Care Hospital In Dhaka Research Articles

Organisms isolated from wound swab and pus with their antibiotic susceptibility pattern in a tertiary care hospital in Bangladesh.

Background: Antimicrobial resistance is a global health problem and the number of organisms developing resistance to commonly used antibiotics is increasing. Objective: The study was aimed to find out the pattern of common organism isolated from wound swabs and pus with their antibiogram. Methods: This observational study was conducted from September 2018 to January 2019 in a tertiary care hospital in Dhaka, Bangladesh. Culture and sensitivity tests were done for wound swabs and pus samples. Data regarding information of the patients, isolated organisms and culture and sensitivity reports were collected from the records of the department of microbiology. Results: Out of 1709 samples, 72.0% yielded growth of organisms of which 86.4% were gram negative and 13.6% were gram positive bacteria. Pseudomonas spp was the most commonly (43.8%) isolated organism from both wound swab and pus samples followed by Escherichia coli (16.6%), Staphylococcus aureus (11.8%), Klebsiella spp (9.8%). Among gram negative bacteria, 14.9% were ESBL producing organisms and Klebsiella spp were the most commonly isolated ESBL producers. Most of the bacteria showed high resistance to commonly used antibiotics. Gram negative bacteria were mostly resistant to amoxicillin followed by fluoroquinolones, co-trimoxazole, and cephalosporins whereas colistin, carbapenems and piperacillin/tazobactum were the most effective drugs against them. Majority of gram positive bacteria were resistant to fluoroquinolones and co-trimoxazole but 100% Staphylococcus aureus were sensitive to vancomycin, followed by linezolid (98.0%) and teicoplanin (86.0%) and 32.0% of them were Methicillin resistant (MRSA). Conclusion: The susceptibility pattern shows that some common antibiotics, especially antibiotics of oral form have very limited usefulness in treatment of infections and also highlight the need for regular reporting and antibiogram guided antibiotic prescription. Bangladesh Med Res Counc Bull 2021; 47(2): 181-187

Assessing the diagnosis Delay Among Breast Cancer Patients Attending in a Tertiary Care Hospital in Dhaka

Background: Diagnosis is a key determinant for any disease outcome. For that, we want to find out in which stage a breast cancer patient got admitted in hospital including various methods of laboratory investigations were done at different visits. Objectives: This study was aimed to generate information on the stages that a breast cancer patient got admitted including various methods of laboratory investigations were done at different visits. Methodology: We conducted a cross sectional study at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh from July 2017-June 2018. We randomly selected a total of 200 patients who came to that hospital through face-to-face interview by using pretested semi-structured questionnaire. Results: A total 77.0% (154) patients investigated Fine Needle Aspiration Cytology (FNAC) at first visit and mean duration for diagnosis was 11 months. Maximum patients came for diagnosis at stage II, III or IV; nobody came at stage I. As consequences, we found that stage of cancer had 7 times more likely to cause diagnostic delay (OR=7.957; 95% CI 3.206-19.749) p <0.0001. Number of consultations was one of the cause for diagnostic delay (c2= 12.825, p <0.0001). Diagnostic delay had strong association between first consultation with physician versus other health care providers (c2= 17.645, p <0.0001). Excluding physicians, first consultation with health care providers also had 3 times more likely to cause delay in diagnosis (OR-3.862; 95% CI1.877-7.944) p<0.0001. Conclusion: Breast cancer patients attended to health care provider at advanced stage. Knowledge, negative perception, social support were the contributing factor for delay in breast cancer diagnosis. Bangladesh Med Res Counc Bull 2021; 47(2): 136-142

Risk factors for diabetic nephropathy among newly diagnosed type 2 diabetic patients with normal blood pressure

Background: Patients with type 2 diabetes mellitus (T2DM) pass through pre-diabetic stages and during diagnosis, half of them may have different complications including diabetic nephropathy. Hypertension has adverse impacts on diabetic nephropathy. We aimed to evaluate the risk factors for diabetic nephropathy among newly detected T2DM patients with normal blood pressure.
 Methods: A case-control study was done at a tertiary care hospital in Dhaka, Bangladesh from January 2018 to June 2019. Newly detected (<3 months), adult ( ³18 years), T2DM patients, who underwent tests for urine albumin-to-creatinine ratio (UACR), at least twice, 6-weeks apart, were included in this study. Patients with hypertension, known kidney disease, features of glomerulonephritis, systemic diseases including systemic lupus erythematosus and vasculitis, history of recent fever and exercise, urinary tract infection and pregnancy were excluded. Patients with UACR ³30 mg/g in at least two samples were cases and those with UACR <30 mg/g were controls.
 Results: Among the total 135 patients, 27 were cases [moderately increased proteinuria (previously, microalbuminuria) (UACR 30–299 mg/g) = 25 and severely increased proteinuria (previously, overt proteinuria) (UACR ³300 mg/g) = 2] and 108 were controls. Multivariate logistic regression revealed that family history of diabetes (OR=2.13; 95% CI, 1.412 to 4.216, p=0.003) and diabetic nephropathy (OR=3.31; 95% CI, 2.145 to 5.249, p=0.001), smoking (OR=3.11; 95% CI, 2.234 to 4.123, p=0.003), dyslipidaemia (OR=2.14; 95% CI, 1.363 to 3.324, p=0.005) and diabetic retinopathy (OR=6.23; 95% CI, 4.197 to 9.464, p=0.004) were significant risk factors.
 Conclusion: We concluded that, family history of diabetes and diabetic nephropathy, smoking, dyslipidaemia and diabetic retinopathy appeared as significant risk factors for diabetic nephropathy among newly diagnosed T2DM patients with normal blood pressure.
 BIRDEM Med J 2022; 12(2): 152-157

MO623: Risk Factors of Diabetic Nephropathy Among Newly Detected Type 2 Diabetic Subjects: Preliminary Report from A Tertiary Care Hospital of Bangladesh

Abstract BACKGROUND AND AIMS Patients with type 2 diabetes mellitus may present with different macro- and micro-vascular complications including diabetic nephropathy. This preliminary study was designed to evaluate the risk factors for diabetic nephropathy among type 2 diabetic patients at the time of diabetes diagnosis. METHOD A case-control study was done at a tertiary care hospital in Dhaka, Bangladesh from January to September 2017. Adult (≥18 years), type 2 diabetic patients, who were detected as diabetic for the first time within the previous 3 months and who tested, at least, two urine samples for urine albumin-to-creatinine ratio (UACR), at least 6 weeks apart, within a 6-month period, were consecutively enrolled for the study. Pregnant ladies, patients with diagnosed kidney disease, patients having features of glomerulonephritis and systemic diseases including systemic lupus erythematosus and vasculitis, history of recent fever, urinary tract infection and menstruation were excluded. Patients having UACR ≥30 mg/g in at least two (out of 3, if tested) samples were taken as cases and those with UACR <30 mg/g were taken as controls. Data were analyzed by statistical package for social sciences (SPSS) version 20. RESULTS Total patients were 224 with female predominance (150, 67%). Fifty one (22.8%) patients had diabetic nephropathy (microalbuminuria = 47 and overt proteinuria = 4). Multivariate regression analysis revealed that hypertension {odds ratio (OR) = 3.71 [95% confidence interval (CI) 1.23–4.31], P = 0.003}, smoking [OR = 3.27 (95% CI 2.91–4.79), P = 0.003], family history of diabetes [OR = 2.31 (95% CI 1.84–3.14), P = 0.005] and diabetic nephropathy [OR = 3.34 (95% CI 2.40–4.97), P = 0.001], dyslipidaemia [OR = 2.31 (95% CI 1.98–3.91), P = 0.023], increased body mass index (BMI) [OR = 2.11 (95% CI 1.54–4.87), P = 0.001] and high glycated haemoglobin (HbA1c) [OR 3.21 (95% CI 1.71–5.97), P = 0.034] were significant risk factors for diabetic nephropathy. CONCLUSION Almost 23% of type 2 diabetic patients had diabetic nephropathy during diabetes diagnosis in this study and most patients had microalbuminuria. Presence of hypertension, dyslipidaemia, smoking, family history of diabetes and diabetic nephropathy, increased BMI and high HbA1c were significant risk factors for diabetic nephropathy among patients with type 2 diabetes at diagnosis.

Frequency and Outcome of Ventilator Associated Pneumonia in an Intensive Care Unit of a Tertiary Care Hospital in Dhaka

Background: Intubation and mechanical ventilation are integral parts of critical care management. Though a lifesaving intervention, invasive mechanical ventilation imposes a great risk of nosocomial pneumonia to the patient. Ventilator associated pneumonia rates in an ICU is a predictor of successful infection control strategy. Objectives: objective of the current study was to study the frequency of ventilator associated pneumonia and its outcome in the critical care setting. Methods: This prospective observational cross-sectional study was done in department of critical care medicine of BIRDEM General Hospital for the period of 1st July, 2017 to 30th June, 2018. All consecutive patients who were intubated and mechanically ventilated for a period of at least 48 hours within the study period were evaluated for the selection criteria of the study. The included study participants were followed up daily for signs of development of VAP. Once VAP was suspected pertinent investigations were sent to confirm the diagnosis. Study participants were observed regularly to identify signs of pulmonary infection. The microbiological tests were done in the Department of Microbiology of BIRDEM. Quantitative culture was done (expressed as CFU/ml) and antibiotic sensitivity was done by standard disc diffusion method. A cutoff value of 105 CFU/ml was taken as a positive culture. CPIS score was calculated to diagnose VAP .The study participants were followed up to transfer to step down unit/ward or death to see the outcome. Data were collected in preformed data collection sheet and analyzed by the statistical packages for social sciences (SPSS) software version 22. Results: In this study total 92 patients out of 625 intubated patients during the study period after fulfilling the inclusion criteria were selected as study participants. The mean age of the the participants who developed VAP was 65.05±14.79 years with a range of 27 to 101 years. 62.9% (n=22) were female and 37.1% (n=13) were male. In this study DM, HTN & Renal disease were the most common co-morbidities. Among the 35 VAP positive participants 51.4% (n=18) developed early onset VAP and 48.6% (n=17) developed late onset VAP. Among the VAP positive participants 31.4% were survivors and 68.6% were non-survivors and among the VAP negative participants 68.4% were survivors and 31.6% were non survivors (p=0.001). Conclusion: Frequency of VAP was 5.6% in the study. It was associated with significantly prolonged length of mechanical ventilation and length of ICU stay and high mortality. Bangladesh Crit Care J March 2022; 10 (1): 43-47

Isolation and characterisation of carbapenem-resistant Pseudomonas aeruginosa from hospital environments in tertiary care hospitals in Dhaka, Bangladesh

Increasing evidence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection in healthcare facilities poses an alarming threat to public health. There is little evidence on the occurrence of this organism in Bangladeshi hospitals. We collected 117 environmental swab samples from two tertiary care hospitals in Dhaka, Bangladesh and tested for Pseudomonas species by nonselective enrichment of swabs followed by plating on Cetrimide agar. We confirmed the isolates as P. aeruginosa by API 20NE test and polymerase chain reaction Polymerase Chain Reaction (PCR) for 16S rRNA gene. We analysed P. aeruginosa isolates for susceptibility against 15 clinically important antibiotics and tested the carbapenem-resistant isolates for metallo β-lactamase (MBL). All CRPA isolates were characterised for carbapenem-resistant genes, virulence genes and biofilm formation genes. Of 117 swab samples, 82 (70%) were tested positive for P. aeruginosa. All P. aeruginosa isolates were multidrug-resistant, and 39% (n=32) of isolates were CRPA. Around 56% (n=18) of CRPA were MBL-producing; 22% (n=7) of isolates were positive for carbapenemase gene blaNDM followed by 16% (n=5) for blaVIM and 13% (n=4) for blaIMP. Sequencing identified these genes as blaNDM-1, blaIMP-13, blaVIM-2 variants. Based on optical density values, 94% (n=30) of CRPA isolates were capable of producing biofilms. All CRPA isolates (n=32) were positive for at least 1 of 6 biofilm-associated genes and 4 of 12 virulence genes tested in the study. Hospital environments in Bangladesh are contaminated with highly virulent CRPA, which might be a potential source of hospital-acquired infections, accentuating the need for strengthening hospital infection control programs.

A retrospective study on the socio-demographic factors and clinical parameters of dengue disease and their effects on the clinical course and recovery of the patients in a tertiary care hospital of Bangladesh.

Dengue, a mosquito transmitted febrile viral disease, is a serious public health concern in Bangladesh. Despite significant number of incidences and reported deaths each year, there are inadequate number of studies relating the temporal trends of the clinical parameters as well as socio-demographic factors with the clinical course of the disease. Therefore, this study aims to associate the clinical parameters, demographic and behavioral factors of the dengue patients admitted in a tertiary care hospital in Dhaka, Bangladesh during the 2019 outbreak of dengue with the clinical course of the disease. Data were collected from the 336 confirmed dengue in-patients and analyzed using SPSS 26.0 software. Majority of the patients were male (2.2 times higher than female) who required longer time to recover compared to females (p < 0.01), urban resident (54.35%) and belonged to the age group of 18–40 years (73.33%). Dengue fever (90.77%) and dengue hemorrhagic fever (5.95%) were reported in most of the dengue patients while fever (98%) was the most frequently observed symptom. A significantly positive association was found between patient’s age and number of manifested symptoms (p = 0.013). Average duration of stay in the hospital was 4.9 days (SD = 1.652) and patient’s recovery time was positively correlated with delayed hospitalization (p < 0.01). Additionally, recovery time was negatively correlated with initial blood pressure (both systolic (p = 0.001, and diastolic (p = 0.023)) and platelet count (p = 0.003) of the patients recorded on the first day of hospitalization. Finally, a statistical model was developed which predicted that, hospital stay could be positively associated with an increasing trend of temperature, systolic blood pressure and reduced platelets count. Findings of this study may be beneficial to better understand the clinical course of the disease, identify the potential risk factors and ensure improved patient management during future dengue outbreaks.

Status of Postpartum Intra Uterine Contraceptive Device in a Tertiary Care Hospital in Dhaka

Background: Timing of insertion, counseling, provider training and institutional support are critical factors for intrauterine contraceptive devices (IUCD) use during the postpartum period.&#x0D; Objective: The objective of the study was to determine the rate of acceptation, discontinuation, expulsion, infection and displacement of PPIUCD after vaginal delivery and cesarean section along with other complications among the study population.&#x0D; Methodology: This was a prospective observational study done in Shaheed Suhrawardy Medical College and Hospital from July 2015 to June 2016 among the pregnant women who delivered healthy baby by normal vaginal delivery and cesarean section. Data was collected by a structured questionnaire. Women who gave informed consent and who gave birth of healthy baby without complications were included. Women who had premature ruptured membrane with chorioamnionitis, pelvic inflammatory disease intrauterine fetal death or who did not give consent were excluded.&#x0D; Result: In this study, only 8.4% gave consent for this method, 77.1% had regular follow up after this method. Only 5.05% had removal and 1.8% had spontaneous expulsion. 10.5% had lower abdominal pain and 4.13% had per vaginal bleeding after this method.&#x0D; Conclusion: This study showed that post-partum intrauterine contraceptive devices insertion rate is low even in a tertiary center, which means, there is a lot of space for counseling the target population in our country. On the contrary, follow up rate was quite high which means that people are being concerned about this health care service. Similarly, the removal rate was also satisfying with minimum expulsion rate.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 165-168

SARS-CoV-2 Infection and Risk Stratification among Healthcare Workers in the Largest COVID-19 Dedicated Tertiary Care Hospital in Dhaka, Bangladesh

Background: The health care workers’(HCWs) are working 24/7 in managing devastating pandemicCorona virus disease19(COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) as front liner which leads them to be at highest risk for contacting infection. In Bangladesh, beinga lower middle-income country and densely populated, the burden is much more on HCWs. Methods: We did a cross-sectional study with an aim to identify the prevalence, risk factors, and outcomesof SARS-CoV-2 infection among the HCWs in a COVID-19 dedicated tertiary care hospital. Statisticalanalysis was done in SPSS version-26. Multivariate regression analysis was done to evaluate risk factorsresponsible for COVID-19 infection and the severity of the COVID-19 disease. We expressed odds ratiowith 95% CI, and considered the p-value of &lt;0.05 as significant in the two-tailed test. Results: A total of 864 HCWs had participated with mean age of 34.16 ± 6.77 and 426 (49.31%) males.Among them 143 (16.55%) were tested RT-PCR positive for SARS-COV-2. Bronchial asthma/COPD andHypertension were the most common co-morbidities with 23 (16.08%) for each. About 102 (71.33%) ofthe RT-PCR positive HCWs became symptomatic. Fever, cough and myalgia were the most commonsymptoms 84(82.35%), 67(65.69%) and 52(50.98%) respectively.Multivariate regression analysis revealed hypertension, gout, and working in the COVID-19 confirmedward had a significant odds ratio for getting infected with SARS-CoV-2 [95% CI, p-value 1.91 (1.08 - 3.41),0.027; 5.85 (1.33 - 25.74), 0.020; and 1.83 (1.10 - 3.03), 0.019].Bronchial asthma/COPD and gout found to be risk factors for moderate to severe COVID-19 disease[95% CI, p-value 3.04 (1.01 - 9.21), 0.049 and 23.38 (3.42 - 159.72), 0.001]. Hospitalization rate was12(85.7%), and 3(100%) and median hospital stays were 11 (5.5 - 15), and 20 (7 - 30) days for moderate andsevere diseases respectively. Outcome was uneventful without any ICU admission and death. Conclusion: HCWs working in the COVID-19 confirmed ward are at increased risk of infection withSARS-COV-2. Some co-morbidities like hypertension and gout are important risk factors for contactingSARS-COV-2 infection. Bronchial asthma/COPD and gout favors disease severity. J MEDICINE 2022; 23: 5-12

Endometrial cytokine expression from clinically suspected genital tuberculosis patients at tertiary care hospitals in Dhaka

ObjectiveThe objective of this study was to measure gamma interferon (IFN-γ) and tumor necrosis factor alpha (TNF-α) expression in endometrial tissue and/or aspirate from suspected genital tuberculosis patients with ectopic pregnancy and infertility in Bangladesh. MethodologyA total 78 women of clinically suspected genital tuberculosis patients were enrolled as study population. These patients underwent manual vaccum aspiration (MVA) procedure, and endometrial tissues and/or aspirates were collected. Ziehl -Neelsen staining (Z-N staining) and Lowen–Stein Jensen (L-J) culture were done to detect Mycobacterium. The study participants were categorized as genital tuberculosis positive cases, genital tuberculosis negative cases and presumptive for tuberculosis cases based on the case definition used in this study. TNF-α and IFN-γ were measured by ELISA. Statistical analysis was done using SPSS (version-22). ResultsOut of 78 participants, pro-inflammatory cytokines IFN-γ and TNF-α were significantly increased in TB positive patients than TB negative patients (p < 0.05). IFN-γ value of TB positive patients (41.26 ± 41.05) was higher than TB negative (22.94 ± 44.51) patients. TNF-α value (44.31 ± 64.22) of TB positive patients was higher than TB negative (15.86 ± 41.45) patients. IFN-γ and TNF-α value of presumptive for tuberculosis cases were not statistically significant. According to ROC analysis, cut off value for IFN-γ was 23.5 and for TNF-α was 10 with highest sensitivity and specificity of 66.7%, 89.3%, and 66.7% and 73.1% respectively. ConclusionIFN-γ and TNF-α were significantly higher in TB positive patients and it may act as a potential biomarker for diagnosis of genital tuberculosis.

Serological Evidence of Rickettsial Infection by Weil-Felix Test in Tertiary Care Hospital in Bangladesh

Introduction: Rickettsial infections are re-emerging diseases and are major causes of febrile illnesses throughout the Asia-Pacific region. It is difficult to diagnose due to the non-specific clinical manifestations, absence of reliable and affordable diagnostic tests thereby contributes to increasing the acute febrile burden and preventive illness in many populations. Undiagnosed or late-diagnosed cases are associated with high morbidity and mortality.&#x0D; Objectives: The study aimed to determine rickettsial disease by Weil-Felix test and to know the frequency of rickettsial diseases in febrile patients presenting to tertiary care hospitals in Dhaka, Bangladesh.&#x0D; Methods: In this study, a total of 135 peripheral blood samples were taken and tested by Weil Felix test from clinically suspected patients of rickettsial fever.&#x0D; Results: Weil- Felix test was positive in 33((24.4%) cases. Of Weil- Felix test-positive cases, OX-2 was positive in 87.87% cases, followed by OX-K (6.06%), OX-19 (3.03%), and both OX-2 &amp; OX-K (3.03%) cases. OX-2 positive cases are suggestive of spotted fever group, OX-K of scrub typhus group, OX-19 of typhus group, and OX-2 &amp; OX-K are suggestive of both spotted fever group and scrub typhus group. This finding suggests that most cases were infected with spotted fever group rickettsiae (SFGR).&#x0D; Conclusion: Analyzing the present study's findings, it may be concluded that rickettsial infection is not uncommon in Bangladesh. Weil-Felix test can be used in laboratories to diagnose rickettsial diseases where specific reliable serological or molecular test is not available.

Risk Factors, Clinical Characteristics, and Outcomes of Recurrent Pediatric Stroke

Objective: Stroke is relatively rare in children, but it can lead to significant morbidity and mortality. Understanding the risk factors related to stroke will optimize the outcomes in children. Published cohorts of children with stroke recurrence rates are variable. This study has been done to determine the risk factors, clinical features, and outcomes of recurrent pediatric stroke in a developing country. Materials and Methods: We enrolled 98 children with stroke: 16 children were excluded due to incomplete investigations and were lost to follow-up. This study was conducted in a tertiary care hospital in Dhaka, Bangladesh from January 2017 to December 2019. Detailed investigations regarding stroke, physical examination, and targeted investigations were done. Results: We studied 82 patients: Among them, 52 had their 1st attack, and 30 had recurrent attacks of stroke. The age range of onset of stroke was 4.78 ± 3.90 and 5.30 ± 4.25 in the first and recurrent stroke, respectively. In this study, 36.5% of the enrolled children presented with a recurrence of stroke, whereas the rest presented with the first episode of stroke. The most common cause of recurrent stroke was intracranial vasculopathy, with the most common being vascular narrowing and moya moya disease (MMD). Protein C deficiency was observed more frequently in recurrent stroke. No significant difference was found in the risk factors of the first and recurrent stroke. During follow-up, patients with recurrent stroke developed cognitive decline, epilepsy, and speech disorder more frequently. Conclusion: In children with recurrent stroke vasculopathy, particularly MMD and protein C deficiency were observed more frequently. Moreover, in this group, sequelae-like cognitive dysfunction, speech disorder, and epilepsy were observed more frequently.

AACE2021-A-1101: Association of Body Mass Index and Serum Vitamin D Level Among Patients Attending a Tertiary Care Hospital in Bangladesh

Obesity is one of the most commonly observed health issues all over the world. Vitamin D deficiency is considered to be a pandemic with implications for compromised bone health and other chronic diseases. Vitamin D deficiency has been implicated in several diseases including CV morbidity and mortality, metabolic syndrome and T2DM1. Several clinical and epidemiological studies reported that obese subjects have lower serum concentrations of 25-hydroxyvitamin D (25[OH] D) with a negative correlation of vitamin D concentrations with BMI and waist circumference2. The aim of this study was to investigate the association of serum (25[OH] D) concentrations with body mass index of patients attending a tertiary care hospital in Dhaka, Bangladesh. The cross-sectional study was conducted during the period from September 2020 to March 2021 and included total 305 patients attending Hormone and Diabetes clinic of a tertiary care hospital in Dhaka, Bangladesh. We included only non-pregnant adult patients of 18 years or older. According to their vitamin D status, they were classified into three groups: group 1 (deficient, vitamin D: <20 ng/ml), group 2 (insufficient, vitamin D: 20–30ng/ml), and group 3(normal, vitamin D :> 30ng/ml). All were subjected to history taking, clinical examination, and assessment of fasting blood samples of serum concentrations of 25-hydroxy vitamin D [Serum 25(OH) D]. According to the Body Mass Index (BMI): weight in kilograms/square of height in meters (kg/m2), the patients were categorized as underweight (≤18.5 kg/ m2), normal weight (BMI: 18.5–22.9 kg/m2), overweight (BMI: 23–24.9 kg/m2) and obese (BMI: ≥25 kg/m2)3. We included 305 subjects aged 31-72 years with a mean age 43.41 ± 8.80(SD) years, and about 66.9% of the participants were women. The mean (± SD) body mass index (kg/m2) was 26.56 ± 3.67 kg/m2 and the mean (± SD) vitamin D level of the participants was 21.58 ± 6.32 ng/ml. Among subjects, 17.0% were overweight and 65.6% were obese. 43% of the participants had vitamin D deficiency (overweight vs. obese: 7.2% vs. 26.6%) and 45.2% had vitamin D insufficiency (overweight vs. obese: 6.9% vs. 30.8%); [p=0.18]. In this study, there was no significant association between vitamin D level and BMI (r = 0.067; p = 0.24). Our study suggests, vitamin D deficiency and insufficiency are more prevalent among obese subjects. But vitamin D status may not be correlated with body mass index (BMI). Future studies are needed to establish the role for Vitamin D supplementation in individuals with high body mass index.

Clinical profile and short-term outcomes of RT-PCR- positive patients with COVID-19: a cross-sectional study in a tertiary care hospital in Dhaka, Bangladesh

ObjectiveThe COVID-19 pandemic is still raging worldwide. While there is significant published evidence on the attributes of patients with COVID-19 from lower-income and middle-income countries, there is a dearth of...

Emergence of OXA-833 in Proteus Species at a Tertiary Care Hospital in Dhaka, Bangladesh.

Context:Proteus species are liable for multitude of infections and associated with resistance to routinely used antibiotics even to reserve drugs such as carbapenems.Aims:The aim of this study was to detect the presence of MBL producers, including blaOXA-833 gene in Proteus spp. along with their antibiotic resistance pattern.Settings and Design:This cross-sectional study was conducted in the Department of Microbiology of a tertiary care hospital of Bangladesh during July 2018 to June 2019.Subjects and Methods:Proteus spp. was isolated from a total of 500 samples. Antibiotic susceptibility was performed by disk-diffusion technique. Minimum inhibitory concentration (MIC) of imipenem was determined by agar dilution method. Carbapenemase producers were phenotypically detected by double disc synergy (DDS) test, combined disc (CD) assay, and modified Hodge test (MHT). Carbapenemase genes (blaKPC, blaVIM, blaIMP, blaNDM-1, blaOXA-23, blaOXA-48-like/blaOXA-833, and blaOXA-58) among imipenem-resistant Proteus spp. were detected by polymerase chain reaction (PCR). Sequencing was performed to differentiate OXA-833 from OXA-48-like gene by capillary method, and the nucleotide sequence of OXA-833 has been deposited to GenBank.Results:Ten (25%) imipenem-resistant isolates were detected during disk-diffusion technique, among them 60%, 70%, 50% carbapenemase producers were detected by DDS test, CD assay, MHT, respectively, and 70% by PCR. A significant increase in MIC was found between 8 and ≥128 μg/ml to imipenem. PCR revealed that 40% imipenem-resistant isolates were positive for blaNDM-1 and blaVIM followed by 20% for blaOXA-48-like/blaOXA-833 and blaOXA-23, respectively. Sequencing of blaOXA-48-like gene established the OXA-833 variant of class D carbapenemase encoding gene.Conclusion:The results of this study showed the presence of high proportion of carbapenemase enzyme-producing Proteus spp. in Bangladesh. blaOXA-833 is emerging in Bangladesh.

"Fungal Skin Diseases and Related Factors in Outpatients of Three Tertiary Care Hospitals of Dhaka, an Urban City of Bangladesh: Cross-Sectional Study"

"Fungal Skin Diseases and Related Factors in Outpatients of Three Tertiary Care Hospitals of Dhaka, an Urban City of Bangladesh: Cross-Sectional Study"

MALTREATMENT IN AUTISM SPECTRUM DISORDER CHILDREN FROM PARENT’S PERSPECTIVE IN BANGLADESH: A CROSS-SECTIONAL STUDY

Children with disabilities are at an increased risk of experiencing child maltreatment (CM). We aimed to estimate the prevalence of different forms of CM among children with autism spectrum disorder (ASD) in Bangladesh. We interviewed 45 randomly selected mothers of ASD children who attended a tertiary care hospital in Dhaka, Bangladesh, to treat their children. Data regarding CM was collected using a standard screening tool recommended by the International Society for the Prevention of Child Abuse and Neglect (ISPCAN). We asked mothers to report about their child-rearing practices to identify CM, including physical, psychological, and sexual abuse, and neglect, along with their non-violent disciplinary practices. The children's age range was 3 to 9 years, and approximately 82 percent were boys. All children were found to have experiences of physical and psychological abuse throughout their childhood. Seventy-three percent of children experienced neglect during the past year while 82 percent during their entire childhood. The reported prevalence of sexual abuse was 4.4 percent in the past year and 8.9 percent during their childhood. However, all parents followed non-violent disciplinary practices, and the prevalence of maltreatment did not differ between boys and girls. Higher instances of CM in Bangladesh, especially among ASD children, raise concern for its adverse social consequences and calls for appropriate mitigation practices as proclaimed by the United Nations Child Rights Charter.

Antibiotic sensitivity patterns of uropathogens isolated from catheterized patients in a tertiary care hospital in Dhaka, Bangladesh

Among nosocomial infections catheter associated urinary tract infection (CAUTI) is one of the most common infection. The antibiotic resistance amongst the uropathogens isolated from CAUTI are multi-drug resistant and a growing public health problem in the world including Bangladesh. The study objective was to determine the aetiology of uropathogens in catheter associated urinary tract infection and find out their anti-microbial sensitivity pattern among the isolates. A cross sectional study was done from July 2016 to June 2017 in Dhaka Medical College, Bangladesh. Urine samples were collected from 400 patients with suspected CAUTI which were processed microbiologically and antimicrobial sensitivity was performed. Out of 400 patients Escherichia coli (38.93%) was the most common isolated organism followed by Pseudomonas spp, (15.98%), Klebsiella spp, (8.61%), Proteus spp. (7.38%) Enterobacter spp, (6.56%) and Acinitobacter spp. (1.22%). Among the Gram positive isolates Staphylococcus aureus (1.64%) and Coagulase negative Staphylococeus (6.97%%) were isolated. Enterobacteriaceae showed high resistant to commonly used antimicrobials Amoxiclav, Gentamycin, Ceftriaxone, azithromycin , ciprofloxacin, cortimoxazole and were sensitive to colistin ,nitrofurantoin ,imepenem, Meropenem. Many isolates showed multi- drug resistance pattern hence strict aseptic precaution has to be taken prior to catheter insertion and after to prevent infection.

Tramadol intoxication in infants: experience at a tertiary care hospital in Dhaka, Bangladesh

Background: Tramadol is a widely used opioid analgesic for different types of pain. Very few cases of acute tramadol intoxication in infants have been reported where respiratory and central nervous system depression are frequent. The aim of this study was to evaluate the clinical manifestation, treatment and outcome of tramadol intoxication in infants.&#x0D; Methods: This was a retrospective observational study of hospitalized infants in the Department of Neonatology and Paediatrics in BIRDEM General Hospital, Dhaka, Bangladesh from February 2014 to November 2019. Ten infants with history of administration of tramadol suppository were included in this study. Data regarding clinical features, cause of the “incident dose and route of administration” of tramadol, effects of naloxone and outcomes were recorded and analyzed.&#x0D; Results: Of 10 infants, 6 were male and 4 were female. The mean age was 5.1±3.0 months and the mean weight was 6.1±1.8 kg. The mean time of onset of symptoms after drug administration was 2.6±1.0 hours with a mean dose of 17.9±6.4 mg/kg body weight. The main clinical features were decreased level of consciousness (100%), seizure (80%), meiosis (80%) and apnoea (50%). In each 50% (5) of cases, tramadol was given erroneously instead of glycerine and paracetamol suppository. Among them 2 (20%) infants received tramadol suppository as an over-the-counter (OTC) drug. All infants were treated with naloxone without any side effect. In addition, three infants needed mechanical ventilation. The average duration of hospital stay was 89.3±47.4 hours. Nine infants were discharged and one (10%) died.&#x0D; Conclusions: Our study suggested that tramadol intoxication among infants is predominantly accidental. Early identification and prompt initiation of treatment are essential. The creation of public awareness about the safe storage of drugs at home and avoidance of OTC drugs can prevent tramadol intoxication in children.&#x0D; BIRDEM Med J 2021; 11(3): 197-201

Neonatal Candidaemia in Tertiary Care Hospitals in Dhaka- A Comparison of Different Carbohydrate Assimilation Methods and Chromagar Technique for Speciation

Background: Nosocomial candidiasis are becoming increasingly important worldwide. Candida is a major causative agent of health care associated bloodstream infections, and lately non-albican Candida species are increasingly isolated from blood samples. Some of the Candida species have intrinsic and acquired resistance to the limited arsenal of antifungals; therefore early speciation is essential for the timely initiation of effective antifungal therapy. Methods: A hospital based cross-sectional study was conducted to evaluate the performance of different carbohydrate assimilation tests and commercially available HiCrome Candida Differential Media (CHROMagar) for the identification of Candida in the four tertiary level hospitals in Dhaka. Results: A total of 58 yeasts samples was included in this study. Non-albicans Candida accounted for 100% of the isolates of which C. tropicalis was the predominant species (81.03%) followed by C. parapsilosis (12.07%), C. auris (5.17%) and C. dubliniensis (1.72%). Swab auxanographic technique and microtitre plate based miniaturized CHO assimilation methods were equally effective in identification of Candida sp. in comparison to CHO impregnated YNB plate method (98.28% and 100% vs 89.66%). Conclusion: By using Chromogenic agar 75.86% yeasts were identified but it could not give the conclusive differentiating color between the species of C. parapsilosis and C. auris.