Bangladesh Journal of Medical Science <p>A journal sponsored by the Ibn Sina Trust. Full text articles available.<br>NLM ID=101563859</p> <p>Bangladesh Journal of Medical Sciences is included on <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a>.</p> <p><strong>Journal Metrics</strong><br><a href="" target="_blank" rel="noopener">CiteScore Tracker 2020</a>: Updated on May 06, 2020</p> <p><a href="" target="_blank" rel="noopener"><img src="/public/site/images/admin/12345.jpg" width="171" height="130"></a></p> <p><a href="" target="_blank" rel="noopener">ResearchGate Journal Impact</a>&nbsp;(2013): 0.62</p> <p><a href=";tip=sid" target="_blank" rel="noopener">Scimago Journal Rank</a> (2019): 0.22</p> <p><img src="/public/site/images/admin/unnamed.png" width="162" height="121"></p> en-US <p>Authors who publish in the Bangladesh Journal of Medical Science agree to the following terms that:</p><ol type="1" start="1"><li>Authors retain copyright and grant Bangladesh Journal of Medical Science the right of first publication of the work.<br /><br /></li><li><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons Licence" /></a><br />Articles in Bangladesh Journal of Medical Science are licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a> CC BY-4.0.This license permits use, distribution and reproduction in any medium, provided the original work is properly cited.</li><li>Authors are able to enter into separate, additional contractual arrangements for the distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li><li>Authors are permitted to post their work online (e.g., in institutional repositories or on their website) as it can lead to productive exchanges, as well as greater citation of published work.</li></ol> (Dr Abu Kholdun Al-Mahmood) (Md Fahmid Uddin Khondoker) Wed, 14 Apr 2021 15:11:02 +0000 OJS 60 Potential Strategies to Improve Antimicrobial Utilisation in Hospitals in Bangladesh Building on Experiences Across Developing Countries <p>Abstract not available</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.469-477</p> Mainul Haque, Brian Godman ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Taking Highly Palatable Food or Naively Consuming Fatal Toxic Diet <p>Abstract not available</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.478-482</p> Siddhartha Dutta, Mainul Haque ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Global surgery: Improving health in low-income countries <p>The aim of this report is to examine the definition of global surgery, discuss the problems and propose some suggestions. Global surgery aims to improve the surgical conditions to maintain a standard and equal surgical care, especially in low- and middle-income countries where burden of surgical diseases are increasing over the years. According to Lancet Commission on Global Surgery, 1.27 million more surgical healthcare workers will be required to provide minimal surgical workforce, by 2030. In resource-limited settings of the world-wide where medical education and post-graduation training programs are disrupted due to brain drain, instable conditions and economic reasons, sustaining a standard and accessible surgical care are possible by training surgeons.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.483-486</p> Orhan Alimoglu, Nuray Colapkulu ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Anxiety Disorders: Recent Global Approach to Neuro-pathogenesis, Drug Treatment, Cognitive Behavioral Therapy, and Their Implications <p>Anxiety is a group of mental disorders characterized by the sudden feeling of intense fear, panic, shortness of breath, chest pain, restlessness, GIT problems, insomnia, fatigue, muscle tension, sweating, loss of memory, blurred vision, and impaired learning. It occurs typically in response to a stressful situation that may become pathological when it is no longer controlled or occurs in the absence of real threat. This review aimed to appraise the literature on the prevalence, classification, neuro-pathogenesis, diagnoses, and treatment of anxiety disorders (AD). The search was made using PubMed, Embase, MEDLINE, and PsycINFO databases. Anxiety disorders are the most common mental disorders affecting humans, especially among developing nations. In general, the lifetime prevalence of AD is about 14%, with an annual prevalence of 31%. Unfortunately, AD, in general, is underdiagnosed and undertreated globally.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.487-503</p> Abdullahi Rabiu Abubakar, Ibrahim Haruna Sani, Sani Malami, Abudllahi Hamza Yaro, Iffat Jahan, Nihad Adnan, Santosh Kumar, Salequl Islam, Siddhartha Dutta, Jaykaran Charan, Mainul Haque ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Forecasting cumulative COVID-19 cases in Malaysia and rising to unprecedented levels <p><strong><em>Background</em></strong><em>: </em>COVID-19 outbreak is being studied throughout the world. Adding more analysis to date strengthening the information about the illness. Here, we analysis the data of Malaysian Ministry of Health from February 15, 2020 until January 10, 2021 was analysed using linear regression model statistical analysis with aim to forecast the trend.</p> <p><strong><em>Materials and Methods: </em></strong>This study reviewed the data by Malaysia Ministry of Health from February 15, 2020, until January 10, 2021. Linear regression model statistical analysis was used for predictive modelling. The forecasting of the linear trend of the Covid-19 outbreak prediction is purposed to estimate the number of confirm cases according to the number of recoveries patients.</p> <p><strong><em>Results</em></strong><em>: </em>Malaysia is currently anticipating another lockdown restriction as new confirmed case of COVID-19 hit new record high. The cumulative confirmed Covid-19 cases in MCO predicted a sharp increase. At the first of March, 2021, the predicted cumulative confirmed Covid-19 cases are 319,477 cases.</p> <p><strong><em>Conclusions</em></strong><em>: </em>Covid-19 cases projected to 315766 by end of February 2021 with 3000- 4000 daily cases predicted. Initiative and proactive measurement by Malaysian government hopefully can reduce the number of cases and flatten the infection curve.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.504-510</p> Wan Muhamad Amir W Ahmad, Mohamad Arif Awang Nawi, Wan Mohd Nazlee Wan Zainon, Nor Farid Mohd Noor, Firdaus Mohd Hamzah, Farah Muna Mohamad Ghazali, Mohammad Khursheed Alam ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 The Maximus of Necessity and Its Application to Organ Transplantation: An Islamic Bioethical Perspective <p>Islam is second largest religion being practiced around the globe. It is fastest growing believe and rapidly expanding in the western world despite several misunderstanding including Islamic standpoint on organ transplantation and tissue grafting. The objective of this study is to determine the Islamic view point on organ transplantation and tissue grafting with special reference pertaining to human needs under the ambit of <em>Shariah </em>doctrine of necessity and world religions. Since, Islam and other world religions have given immense consideration to humans whether they are alive or dead, and the desecration of human body is considered a violation sufficed to a great sin. Injunctions of the holy <em>Quran </em>and <em>Sunnah </em>have evidently expressed sanctity to human life/body. Hence, taking one’s life without a legal rights or even inflicting any sort of harm, injury, and aggression against an individual is terming an unlawful act. Notably, some scholars contended that, classical jurists’ are silent on the issue of organ transplantation predominantly the transfer of organs from one species to another species. But, in reality, our argument is that, the organ re-plantation can be seen in the Prophetic era. However, as per their view, the reason is obvious, since the organ transplantation associated with the advancement of science. Accordingly, the recent progress in transplant sciences were not totally known to the classical jurists, although, issues pertaining to the sale of human organs have been discussed by them (jurists). Similarly, many other innovative matters can be seen in Prophetic traditions, and that is why, as per jurist’s assertion, it can practically be traced in the Prophetic era.Consequently, this study argues that, the permissibility of organ donation and transplantation somehow mentioned in the main sources of Islamic law and biomedical ethics. Therefore, the basis and rules of permissibility will be derived while discussing organ transplantation, particularly in homo, allotransplant and other inter-related issues under the rubric of necessity doctrine.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.511-524</p> Fazli Dayan, Mian Muhammad Sheraz, Abu Kholdun Al Mahmood, Sharmin Islam ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Quantification of Pre-Analytical Quality Indicator in a Clinical Laboratory <p><strong><em>Introduction: </em></strong>Quality in laboratory medicine have a significant role in ensuring the adequate and complete total testing process. Clinical laboratory and testing process is an integral part of modern medicine as it has a direct effect on the patient. As per the requirement of certification or accreditation bodies, different laboratories use different ways of developing quality indicators (QI), which helps to monitor, progress and maintain the quality of the laboratory services.</p> <p><strong><em>Materials and Methods</em></strong>: A cross sectional retrospective study carried out in the Hematology Laboratory of a tertiary care hospital. Data of pre-analytical quality indicators was collected for months from August 2015 to January 2016. Pre-analytical quality indicators analysed for sample collections were clotted sample, hemolyzed sample, incompletely filled form, wrong labelled sample, insufficient sample volume and patient waiting for sample collection after registration in the laboratory- turnaround time (TAT). Turn around time for patient waiting for sample collection is 15 minutes from the registration of the request form.</p> <p><strong><em>Results: </em></strong>The overall sample received during the six months was 2,03,337 among these pre-analytical errors found in 1067. The highest rate indicators were clotted sample 589 (0.28%), followed by insufficient sample volume 376(0.18), incompletely filled form and wrongly labelled sample 67(0.03%), Hemolyzed sample 35(0.017%). 94.49 % of the patient waiting time for the sample collection from registration was within the Turnaround time (TAT).</p> <p><strong><em>Conclusion: </em></strong>The development of a quality indicator for clinical laboratory medicine helps to improve quality in processing and testing of samples. Quality indicator plays a vital role in continuous improvement activities of clinical practice, which are aiming to deliver quality result and reducing the errors.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.525-529</p> Saritha Kamath U, Sushma Belurkar, Reshma GS, Shifani Edline D’Souza, Asha Patil ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Azithromycin and Co-Trimoxazole in Antimicrobial Prophylaxis: Special Emphasis on Primary Immunodeficiencies in Children <p>Patients with primary immunodeficiency diseases (PID) are prone to infectious, and they often determine the course of the disease. Antimicrobial prophylaxis for patients with PID includes co-trimoxazole, amoxicillin and macrolides. Co-trimoxazole is a widely used antimicrobial agent for pneumocystosis prophylaxis in immunocompromised patients, including patients with primary cellular immunodeficiency. Antiinflammatory effect of azithromycin made it a drug of choice in the management of chronic lung diseases in the patients with primary immunodeficiencies, especially in those with antibody deficiencies. Further randomised controlled studies are needed to define the optimal agent for all types of primary immunodeficiencies, its dose, duration of treatment, benefits and safety of long-term use.A recommendation for the prophylactic use of long-term therapy should consider the balance between benefits and risk of adverse events.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.530-538</p> Oksana Boyarchuk ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Upper Limb Dysfunction Increases Fear of Falling in People With Stroke <p><strong><em>Objective</em></strong><strong>: </strong>Our study was planned to investigate the effect of upper limb function on fear of falling in stroke patients.</p> <p><strong><em>Materials and methods</em></strong><strong>: </strong>A total of 61 patients, 33 women with chronic hemiplegia or hemiparesis, were included in the study. Patients’ upper limb motor condition was obtained using the Fugl-Meyer Upper Extremity Rating Scale (FMA), upper limb function Arm Motor Ability Test (AMAT) and fear of falling International Fall Efficacy Scale (FES-I). Standard Mini-Mental Examination scale was used to exclude patients with mental disorders.</p> <p><strong><em>Results and Discussion</em></strong><strong>: </strong>There was a highly significant negative correlation between FES-I and AMAT and FMA scores (p &lt;0.001, r = -0.926 and r = -0.888, respectively). There was also a significant positive correlation between FMA and stroke time (p &lt;0.05). It was observed that the fear of falling with the level of upper limb dysfunction increased in parallel.</p> <p><strong><em>Conclusion</em></strong><strong>: </strong>It suggests situation that this is due to the fact that they experience balance problems as a result of upper limb dysfunction and when they fail to reveal protective reflexes in a quality way</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.539-542</p> Furkan BİLEK ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Gender based variations of mulligan mobilization with movement on chronic nonspecific low back pain <p><strong><em>Objective: </em></strong>To discover the adequacy of mulligan mobilization with movement to lessen the pain to enhance the functional activities, to enhance the ROM of lumbar vertebra and to expand the back muscle function on subjects with chronic nonspecific low back pain.</p> <p><strong><em>Background of the study: </em></strong>These days, a large portion of the populations are experiencing low back pain comprehensively. It has turned into a main source for inability most likely the population influencing from low back pain has been thought to be understudies and stationary employment laborers. Along these lines investigation goes for diminishing the likelihood of low back pain in those populations by mediating with a method mulligan mobilization with movement (MWM).</p> <p><strong><em>Materials and methods: </em></strong>This was an experimental examination with sixty subjects between the age group of 18-50 (males and females) with chronic nonspecific low back pain(Natour et al 2015). The length of the examination is thrice a week for four weeks. The examination was hung on Dr.MGR Educational and Research Institute. The subjects in avoidance criteria are specific low back pain (spondylosis, radiculopathy, and spondylolisthesis), intellectual issue, pregnancy. VAS scale, Modified Oswestry Low Back Pain Disability Questionnaire and Finger to Floor test (FFT) were utilized as a result measures.</p> <p><strong><em>Result: </em></strong>There is vast improvement in the post-test estimations of the VAS Score, MODQ, and FFT of Group A when comparing with Group B. On correlation there is distinction in Group A than Group B. In this way the after effect of the investigation has been found to enhance useful functional activity, ROM and lessens pain.</p> <p><strong><em>Conclusion: </em></strong>Outcome has been proposed that Mulligan Mobilization with Movement (MWM) with SNAG to the Group A has given huge difference and more noteworthy change when compared with Group B.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.543-549</p> Mohan Kumar G, Jibi Paul, Sundaram MS, Mahendranath P ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Rare Clinical Cases of Renal Artery Thrombosis <p><strong><em>Objective: </em></strong>Renal vascular thrombosis is a thrombotic blockage of the major renal arteries resulting in acute damage or chronic kidney disease. The study aims to analyze rare clinical cases of renal artery thrombosis with following renal infarction.</p> <p><strong><em>Materials and methods</em></strong><strong>: </strong>The article present a retrospective study of examination and treatment results of patients diagnosed with the renal arteries thrombosis in the urological hospital of the Irkutsk Clinical Hospital No. 1 in the period 2012-2020.</p> <p><strong><em>Results and Discussion: </em></strong>During the entire observation period, there were two clinical cases of acute renal artery thrombosis. The 86-year-old woman developed thrombosis because of atrial fibrillation, which was probably the result of inadequate correction (insufficient dose of anticoagulant). Kidney infarction had complications like rapid suppuration because of chronic urinary infection and calculus of the renal pelvis. It resulted in nephrectomy with subsequent recovery. The second case was the 45-year-old man examined according to existing standards, and the diagnosed-on time in the first hours of the disease. However, complete thrombosis of the right renal artery neutralized the effectiveness of conservative therapy with warfarin. In this case, nephrosclerosis and renal failure were natural.</p> <p><strong><em>Conclusion</em></strong><strong>: </strong>Renal artery thrombosis is a rare pathology that requires special attention from the clinician due to the high risk of renal function loss. Timely diagnosis and correct treatment tactics are especially important.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.550-555</p> Vladimir Vorobev, Vladimir Beloborodov, Natalya Balabina, Konstantin Tolkachev, Sergei Popov, Stepan Sidorov, Irina Antipina ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Gene expression profiling in normal cytogenetic acute myeloid leukaemia of Malay patient <p><strong><em>Background: </em></strong>Insight into recent molecular analyses of patients with acute myeloid leukaemia (AML) and a normal cytogenetic have revealed a striking heterogeneity with regard to the presence of acquired changes in gene expression. Nano String technology which is aimed to identify descriptive profiling of normal cytogenetic AML in differentially expressed genes involved in the different pathways in normal cytogenetic AML patients.</p> <p><strong><em>Materials and method: </em></strong>Blood samples were obtained from eight at diagnosis patients with normal cytogenetics AML, two follow-up patients and two normal healthy controls prior to RNA extractions. RNA gene expression assay was performed using Nano Stringn Counter® Pan Cancer Pathway Panel (Nanostring Technologies, Seattle, Washington). Briefly, 100 ng of each total RNA sample was used as input into then Counter Pan Cancer Pathway Panel sample preparation. Data was extracted using then Counter RCC Collector and raw data output was imported into nSolver v2.6 analysis software for data analysis<em>.</em></p> <p><strong><em>Results: </em></strong>The age range was from 13-69 years, with a median age-range of 41 years. We found the most enriched up regulated genes in newly diagnosed normal cytogenetic AML enlisted MPO (7.25 log FC), FLT3 (5.02 log FC), MYCN (4.99 log FC), MYB (4.74 log FC), ITGA9 (4.48 log FC), KIT (4.41 log FC), MCM2 (3.47 log FC), RAD51 (3.40 log FC), CCNA2 (3.37 log FC) and PROM1 (3.24 log FC) which those commonly be found in AML cases. For highly expressed down regulated genes were GZMB (-5.80 log FC), IL8 (-5.79 log FC), TNFRSFSF10C (-5.03 log FC), LEF1 (-4.82 log FC), IL2RB (-4.70 log FC), IL7R (-4.44 log FC), BCL2A1 (-4.15 log FC), RASGRP1 (-4.13 log FC), IL1R2 (-4.00 log FC) and HSPA6 (-3.99 log FC).</p> <p><strong><em>Discussion and conclusion: </em></strong>Nano String required smaller amounts of starting material, and can perform mRNA expression profiling with digital precision, therefore the results do not require further validation by another method. MPO expression was significantly associated with disease-free survival (DFS). Previous report demonstrated that the groups by the MPO expression in the intermediate cytogenetic risk group showed a significant difference in DFS (<em>p</em>&lt;0.001). A study by Valk et al., (2004) showed FLT3, a hematopoietic growth factor receptor, is the most common molecular abnormality in AML. The presence of such mutations in FLT3 and elevated expression of the transcription factor EVI1 confer a poor prognosis. N-MYC expression levels in AML samples from patients with favorable, intermediate, or unfavorable prognosis were compared with that in CD34+ cells from four healthy bone marrow donors. The most highly down regulated gene in newly diagnosed AML goes to Granzyme B (GZMB) which involved in cytolytic activity that showed high correlation with other transcripts expressed in activated cytotoxic T lymphocytes (CTLs) and natural killer (NK) cells as well as lymphocyte activation-related gene validating it as a robust and specific metric of active cellular immunity. Increased expression of IL-8 and/or its receptors has been characterized in cancer cells, endothelial cells, infiltrating neutrophils, and tumor-associated macrophages, suggesting that IL-8 may function as a significant regulatory factor within the tumor microenvironment.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.556-562</p> Najah Kamarudin, Imilia Ismail, Rosline Hassan, Muhammad Farid Johan, Marini Ramli ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 D4 and D5 dopamine receptor mRNA expression in human peripheral blood lymphocytes among cooccurring opioid and amphetamine-type stimulants use disorder undergoing methadone maintenance therapy <p><strong><em>Introduction: </em></strong>Opioid and amphetamine type stimulant (ATS) exert their rewarding effects by stimulating the dopaminergic system in the mesolimbic area. It has been suggested that dopamine system in peripheral blood lymphocytes reflect the central dopamine system’s activity and pathology, especially in neuropsychiatric diseases including drug addiction. The present study aimed to assess the effect of co-occurring opioid and ATS (COATS) addiction towards mRNA expression of dopamine receptors DRD4 and DRD5 in peripheral blood lymphocytes (PBLs) of drug dependent subjects (n=36) undergoing methadone maintenance therapy in comparison to control subjects (n=36).</p> <p><strong><em>Materials and methods</em></strong><strong>: </strong>Ten mL blood were obtained from the subjects followed by lymphocyte isolation, RNA extraction and reverse transcription. DRD4 and DRD5 mRNA expression in peripheral lymphocytes was assessed using real-time PCR. The DRD4 mRNA expression but not DRD5 was significantly reduced in the peripheral lymphocytes of COATS subjects.</p> <p><strong><em>Results: </em></strong>Mean expression value for DRD4 was 14.0+0.24 among patients and 13.3+0.25 among control subjects. For DRD5 it was 12.87 + 0.75 among patients and 12.59 + 1.24 among controls<em>.</em></p> <p><strong><em>Conclusion</em></strong><strong>: </strong>Inconclusion, co-occurring opioid and ATS addiction was associated with persistent deficiency of DRD4 but not DRD5 in PBLs.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.563-568</p> Nur Khadijah Muhamad Jamil, Asma Abdullah Nurul, Imran Ahmad, Ismail Samhani, Ruzilawati Abu Bakar ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Efficacy of several insecticide formulations against Periplaneta americana (L.) (Blattaria: Blattidae) in sewers <p><strong><em>Objective: </em></strong><em>Periplaneta americana </em>(L.) is the most important invasive urban pests in sewers with high significance of public health. The aim of the study was to evaluate the efficacy of several insecticide formulations against American cockroaches in sewers.</p> <p><strong><em>Methods: </em></strong>The population density of cockroaches was estimated before and after 1 and 5 months of the use of insecticides in sewer manholes. About 10 manholes were allocated for treatment of each insecticide formulation. Twenty manholes were allocated to controls (without the use of insecticides). Insecticides were considered effective achieving more than of 90% mean density reduction of cockroach population per a manhole.</p> <p><strong><em>Results: </em></strong>The effectiveness of insecticide formulations in sewer manholes were considered effective after 1 month of insecticide treatments while the effectiveness of diazinon EC 5% and 0.05% formulations considered insufficient including 47.% and 19.5%mean density reduction of cockroaches, respectively. The effectiveness of chlorpyrifos EC 5% and Fog, and diazinon EC 5% were observed about 80.5%, 81.5%and 53.5% mean density reduction of cockroaches, respectively after 5 months of treatment while the other formulations did not achieve effectiveness.</p> <p><strong><em>Conclusions</em></strong><strong>: </strong>The insecticide formulations were considered effective and ineffective after 1 and 5 months of the use of insecticides, respectively. It would be more satisfied if insecticide formulations repeated every three months. A reasonable manner is using a combination of integrated pest management strategies recommending for successful <em>P. americana </em>control.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.569-585</p> Hassan Nasirian, Abedin Saghafipour ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Clinical Assessment and Pedobarographic Analysis after Radial Shock Wave Therapy of Ankle Plantar Flexor Spasticity in Stroke <p><strong><em>Objective: </em></strong>Radial shock wave therapy (RSWT) has increasingly been utilized in the treatment of spasticity recently. The purpose of the current study is to assess the effectiveness of RSWT in the treatment of ankle plantar flexor muscles spasticity of stroke patients by pedobarography and clinical evaluation.</p> <p><strong><em>Materials and Methods</em></strong><strong>: </strong>A total of 23 stroke patients were enrolled into the study. Patients received an initial sham treatment of RSWT, followed by three separate interventional sessions received one week apart. Treatment success was assessed using the Modified Ashworth Scale (MAS), ankle passive range of motion (pROM) measurement and pedobarography.</p> <p><strong><em>Results and Discussion</em></strong><strong>: </strong>No significant change was observed in clinical and pedobarographic values following sham RSWT. In the intervention group, however, MAS decreased from3.34±0.7 to 2.39±0.89 after a single RSWT session and to 2.04±0.92 first week and to 2.52±0.89 fourth week after three RSWT sessions. As a result of the study, heel peak pressure and total plantar contact area were improved. In particular, three RSWT sessions were more effective than single RSWT session.</p> <p><strong><em>Conclusions: </em></strong>We observed a significant improvement in plantar flexor spasticity in stroke patients after both a single and three RSWT sessions and this improvement persisted during the four-week study period.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.586-593</p> Ömer Dikici, Özlem Solak, Alper Murat Ulaşlı, Selma Eroğlu, Hasan Toktaş, Ümit Dündar ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Barriers and promotors in receptivity and utilization of feedback in a pre-clinical simulation based clinical training setting <p><strong><em>Objective: </em></strong>Many studies have explored feedback effectiveness using interventions focused on feedback delivery. It is equally important to consider how learners actively receive, engage with and interpret feedback. This study explores how medical students receive and use feedback in pre-clinical skills training.</p> <p><strong><em>Method: </em></strong>Focus group data from 25 purposively selected thirdyear medical students was thematically analysed. Four major themes and eight sub-themes related to the facilitators and barriers to feedback receptivity and utilisation to feed forward emerged from the data.</p> <p><strong><em>Results and Discussion: </em></strong>Students were receptive to feedback when its purpose and content aligned with their personal objectives, when it was consistent between tutors, and when it involved developing longitudinal relationships. The clinical skills formative logbook feedback culture with a learning focus was perceived to be predictive of their future performance and they were likely to take feedback on board, emphasising the role of reflection in this process. The depth and timing of actual feedback use varied among students, and language barriers hindered decoding feedback. Students’ self-regulatory focus on the feedback process had a dominant influence on their active use of feedback.</p> <p><strong><em>Conclusion: </em></strong>Incorporating learner behaviour underlying feedback use should be considered when designing interventions to promote feedback engagement, feedback literacy skills and responsibility sharing in the feedback process. Establishing a learning culture that promotes shared responsibility between clinical educators and learners enable greater control by learners over assessment and feedback processes and a commitment to behaviour change.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.594-607</p> Reina M Abraham, Veena S Singaram ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Auditory Cognitive Function Assessment during Pregnancy: An Event-Related Potential and Neuropsychological Study <p><strong><em>Objectives: </em></strong>We investigated the auditory cognitive and behavioral functions during 2nd and 3rd trimesters of pregnancy using event-related potentials (ERPs) and different neuropsychology tests, respectively.</p> <p><strong><em>Methods: </em></strong>The ERPs were studied by using a 128-sensor net, and PAS/COWA, WCST, ZCT, RAVLTIM/RAVLTDR/RAVLTTS, and BDI were tested for neuropsychology assessment. Total 39 subjects were recruited for control group (G1, n=15, non-pregnant), 2nd trimester group (G2, n=12, 13-26 weeks gestation), and 3rd trimester group (G3, n=12, 26- 40 weeks gestation). Auditory oddball paradigm was used during ERP study. Subjects silently counted only the target stimuli with attention by ignoring standard stimuli. Value of the mean differences of the target and standard stimuli were measured across groups in 10-20 electrode systems.</p> <p><strong><em>Results: </em></strong>The P50, N100, and P300 ERP components were analyzed. The G3 (at F7 and C3) and G2 (at T4) groups evoked the highest significant amplitudes in P50, and G3 (at Cz and Pz) and G1 (at F8 and T4) evoked the highest significant amplitudes of N100 with significantly prolonged latencies at Cz and O1 (in G1) and F8 (in G2). However, significantly higher amplitudes of P300 were found at Fz (in G3) and FP1 (G2) (G2&gt;G3). On the other hand, neuropsychology tests revealed that G2 possessed the highest significant score in WCST and G1 in ZCT. The G3 performed poorly in all tests.</p> <p><strong><em>Conclusion: </em></strong>We concluded that pregnant groups performed better in auditory (attention/memory) and executive function assessment. Moreover, the 2nd trimester group has better auditory cognitive function compared to the 3rd trimester group due to the effect of hormonal changes during pregnancy, which might be a positive influence during the pregnancy period.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.608-617</p> Tahamina Begum, Faruque Reza ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Characterization of β-Globin Gene Cluster Deletions Using Multiplex-Gap Polymerase Chain Reaction (PCR) and Multiplex Ligation-Dependent Probe Amplification (MLPA) <p><strong><em>Background : </em></strong>Deletions in the β-globin gene cluster are usually rare, problematic to detect, and subsequently possess a challenge in many diagnostic laboratories. They are normally related to the heterozygous of the delta beta (δβ) thalassemia, hereditary persistence of fetalhemoglobin (HPFH) and some of the hemoglobin variants. These disorders are typically presented by elevated levels of hemoglobin F (Hb F), but with low to normal hemoglobin A2 (Hb A2). However, despite their existence, there is still a limited number of studies focusing on this area, hence no definitive diagnosis could be conclusively established. Therefore, this pilot study was carried out to fill this knowledge gap.</p> <p><strong><em>Methods: </em></strong>In this study, screening of the selected deletional mutations in the β-globin gene cluster among patients with Hb F (&gt;1%) and Hb A2 (&lt;4%) were performed using multiplex Gap-PCR and multiplex ligation-dependent probe amplification (MLPA).</p> <p><strong><em>Results: </em></strong>The results showed that out of 54 samples tested using multiplex Gap-PCR against four target deletions; Thai (δβ)°-thalassemia, HPFH-6, Siriraj J and HbLepore, one sample was found positive with Thai (δβ)°-thalassemia. Further findings from the MLPA screening on 12 randomly selected samples revealed that another patient was positive with double deletions within the region of the β-globin gene cluster. These deletions occur at the gamma-globin gene 1 (HBG1) and gamma-globin gene 2 (HBG2) in exon 3.</p> <p><strong><em>Conclusions: </em></strong>In conclusion, this study highlighted the importance of these deletions’ characterization using multiplex Gap-PCR and MLPA which helps in establishing a definitive diagnosis among this selected group of patients.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.618-624</p> Yasmin n Mohamad Redzuwan, Siti Nor Assyuhada Mat Ghani, Rozanah Abdul Ghani, Yousef Saeed Mohammad Abu Za’ror, Rosnah Bahar, Maryam Azlan, Zefarina Zulkafli, Rozieyati Mohamed Saleh ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 The physical fitness evaluation of medical student in Semarang : a cross sectional study <p><strong><em>Objective</em></strong>: Physical activity (PA) is one of the most important determinants for physical fitness (PF) in adolescence and young age. The previous study showed that most medical students as part of young population were found to be physically inactive. Our study aims to evaluate the correlation between PA and PF status among medical students.</p> <p><strong><em>Materials and methods: </em></strong>One hundred and twenty five medical students of UNISSULA were enrolled in this study. PA level was measured using international physical activity questionnaire (IPAQ)-short form. PF status was evaluated by cardiorespiratory capacity (VO2<em>max </em>score), handgrip muscle strength (HGS), and body composition (fat persentage and BMI). The data were analyzed using pearson correlation analysis.</p> <p><strong><em>Results and discussion: </em></strong>The majority of PA level among participants were low. There was a correlation between PA level and sex (p= 0.001, r = 0.272), PA level and BMI (p = 0.001, r = 0.264), PA level and HGS score (p=0.000, r = 0.345). However, there was no correlation between PA level and VO2max or fat percentage.</p> <p><strong><em>Conclusion: </em></strong>The PA level and PF status among participants were considered to be low and fair, respectively. Only one component of PF status (HGS) was correlated with PA level. Further investigations on the correlation between PA level and PF status using more objective methods are needed especially when involving medical students.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.625-630</p> Nura Eky Vikawati, H Sarosa, I Rosdiana ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Effect of Averrhoa bilimbi Fruit Extract on Blood Pressure and Mean Arterial Pressure of NaCl Induced Hypertensive Rats <p><strong><em>Objective:</em></strong><em>Averrhoa bilimbi </em>fruit contains potassium and flavonoid expected to play a role in lowering blood pressure. This study aim to examine the effect of <em>Averrhoa bilimbi </em>fruit extract on blood pressure and mean arterial pressure in NaCl-induced hypertensive rats.</p> <p><strong><em>Materials and methods: </em></strong>This research employs pre- and post-test randomized control group design and uses 15 rats which are divided into 3 groups. On day 6, all groups are pretreated with NaCl 8% solution to induce hypertension for 14 days. On day 20, the control, furosemide and bilimbi groups are respectively treated with distilled water, 0.72mg/200gBW furosemide, and 150mg/200gBW <em>Averrhoa bilimbi </em>fruit extract for 7 days. The (systolic and diastolic) blood pressure and mean arterial pressure of each group are evaluated on day 20 and 27. The results are analyzed with Repeated Anova.</p> <p><strong><em>Results: </em></strong>The mean systolic and diastolic blood pressure of the control, furosemide and bilimbi group before treatment are (128.4±11.8/88.0±7.8mmHg); (142.8±13.6/85.4±16.7mmHg); and (144.8±15.1/98.0±14.9mmHg) respectively. The mean systolic and diastolic blood pressure of the control, furosemide and bilimbi group after being treated are (88.0±11.8/60.8±7.8mmHg); (98.0±13.6/71.0±16.7mmHg); and (85.4±15.1/65.0±14.9mmHg) respectively. The mean arterial pressure of the control, furosemide and bilimbi groups are (69.4±8.2mmHg); (79.6±14.8mmHg); (71.4±15.0mmHg) respectively. There is a statistically significant difference in the blood pressure and the mean arterial pressure among the groups (p=0.000). <em>Averrhoa bilimbi </em>fruit extract has an effect on the blood pressure and the mean arterial pressure of NaCl-induced hypertensive rats.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.631-636</p> Rafida M, AH Safitri, Nurina Tyagita ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 The Predictors of Acute Lower Limb Ischemia on the Background of the Recommended Prophylaxis <p><strong><em>Objective: </em></strong>Acute limb ischemia (ALI) manifests as sudden lower limb ischemia that, regardless of the underlying cause, can lead to amputation unless there is an appropriate treatment.The study aims to analyze predictors of the lower limb occlusive thrombosis with the acute ischemia development (ALLI), depending on the localization under specifically recommended prophylaxis.</p> <p><strong><em>Materials and methods: </em></strong>The researchers performed a retrospective analysis of clinical cases with a confirmed diagnosis of acute lower limb ischemia (ALLI) for 2019. During this period, 20 patients met the study criteria.</p> <p><strong><em>Results and Discussion: </em></strong>A multivariate analysis (predictors with a p&lt;0.1) established hyperglycemia as a significant predictor of ALLI development under specific prophylaxis (RR 2.2; 95% CI -8.2; 8.4; p = 0.097). It indicates a double risk of ALLI for patients with hyperglycemia.</p> <p><strong><em>Conclusion: </em></strong>The results indicate the need to correct glycemic parameters to reduce the risk of acute lower limb ischemia, even under antiplatelet or anticoagulant prophylaxis. It is also necessary to analyze the management protocols currently used for such patients to correct the recommended antiplatelet or anticoagulantschemes.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.637-641</p> Vladimir Beloborodov, Vladimir Vorobev, Natalya Balabina, Vladimir Luchkevich, Olga Rizakhanova, Andrey Bolsheshapov, Tatyana Maksikova ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Omphalopagus Conjoined Twins: A Case Report <p>We present a case of conjoined omphalopagus twins in a 35-year-old woman who came for antenatal booking at 9 weeks of gestation to a health centre in Kota Bharu, Kelantan. The diagnosis was confirmed via ultrasonography by an obstetrician in a tertiary Hospital at 12 weeks of gestation. The pregnancy was allowed to progress as it carried the best chance of survival. However, the parents were in dilemma with the decision. Primary care practitioners play an important role to prepare patients mentally and physically to face the outcome of the pregnancy.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.642-645</p> Norazlin Zainuddin, Azlina Ishak, Nani Draman ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Outcome of treatment of Eichenholtz stage III charcot neuroarthropathy by using bilayer insole: a single center study <p><strong><em>Introduction: </em></strong>Insoles are recommended for the treatment of patients with neuropathic foot to distribute the foot plantar pressure while preventing recurrent ulceration. Different types of insole are available but the cost is the major limiting factor. Thus, it is justifiable to conduct this study to evaluate the efficacy of cost effective locally-designed bilayer Lunairmed insoles as an adjunctive treatment for patients with Eichenholtz Stage III Charcot neuroarthropathy in our centre.</p> <p><strong><em>Methods: </em></strong>This was a prospective observational study conducted in tertiary centre, Malaysia from September 2016 to September 2017. A total of ten patients with Stage III Charcot neuroarthropathic foot without ankle instability were included. All patients were evaluated for foot plantar pressure by using Tekscan, short form (SF-36) and American Orthopaedic Foot and Ankle Society(AOFAS) score before and after using insoles.</p> <p><strong><em>Results: </em></strong>Fifteen out of twenty feet showed reduction in peak plantar pressure (PP) and force-time-integral (FTI) at forefoot and heel after using bilayer Lunairmed insoles. There was a mean reduction of 24.8% of total foot PP.</p> <p><strong><em>Conclusion: </em></strong>Locally designed bilayer Lunairmed insoles could be used to reduce PP in Eichenholtz Stage III Charcot neuroarthropathic foot without ankle instability.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.646-650</p> Ng Bing Wui, Ohnmar Htwe, Amaramalar Selvi Naicker, Brenda Saria Yuliawiratman, Mohd Yazid Bajuri, Manimalar Selvi Naicker, Nurwahidah Abdul Rouf ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 A case of Peritonitis with pneumoperitoneum secondary to a spontaneous rupture of splenic abscess <p>Sponteous rupture of a splenic abscess is rare and little described in the literature. It can cause peritonitis with pneumoperitoneum. Our case illustrates this exceptional complication in a 77 year-old diabetic patient who consulted for abdominal pain with asthenia. The abdominal computed tomography showed an acute peritonitis caused by with splenic abscess. Aeoporty was also observed. He was operated but died postoperatively for severe sepsis. Our case is rare and interesting. Indeed, a splenic abscess can be the cause of peritonitis, pneumoperitoneum and aeorportie.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.651-653</p> - Mohamed Hajri, Ghofrane Talbi, Dhouha Bacha, Wael Ferjaoui, Lassad Gharbi, Mohamed Taher Khalfallah ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Acute paroxysmal cold haemoglobinuria; a case report and literature review <p>Paroxysmal cold hemoglobinuria (PCH) is a very rare subtype of autoimmune hemolytic anemia caused by the presence of cold-reacting autoantibodies in the blood and characterized by the sudden presence of hemoglobinuria, typically after exposure to cold temperatures. The acute onset PCH occurs following viral illnesses whilst the chronic form is secondary to hematological malignancies and tertiary syphilis. It is a complement mediated intravascular hemolytic anemia associated with a biphasic antibody against the P antigen on red cells. We describe a three year child who had acute onset PCH following likely viral infection. The diagnosis was confirmed by demonstration of strongly positive Donnath Landsteiner antibodies. She made a gradual recovery with supportive treatment, ten days following the initial detection of haemolysis. Parents were educated about the need to avoid cold exposure to prevent precipitation of further haemolysis and folic acid was commenced to assist the recovery of erythropoiesis.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.654-657</p> Hasitha Gajaweera, Kavinda Dayasiri, Nayani Suraweera, Chandrachapa Gamage, Kumudu Weerasekara ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Ectopic carcinoma ex-pleomorphic adenoma in the lower neck: a rare entity at a rare location <p>Ectopic salivary gland tissue (ESGT) is salivary tissue located outside the major, minor and accessory salivary glands. Neoplasms rarely arise from ESGT, let alone carcinoma expleomorphic adenoma (CEPA) which is a malignant tumour that arises from the epithelial component of pleomorphic adenoma. It usually occurs in the parotid gland and in lesser instances, from submandibular gland or minor salivary glands. Herein, we report a rare case of CEPA in right supraclavicular ESGT of a 67-year-old lady.She underwent complete surgical excision of the mass and is free from any recurrence to date. Brief review of pathogenesis, clinical features and treatment of ectopic CEPA are discussed. A thorough review of the English literature reveals that our patient may be the second case of ectopic CEPA in the neck region ever reported to date.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.658-661</p> Kuganathan Ramasamy, Yatiee Swany Lahuri, Norhaslinda Abdul Gani, Noor Hasni Shamsudin ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Gastric Glomus Tumor: Report of a Case <p>Abstract not available</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.662-664</p> Metin Leblebici, Cem Ilgin Erol, Ozgur Ekinci, Tunc Eren, Orhan Alimoglu ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 A 3 Month Old Child with Atypical Kawasaki Disease <p><strong><em>Background: </em></strong>Kawasaki Disease <strong>(</strong>KD) is an autoimmune vasculitis of unknown etiology that occurs predominantly in infants and young children with special predilection to coronary arteries.</p> <p><strong><em>Case Presentation</em></strong><strong>: </strong>We report the case of a 3-month-old child with an atypical form of KD, characterized by prolonged fever and non- specific symptoms, who developed an aneurysm of the left anterior descending coronary artery.</p> <p><strong><em>Conclusion: </em></strong>This case report underlines the challenges in recognizing atypical forms of the illness in young infants with minor features, who are at higher risk of long term cardiac complications.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.665-668</p> Md Salim Shakur, Sharmin Afroze ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Rh-D-primigravida mother with anti Rh-17 antibodies causing mild haemolytic disease of foetus and newborn in baby: a case report <p>Rh-D- is an unusual phenotype in Rh blood group system, lacking all Cc or Ee antigens but demonstrates a stronger D antigen expression. We describe here an extremely rare Rh-D phenotyped mother with first baby affected by haemolytic disease of foetus and newborn (HDFN). A 20-year-old pregnant lady, presented in active labour with foetal distress and planned for emergency cesarean section. Her blood group was A RhD positive, with positive antibody screening. Antibody identification demonstrated multiple antibodies against RhCc Ee polypeptide by the reference laboratory. Rh phenotype was -D-/-D- with no C/c and E/e antigen but strong D antigen. Crossmatch was incompatible with all A RhD positive units. Management of such patient is extremely difficult due to the scarcity of Rh-D- donor blood. In this case, reference laboratory had one frozen Rh-D- blood ready for use if indicated. Fortunately, patient underwent caesarean section without any complication. Baby was grouped as A Rh-D positive with probable Rh genotype as CDe/-D-. Baby’s DCT was positive and eluate showed antibodies of identical reactivity as mother. Baby developed mild jaundice at day-2 and managed with phototherapy. Clinically Rh-D- phenotype in pregnant women can cause mild to fatal HDFN. Routine antibody screening in pregnant women can detect such rare case that helps proper management of mother and baby. Prior arrangement of this rare blood is warranted to prevent the maternal and infant mortality and morbidity.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.669-672</p> Rabeya Yousuf, Nor Fadzliana Abdullah Thalith, Yee Loong Tang, Chooi Fun Leong ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Kratom Dependence in Adolescents: Is Methadone A Lifesaver? <p>Kratom dependence among adolescent, even though underreported, is increasing in prevalence in Southeast Asia. Kratom can be simply misused with a great possible addiction and subsequently cause serious undesirable physical and mental health consequences, which is not something to be taken lightly. We present three case series of late adolescents who consumed kratom for more than six months, which leads to poor school performance and had already developed withdrawal symptoms. This case series illustrates the effectiveness of treating adolescents with kratom dependency using combination of medical therapy - Methadone as Drug Substitution Therapy (DST) and supportive therapy from their family members. Therefore, it is crucial for primary care practitioners to screen the adolescents and alert the withdrawal symptoms as well as initiating early discussion with psychiatrist in order to start the prompt treatment since DST is available in primary care clinic.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.673-677</p> Nawal Nabilah Kamaludin, Mohd Ariff Mohd Noor, Rosediani Muhamad, Zainab Mat Yudin, Nur Ilyani Mohamed Nawi ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Hemorrhagic thyroid nodule causing shifted airway <p>Sudden rapidly increased neck swelling due to spontaneous intranodular bleeding of the thyroid gland is rare occurrence but can be considered. Here, we report an extremely rare case of spontaneous rupture intrathyroidal nodule in a healthy young female who had no history of neck swelling, thyroid disease or neck trauma. She was closely observed and treated conservatively as there was no compromised airway. She was discharged well after completed intravenous antibiotic.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.678-681</p> Nurul Anis Mohd Fauzi, Mohd Shaiful Nizam Mamat Nasir, Zubaidah Mohamad, Azliana Aziz, Irfan Mohamad ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Timely Combination Therapy of Skeletal and Dental Class II malocclusion with Temporary Anchorage Device and Mesially Impacted Mandibular 2ndMolars: A Case-Report <p><strong><em>Introduction</em></strong><strong>: </strong>Patient is a 14 years old Chinese boy presented with skeletal Class II with incompetent lips, severe dental Class II malocclusion and severe crowding complicated with both sides mesio-angular impacted of mandibular 2nd molars.</p> <p><strong><em>Treatment Plan</em></strong><strong>: </strong>Growth modification using functional appliance for skeletal Class II correction with maxillary arch expansion and correction of mandibular plane angle by intrusion of maxillary molars. Extraction of lower 1st premolars and 2nd molars on both sides was carried out in conjunction with fixed orthodontic alignment and to facilitate of spontaneous eruption of lower third molar. Midline correction was followed by space closure and finishing and detailing.</p> <p><strong><em>Results: </em></strong>Alignment of upper arch in the regained space with maxillary expansion without any extraction was done. Anterior maxillary dentitions were retracted using Temporary Skeletal Anchorage Devices (TSADs). In lower arch 1st molars were mesially protracted by using class II elastics. 3rd molars spontaneously erupted in the extraction space of 2nd molar. Midline corrected with good facial profile and competent lips.</p> <p><strong><em>Conclusions: </em></strong>Timely execution of expert treatment plan can bring cost effective and time saving results with minimum loss. By proper counseling, patient compliance and confidence can be boosted which could have a positive effect on the treatment outcome.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.682-690</p> Norma Ab Rahman, Mohammad Khursheed Alam, Aida Nur Ashikin Ab Rahman, Wey Mang Chek ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 A 60-year-old man with isaacs mertens-syndrome a rare entity <p>Isaacs-mertens syndrome also known as neuromyotonia is a rare neuromuscular disorder caused by hyperexcitability and continuous firing of axons of the nerve that innervate the muscle fibers. It is an immune-mediated disorder with elevated antibody level against voltage gated potassium channels (VGKC). Symptoms include progressive muscle weakness, continuously twitching muscles (myokymia), cramping, increased sweating and delayed muscle relaxation. This is a case report of a 60-year-old man who presented with pain and weakness of right lower limb for 3 months, which gradually became worse to involve both the lower and upper limbs. NCS revealed to have motor neuropathy and EMG showed fibrillations and fasciculations with positive sharp waves. After which he was diagnosed with Isaacs-mertens syndrome and was followed up for 8 weeks with medications and physiotherapy management.</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.691-693</p> G Tharani, K Kamatchi, G Yuvarani ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000 Self-management for elderly during the COVID-19 pandemic <p>Abstract not available</p> <p>Bangladesh Journal of Medical Science Vol.20(3) 2021 p.694-695</p> Md Sazedur Rahman, Zohra S Lassi ##submission.copyrightStatement## Sun, 04 Apr 2021 00:00:00 +0000