders. However, Indonesian Islamic banks share a still infant Islamic banking market, and enjoy less rent opportunity under a severe competition with conventional banks.Research limitations/implicationsThe bank rent approach suggests that the syndrome observed both in Bangladesh and Indonesia can be ironically justifiable. Moreover, the mode of profit-and-loss sharing provides, in practice, an idea of the difficulty in managing the participatory financing embedded with high credit risk. Under this scenario, it is necessary for Islamic scholars and the regulatory authority to design an appropriate financial architecture, enabling Islamic banks to avail the benefit from a wider variety of Sharīʿah-based Islamic financing.Originality/valueThis paper expands the newly emerged concept of “Islamic bank rent” to make sense of the murabaha syndrome in Bangladesh and the quasi-murabaha syndrome in Indonesia. This approach also contributes to clarifying the unique risk and cost to be compensated with the spreads that Islamic banks are expected to earn.

Toll-like receptor-4 299Gly allele is associated with Guillain-Barré syndrome in Bangladesh.

ObjectiveTLR4 plays an important role in the pathogenesis of Guillain‐Barré syndrome (GBS). The relationships between TLR4 polymorphisms and susceptibility to GBS are poorly understood. We investigated the frequency and assessed the association of two single nucleotide polymorphisms (SNPs) in the extracellular domain of TLR4 (Asp299Gly and Thr399Ile) with disease susceptibility and the clinical features of GBS in a Bangladeshi cohort.MethodsA total of 290 subjects were included in this study: 141 patients with GBS and 149 unrelated healthy controls. The TLR4 polymorphisms Asp299Gly and Thr399Ile were genotyped using polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) assay.ResultsThe minor 299Gly allele was significantly associated with GBS susceptibility (P = 0.0137, OR = 1.97, 95% CI = 1.17–3.31), and was present at a significantly higher frequency in patients with the acute motor axonal neuropathy (AMAN) subtype of GBS (P = 0.0120, OR = 2.37, 95% CI = 1.26–4.47) than acute inflammatory demyelinating polyneuropathy (AIDP) subtype (P = 0.961, OR = 1.15, 95% CI = 0.38–3.48); when compared to healthy controls. The genotype frequency of the Asp299Gly polymorphism was not significantly different between patients with GBS and healthy controls. The Asp299‐Thr399 haplotype was associated with a significantly lower risk of developing GBS (P = 0.0451, OR = 0.63, 95% CI = 0.40–0.99). No association was observed between the Thr399Ile polymorphism and GBS disease susceptibility.InterpretationThe TLR4 minor 299Gly allele was associated with increased susceptibility to GBS and the axonal GBS subtype in the Bangladeshi population. However, no associations were observed between the genotypes of the Asp299Gly and Thr399Ile SNPs and antecedent C. jejuni infection or disease severity in Bangladeshi patients with GBS.