Bangabandhu Sheikh Mujib Medical University

Childhood adverse and favorable experiences before the age of 18 have enduring effects on an adult's mental health.

We investigate the moderating effect of benevolent childhood experiences (BCEs) on the link between adverse childhood experiences (ACEs) and poor mental health outcomes (depression, anxiety, stress) in an adult's later life.

This cross-sectional study was conducted among 384 adults aged ≥40 years from September 2021 to March 2022 at Dhangara Union of Raiganj Upazila, Bangladesh.

Face-to-face interviews were conducted in randomly selected households using a semi-structured questionnaire. Analysis and plots were generated using SPSS and R software.

Most of the respondents (95·6 %) experienced different types of ACEs, 20·5 % reporting >4 ACEs, and 31·7 % reporting all ten BCEs. Significant associations were found between ACEs and depression (b = 0.761, p = 0·001), anxiety (b = 0.740, p = 0·0003), stress (b = 0.812, p = 0·0003). The interactions showed that BCEs have moderating effect on the relationship between ACEs and depression (b = -0·35, p = 0·009), anxiety (b = -0·27, p = 0·009), and stress (b = -0·30, p = 0·018) symptoms. The Johnson-Neyman region of significance evidenced that the moderating effect of BCEs was significant up to a certain threshold (depression = 8·91, p = 0·05; anxiety = 9·04, p = 0·05; stress = 8·97, p = 0·05). Beyond this threshold, no significant change was observed, suggesting a limit to the buffering effect of BCEs.

Our findings suggest that beyond a certain threshold, the effects of ACEs become resistant to further mitigation by BCEs, resulting in poor mental health outcomes. So, it is essential to promote healthier childhood experiences by developing targeted interventions and policies.

Disseminated histoplasmosis (DH) is a rare deep fungal infection caused by Histoplasma capsulatum and it usually occurs in immunocompromised patients like in acquired immunodeficiency syndrome (AIDS) or patients getting any immunosuppressive therapy. Histoplasmosis usually remains unrecognized in immunocompetent individuals. Here we are reporting a case of a 55-year-old immunocompetent man with DH who presented to us with dysphagia, occasional vomiting, slurred speech with left sided hemipaeresis, weight loss and after hospital admission he developed fever, but no cough. On investigations, he was found to have bilateral adrenal mass, rim enhancing lesion in the brain, nodular lesions in duodenum and soft tissue mass in lung. DH was confirmed by the presence of Histoplasma capsulatum in the cytopathology of adrenal mass and histopathology of tissue from duodenum which revealed PAS positive yeasts. He was treated with itraconazole rather than recommended choice of liposomal amphotericin B as he could not afford this expensive drug. After getting itraconazole on subsequent follow up at 4 months, he was found to be clinically improving, gained weight about 10 kg with disappearance of other symptoms. DH may present with atypical symptoms like dysphagia, slurred speech with hemiparesis rather than common presentation with fever, cough or weight loss. Though DH is more common in immunocompromised patients, if multisystem involvement occurs in immunocompetent patients, we should always consider deep fungal infection as one of the differentials.

Objectives: Obsessive-compulsive disorder (OCD) is a prevalent mental health condition that impacts daily life. It is thought to be associated with genetic, biological, and structural brain changes, serotonergic abnormalities, altered neuromodulation, and environmental factors. Limited observational studies have examined cytokines in Bangladeshi patients with OCD. This study aimed to assess the levels of eotaxin-1 and interleukin (IL)-34 in individuals with this disorder.Methods: This case-control observational study included 58 patients with OCD and 30 healthy controls (HCs) matched for age, sex, and body mass index. The severity of OCD was assessed using the Yale-Brown obsessive-compulsive scale (Y-BOCS). Psychiatrists evaluated participants according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Serum levels of eotaxin-1 and IL-34 were measured using enzyme-linked immunosorbent assay kits.Results: Patients with OCD exhibited significantly higher serum eotaxin-1 levels (121.13±7.84 pg/mL) than HCs (85.52±9.42 pg/mL). Conversely, IL-34 levels were considerably lower in patients than in HCs (119.02±14.53 pg/mL vs. 179.96±27.88 pg/mL). The Cohen d values for eotaxin-1 and IL-34 were 0.55 and −0.48, respectively. Among patients with OCD, a significant positive correlation was found between serum eotaxin-1 level and Y-BOCS score, along with a negative correlation between serum eotaxin-1 and IL-34 levels.Conclusion: The findings suggest that altered eotaxin-1 and IL-34 levels may be associated with OCD. These chemokines and cytokines could serve as primary tools for assessing the risk of OCD, warranting further clinical investigation. This could potentially support more extensive research and the development of diagnostic and therapeutic strategies targeting these pathways.