College Hospital Of Bangladesh Research Articles

Outcome of Empirical Antibiotic Prescription for the Treatment of Community Acquired Pneumonia

Background: The primary cause of illness and death in Bangladesh is community acquired pneumonia (CAP). Many hospitals in Bangladesh lack the resources to perform sputum cultures and sensitivity tests, making it difficult to identify the etiological agent of an infection. As a result, antibiotics are prescribed on a "empirical basis" rather than as part of a specific anti microbial treatment. The optimal antibiotic for treating CAP should be chosen using an empirical approach. Objective: The purpose of this study is to evaluate the effectiveness of various empirical antibiotic choices in the management of CAP. Methods: Eighty-two patients with CAP were included in this prospective observational research at a tertiary medical college hospital in Bangladesh. Inclusion and exclusion criteria were used to choose patients. Chest x-rays confirmed the diagnosis of CAP. The antibiotic was chosen based on clinical experience, which is an empirical method. The majority of patients received a combination antibiotic, whereas the remaining handful received monotherapy. The result served as an evaluation of the empiricism used in selecting the antibiotic. During the research, data were recorded in standardized formats. SPSS was used for the statistical analysis. Results: A total of 82 people were treated, and of them, 62 (or 76%) were men and 20 (or 24%) were women. The average age was 54.4% (9.6%). The round of antibiotics was supposed to last for a week. There were no unwanted medication reactions. No cases of lung abscess or parenchymal damage to the lungs occurred, and only one patient had paraneumonic effusion. Every single person made a full recovery. Conclusion: In many hospitals in Bangladesh, the choice of antibiotic for treating CAP is made on a "empirical" basis. Selecting an appropriate antibiotic requires better sputum culture and sensitivity testing in hospital labs.

Professionalism Among the Medical Graduates and Ethical Responsibility: Bangladesh Perspectives

Background: Ethics and professionalism, though interconnected, represent distinct aspects of professional conduct. Ethics are explicit guidelines that dictate acceptable behaviour within a profession, while professionalism encompasses personal attributes such as competence, reliability, and ethical integrity. Objectives: This study aimed to assess the attitude of recent medical graduates towards medical ethics and professionalism. Methods: This descriptive cross-sectional study explored the status of professionalism and ethics regarding knowledge, attitude and behavioural skills among graduates of different medical college hospitals in Bangladesh. This study period was July 2015 – June 2016. The sample size was 300 and a convenience sampling technique was adopted. Result: This cross-sectional descriptive study was carried out to evaluate 300 intern doctors based on their knowledge, attitudes, and behavioural skills as it concerns professionalism and ethics through the use of questionnaires, direct observation, and evaluation by patients. Of the participants, 73.3% were from government medical colleges with almost equal male-to-female ratios. Behavioral skills were assessed among 72 interns by assistant registrars and patients assessed 60 interns. While 68.3% of the interns reported prior knowledge about professionalism, only 15% correctly identified core elements of professionalism. Most participants, 52.3%, were unclear about the difference between ethics and professionalism. Conclusion: This study underscores how vital professionalism and ethics are in shaping Bangladesh's future workforce. Combining ethical training with technical education is key as the economy grows, particularly in healthcare. New graduates must blend expertise with empathy and strong ethics to build public trust and support the country's development on a global scale

Cleft lip and palate surgery in the Otolaryngology and Head-neck surgery department of a Medical College Hospital in Bangladesh

Background: Cleft lip and palate (CLP) are one of the most common developmental anomalies in orofacial region. CLP surgery lies in the anatomical domain of Ear Nose Throat and Head - Neck Surgery. In Bangladesh specialty of plastic surgery is still in developing stage and plastic surgeons are not easily available everywhere. ENT and Head-Neck surgeon had to take up the responsibility of some of cleft patients. This article is a retrospective analysis of a series of 200 cases of cheiloplasty and palatoplasty done in ENT and Head-Neck Surgery department of Khulna City Medical College Hospital, Bangladesh. Results were satisfactory in our, patient and parent's consideration. Objective: Our aim is to discuss the demographic profile, presentations, degree & type of cleft and outcome of CLP surgery in Otolaryngology and Head-Neck Surgery department of a Medical College Hospital of Bangladesh. We will also discuss the embryology of face & historical background of the cleft surgery. Materials and Methods: This is a retrospective analysis of CLP surgery for 200 cleft patients. We based on inclusion and exclusion criteria for selection of patients. Majority of cleft lip patients were operated following the Millard modified rotation advancement technique and isolated cleft palate patients were operated following Von Langenbeck bipedicle flap and Veau-Wardil-Kilner V-Y pushback technique in the ENT and Head-Neck Surgery Department of a Medical College Hospital. Patients were advised for periodic follow up. Results: Total of 200 patients of CLP were operated in our department out of which male was 92 (46%) and female was108 (54%)), male and female ratio being 1:1.08. The age range was 3 months to 40 years with a mean of 8.38 years. Pre alveolar group both male and female comprised of 134 (67%) and alveolar group 66 (33%) patients and that of isolated cleft palate 7 (10.60%) patients. Pre alveolar unilateral CLP was high. The results of surgery were satisfactory in our postoperative evaluation. Patients and parents were also satisfied with the outcome. Conclusion: Majority of CLP patients don’t suffer functional problem apart from facial disfigurement. Restoration of normal anatomy, facial appearance and function can be achieved by surgery in appropriate time and age. Few cases may be associated with feeding difficulties, dental and hearing problems. Some cases are associated with other congenital anomalies and syndromes. Those cases demand team approach of different specialty.

Hepatitis B Awareness among Adult People in Community Based Medical College, Bangladesh

Background: Hepatitis B (HB) is a major health issue in Bangladesh, with an approximated percentage ranging from 2-7% among the population of the country. HB remains a significant problem due to lack of awareness and inadequate knowledge regarding its transmission, prevention, and risk factors. Objective: To evaluate the current state of knowledge and perception regarding hepatitis B infection among the adult patients of Community Based Medical College Hospital in Bangladesh. Methods: This descriptive cross-sectional study recruited 90 adult patients at the Department of Medicine between July 2022 and June 2023. An interview survey using a structured questionnaire was used to gather data from the respondents. The data analysis was done by descriptive statistics means. Results: A larger proportion of the respondents were male (61.1%), within the age group of 26-35 years (30%), married (66.7%), and primary education (46.7%). Individuals who acquired their HB information from doctors were the highest at 38.9%. 4% were able to point out accurately that blood can transmit the virus, while 22.2% were still convinced that water could spread HB. As for the means of transmission, only 2% knew that it could be sexually transmitted. Only 9% knew about vaccination, but 22.2% of the respondents had the wrong perception that safe drinking water reduces the risk of getting HB. Doctors were most frequently reported as a high-risk group (38.9%), followed by drug abusers (27.8%). Conclusion: The findings of this study show that the study population has limited knowledge about hepatitis B and contains misconceptions about the means through which it spreads and the methods of avoiding it. The study emphasizes the imperative of designing effective health education interventions to fill these knowledge deficits with regards to transmission, risk factors, and vaccination coverage. They said that healthcare providers are very important in transmitting information and should ...............

#330 Pattern of short-term outcomes of renal function in postpartum acute kidney injury patients: a single-center study in Bangladesh

Abstract Background and Aims Postpartum acute kidney injury (PPAKI) is a formidable health problem in pregnant woman especially in developing country. Monitoring outcomes like serum creatinine levels and glomerular filtration rates is vital. Understanding these short-term results is crucial for timely interventions and better patient care, improving prognosis in this critical condition. The aim of the study was to assess the short-term outcomes of renal function in postpartum acute kidney injury patients. Method This prospective observational study was conducted at Mymensingh Medical College Hospital in Bangladesh between March 2020 and April 2021. The study enrolled 153 postpartum acute kidney injury (AKI) patients from the Departments of Nephrology and Departments of Obstetrics & Gynaecology using purposive sampling. Data on patient demographics, etiology, and presentation were collected. Statistical analysis was performed using SPSS version 23.0 and a p- value of <0.05 was considered statistically significant. Results After three months, among 153 postpartum acute kidney injury (PPAKI) patients, 77.8% of the patients fully recovered, 5.2% of the patients developed chronic kidney disease. Dialysis was required in 24.2% of the patients, among them 2.2% remained on dialysis. Sadly, 15.7% didn't survive, that highlight the severity of postpartum acute kidney injury. Mortality rates didn't significantly differ between vaginal delivery (14.9%) and cesarean section (16.0%) groups (p=0.488). Both groups show positive outcomes, with 75.5% of vaginal delivery and 79.2% of cesarean section patients achieving full recovery. Blood urea also significantly decreased from 128.51 ± 39.59 to 101.65 ± 55.57 mg/dl during this period Conclusion Most postpartum acute kidney injury patients show promising recovery, but some still grapple with persistent renal impairment. Tragically, mortality rates underscore the severity of this condition. Importantly, survival rates don't significantly differ between vaginal delivery and cesarean section patients, emphasizing timely interventions.

Demographic Profile, Respiratory Presentation and Outcome Analysis of Acute Encephalitis Syndrome in a Tertiary Hospital in Bangladesh

Acute encephalitis syndrome has been a major health problem worldwide due to its high morbidity and mortality. The aim of this study was to find out the demographic profile of acute encephalitis syndrome and to determine the association of the outcome of the disease with the demographic factors and respiratory symptoms at presentation. This observational analytic cross-sectional study was conducted in the departments of Medicine, Paediatrics, and Neurology in Bangabandhu Sheikh Mujib Medical College Hospital in Bangladesh from September 2013 to August 2014. People of all ages who fulfilled the inclusion criteria of acute encephalitis syndrome were included in the study. In this study, 270 cases were diagnosed with acute encephalitis syndrome. Most cases were clustered around the age groups of 0-5 year (24.1%), 6-17 year (24.8%), and 18 -45 year (28.5%). Death was higher among the 18-45 age groups (33.3%) as well as in males (59.3%). Apart from neurological symptoms, respiratory symptoms on presentation were present in 66.9% cases with 89.6% death and this association was found statistically significant (p value < 0.001, AOR 6.96, COR 5.3 with 95% CI). Influence of socio-demographic factors and delay in seeking hospital admission on adverse outcome was not statistically significant. Most cases occurred in January-February (12.6% and 11.1%) and in July (14.4%). Overall mortality was 17.8%. Encephalitis presenting with respiratory symptoms in association carries higher mortality. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):22-26

Outcome of varicose vein surgery in a general surgical unit

Background: Varicose veins are tortuous, widened veins in the subcutaneous tissues of the legs and are often easily visible. In our country, we do have not sufficient vascular surgery centers or vascular surgeons. So general surgeons have training in vascular surgery and performing operations of varicose veins. This study aimed to show the operative procedure, results of treatment in terms of symptom improvement, and complications of varicose vein surgery done by general surgeons in a rural medical college hospital in Bangladesh. Methods: This retrospective study was conducted at the Department of General Surgery in Sheikh Hasina Medical College, Jamalpur, Bangladesh from January 2017 to December 2022. A total of 20 patients were selected as study subjects by simple random sampling. Operative procedure depended upon pre-operative duplex imaging findings, and patients were kept under 6 months follow-up. The outcome was based on the cure and recurrence rate of varicose veins. Collected data were analyzed using descriptive statistics. Analysis of data was carried out by using a statistical package for social science (SPSS) 22.0 for Windows. After analysis, the data were presented in tables and charts. Results: It was observed that 3 (15.0%) patients experienced ulceration after surgical procedure, followed by 2 (10.0%) developed DVT, 1 (5.0%) patient had wound hematoma, and 1 (5.0%) patient showed recurrence. Concerning the outcome of varicose veins after surgical procedures, the majority (18,20.0%) of the patients showed complete cure, 1 (5.0%) patient presented with recurrence, and 1 (5.0%) patient developed complication. Conclusions: Despite the relatively low occurrence of complications and recurrence following surgery for varicose veins, the substantial 90% cure rate it offers is noteworthy. This study underscores the feasibility of conducting varicose vein surgery by general surgeons equipped with training in vascular surgery, ensuring safety and minimizing complications.

Evaluation of scrotal pathology: an observational study

Background: Scrotal issues often prompt patients to seek evaluation through physical examinations and scrotal ultrasonography. Accurate diagnosis requires a comprehensive exploration of potential conditions, with both grayscale ultrasonography (USG) and duplex Color Doppler ultrasonography employed for assessment. Methods: This prospective observational study, conducted at Dhaka Medical College Hospital in Bangladesh from July 2004 to June 2005, aimed to compare the effectiveness of grayscale ultrasonography and duplex color Doppler ultrasonography in evaluating scrotal pathology. Fifty-two patients with intra-scrotal disease were included using purposive sampling. Grayscale USG and duplex color Doppler ultrasonography were performed, and demographic and clinical data were processed using MS Excel and SPSS version 23.0. Results: Grayscale ultrasonography identified hydrocele, varicocele, and epididymitis in 21%, 15%, and 13.5% of cases, respectively. Color Doppler imaging revealed various pathologies, with varicocele and hydrocele most common (21.20%). Diagnostic accuracy varied between the two techniques, with Color Doppler excelling in specific conditions such as testicular torsion (100% accuracy, sensitivity, and specificity). Overall, Color Doppler demonstrated superior accuracy (96.10%) compared to grayscale (80%). Conclusions: While both grayscale ultrasonography and duplex Color Doppler ultrasonography are valuable tools for evaluating scrotal pathology, the latter demonstrates superiority in terms of accuracy, sensitivity, and specificity. Color Doppler's effectiveness in diagnosing specific conditions suggests its preference for comprehensive scrotal assessments.

Post-Operative Wound Infections and its Risk Factors in Surgical Wards at Rajshahi Medical College Hospital

Post-operative wound infections are a pressing concern in surgical wards, contributing to increased morbidity, mortality, healthcare costs, and prolonged hospital stays. This study investigates the prevalence and risk factors of postoperative wound infections in the surgical wards of Rajshahi Medical College Hospital in Bangladesh. A cross-sectional design was employed, encompassing 300 participants who underwent surgical procedures at the hospital. Structured questionnaires and observational techniques were used to collect data on demographic attributes, hand hygiene practices, dressing techniques, sterilization procedures, environmental cleanliness, and patient-related elements. The study revealed that among the participants, 135 (45.0%) practiced hand washing before dressing, while 198 (66.0%) practiced hand washing after dressing. The dressing technique of the doctor or nurse was perceived as proper by 154 participants (51.3%), while 174 (58.0%) reported that dressing materials were sterilized. Moreover, 183 participants (61.0%) perceived the bed sheets to be clean, while 161 (53.7%) considered the cleanliness of the patient's dress to be satisfactory. Additionally, 196 participants (65.3%) reported that the instruments used were sterilized, and 191 (63.7%) found the arrangement of the trolley to be proper. Statistical analyses were performed to assess relationships between variables. No significant relationship was found between educational status and cleanliness of bed sheets (χ² = 0.41, df = 3, p > 0.05), or between educational status and cleanliness of the patient's dress (χ² = 10.38, df = 3, p > 0.05). These results suggest that educational status may not significantly impact these aspects of infection control. The study underscores the complex nature of postoperative wound infections and infection control practices. Findings align with previous research on surgical site infections (SSIs) and emphasize the importance of standardized protocols, consistent surveillance, and context-specific interventions. The study's contributions offer valuable insights for optimizing infection control strategies in similar healthcare settings. Through the implementation of recommended strategies, Rajshahi Medical College Hospital and other healthcare institutions can enhance infection control practices, ultimately leading to improved patient outcomes and reduced rates of post-operative wound infections.

Association of Serum Homocysteine Level with Acute Ischaemic Stroke among Young Adult Patients: Experience at a Largest Medical College Hospital in Bangladesh

Background: Hyperhomocysteinemia is emerging as a possible risk factor for stroke, possibly because of accelerated atherosclerosis. Objectives: This study was conducted to evaluate the association between the serum homocysteine level and ischemic stroke in young Bangladeshi patients. Methodology: This cross-sectional study was carried out among patients 18 to 40 years of either gender with sign and symptoms of acute focal neurological deficit, in the Department of Medicine of Dhaka Medical College Hospital, Dhaka, from January 2015 to December 2015. History taking and physical examination were done in a predesigned data collection sheet. Then required investigations like CT-scan of brain, fasting serum homocysteine, fasting blood sugar, 2 hours ABF blood glucose, HbA1c and fasting lipid profile were done. Results: Out of 96 patients after completing brain imaging 61(65.0%) patients were found suffering from ischemic stroke. Among the patients 74 had normal homocysteine level, 17 patients had moderate hyperhomocysteinemia and 5 patients had intermediate hyperhomocysteinemia. Mean levels of fasting serum homocysteine were significantly higher in patients those had ischemic stroke (16.02 μmol/L, 95% CI: 12.87 to 19.87) compared with those who did not have ischemic stroke (10.47 μmol/L, 95% CI: 9.16 to 11.95, P<0.001). Logistic regression showed fasting homocysteine as an important independent risk factor, with an adjusted OR of 1.1 (95% CI: 1.1 to 1.2; p=0.04966) for every 1 μmol/L increase in homocysteine. Conclusion: The relationship between increasing homocysteine and ischemic stroke risk is strong, graded, and significant. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):24-29

Risk Factors for Hemorrhoids on Screening Proctoscopy at Rajshahi Medical College Hospital in Bangladesh: A Prospective Study

Background: Hemorrhoids are a common medical condition that affects a significant portion of the population worldwide. Understanding the risk factors associated with hemorrhoids is crucial for effective prevention and management. This prospective study conducted at the Department of Surgery, Rajshahi Medical College Hospital in Bangladesh aimed to identify and analyze the risk factors for hemorrhoids in a sample of 156 patients over a three-year period from June 2017 to June 2020. Methods: A total of 156 patients who presented with symptoms suggestive of hemorrhoids underwent screening proctoscopy at Rajshahi Medical College Hospital. Data on demographic variables, lifestyle factors, medical history, and dietary habits were collected through structured interviews and medical records review. Statistical analysis, including logistic regression, was employed to identify significant risk factors associated with the development of hemorrhoids. Results: The study revealed several key risk factors associated with hemorrhoids, including age, gender, family history, dietary habits, and sedentary lifestyle. Logistic regression analysis identified age over 40 years (OR=2.58, 95% CI: 1.34-4.97), male gender (OR=1.92, 95% CI: 1.07-3.44), positive family history of hemorrhoids (OR=2.14, 95% CI: 1.18-3.86), low fiber diet (OR=2.36, 95% CI: 1.27-4.40), and prolonged sitting (OR=1.78, 95% CI: 1.02-3.10) as significant risk factors for hemorrhoids. Conclusion: This prospective study conducted at Rajshahi Medical College Hospital in Bangladesh provides valuable insights into the risk factors associated with hemorrhoids in the study population. The findings underscore the importance of lifestyle modifications and early intervention strategies to reduce the burden of this common medical condition in Bangladesh.

Drug use Pattern with Standard Indicators in Chattogram Medical College Hospital in Bangladesh

Irrational prescription being a global problem leading to ineffective, unsafe treatment. This study was conducted between November 10, 2019 to January 20, 2020 to assess drug use pattern using WHO/INRUD core prescribing indicators at Chattogram Medical College Hospital (CMCH). Total 500 patients were selected randomly. The results showed average number of drugs per encounter is 4.41 (optimal range = 1.6–1.8), generic drug prescription was 1.54% (optimal value = 100%), encounters with an antibiotic prescribed were 32.6% (optimal range =20.0–26.8%), encounters with an injection prescribed were 24.8% (optimal range =13.4–24.1%), drugs prescribed from EDL were 50.43% (optimal value = 100%) and drugs prescribed from the WHO EDL were 56.96% (optimal value = 100%). Average consultation time was 3.1 min (optimal value ≥10 min), average dispensing time was 35 s (optimal value ≥90 s) and the patients’ knowledge of correct dosage was 62.1% (optimal value =100%. The hospital had no copy of EDL and key drugs available in the stock were 82% (optimal value =100%). The concept of generic prescribing was negligible. There was reduced prescription of drugs from the National List of Essential Medicines, the prescription of antibiotics and injections was slightly higher than normal. Shorter consultation and dispensing time may lead to inadequate information about the medication being given to patients and patients had little chance to obtain information about their treatment. This study necessitates we are in need of strict scrutiny on the prescribing method of our country. So, we can achieve the goal of rational use of drug.

Spatio-temporal evaluation of respiratory disease based on the information provided by patients admitted to a medical college hospital in Bangladesh using geographic information system

In Bangladesh respiratory illnesses are one of the leading risk factors for death and disability. Limited access to healthcare services, indoor and outdoor air pollution, large-scale use of smoking materials, allergens, and lack of awareness are among the known leading factors contributing to respiratory illness in Bangladesh. Key initiatives taken by the government to handle respiratory illnesses include, changing of respiratory health policy, building awareness, enhancing healthcare facility, and promoting prevention measures. Despite all these efforts, the number of individuals suffering from respiratory diseases has increased steadily during the recent years. This study aims at examining the distribution pattern of respiratory diseases over space and time using Geographic Information System, which is expected to contribute to the better understand of the factors contributing to respiratory illness development. To achieve the aims of the study two interviews were conducted among patients with respiratory sickness in the medicine and respiratory medicine units of Rajshahi Medical College Hospital between January and April of 2019 and 2020 following the guidelines provided by the Ethics Committee, Department of Geography and Environmental Studies, University of Rajshahi, Bangladesh (ethical approval reference number: 2018/08). Principal component extraction and spatial statistical analyses were performed to identify the key respiratory illnesses and their geographical distribution pattern respectively. The results indicate, during January–February the number of patients was a lot higher compared to March–April. The patients were hospitalized mainly due to four respiratory diseases (chronic obstructive pulmonary disease, asthma, pneumonia, and pulmonary hypertension). Geographical distribution pattern of respiratory disease cases also varied considerably between the years as well as months of the years. This information seems reasonable to elucidate the spatio-temporal distribution of respiratory disease and thus improve the existing prevention, control, and cure practices of respiratory illness of the study area. Approach used in this study to elicit spatio-temporal distribution of repertory disease can easily be implemented in other areas with similar geographical settings and patients’ illness information from hospital.

Evaluation of radial nerve palsy treatment: tendon transfer with the flexor carpi radialis combination

Introduction: Radial nerve palsy, a common peripheral nerve injury, significantly impacts the quality of life of affected individuals. The standard treatment is tendon transfer, but the optimal choice of tendon transfers remains a subject of ongoing debate. This study aimed to evaluate the treatment of radial nerve palsy through tendon transfer with the flexor carpi radialis combination in a Bangladeshi population. Methods: This observational study was conducted over 18 weeks at the Department of Orthopedic Surgery of 3 medical college hospitals in Bangladesh. Forty adult patients with radial nerve palsy were selected based on specific inclusion criteria. Participants were evaluated preoperatively and postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Complications were also recorded. Results: The majority of participants were male (77.5%) and had right-sided injuries (72.5%). The most common cause of injury was humerus shaft injury (55.0%). The most common site of injury was middle third of the humerus shaft (67.50%). Postoperatively, 85.0% achieved an "Excellent" grade. Complications were minimal, with 90% of participants experiencing no complications. Conclusions: Tendon transfer with the flexor carpi radialis combination appears to be an effective treatment for radial nerve palsy, with significant improvements in DASH scores postoperatively and minimal complications. Further research is needed to confirm these findings and compare the effectiveness of this treatment with other tendon transfer combinations.

Clinical Characteristics of Deceased with COVID-19 Infection: Data from the Largest COVID-19 Dedicated Hospital in Bangladesh

The death toll of the coronavirus disease 2019 (COVID-19) has been considerable. Several risk factors have been linked to mortality due to COVID-19 in hospitals. This study aimed to describe the clinical characteristics of patients who either died from COVID-19 at Dhaka Medical College Hospital in Bangladesh. In this retrospective study, we reviewed the hospital records of patients who died or recovered and tested positive for COVID-19 from May 3 to August 31, 2020. All patients who died during the study period were included in the analysis. A comparison group of patients who survived COVID-19 at the same hospital during the same period was systematically sampled. All available information was retrieved from the records, including demographic, clinical, and laboratory variables. Of the 3115 patients with confirmed COVID-19 during the study period, 282 died. The mean age of patients who died was higher than that of those who survived (56.7 vs 52.6 years). Approximately three-fourths of deceased patients were male. History of smoking (risk ratio 2.3; 95% confidence interval: 1.6–3.4), comorbidities (risk ratio: 1.5; 95% confidence interal:1.1–2.1), chronic kidney disease (risk ratio: 3.2; 95% confidence interval: 1.7–6.25), and ischemic heart disease (risk ratio:1.8; 95% confidence interval: 1.1–2.9) were higher among the deceased than among those who survived. Mean C-reactive protein and D-dimer levels [mean (interquartile range), 34 (21–56) vs. 24 (12–48); and D-dimer [1.43 (1–2.4) vs. 0.8 (0.44–1.55)] were higher among those who died than among those who recovered. Older age, male sex, rural residence, history of smoking, and chronic kidney disease were found to be important predictors of mortality. Early hospitalization should be considered for patients with COVID-19 who are older, male, and have chronic kidney disease. Rapid referral to tertiary care facilities is necessary for high-risk patients in rural settings J MEDICINE 2023; 24: 28-36

Job Satisfaction and Associated Factors among Registered Nurses in Medical College Hospitals

Job satisfaction among registered nurses has become a burningmatter in the medicalcare sectors, mainly for the public hospitalsin Bangladesh. Literature is evident that little is known regarding the associated reasons that influence registered nurses’ job satisfaction. Objective: Aim of this study was identified the predictive power of intrinsic motivation, extrinsic motivation, servant leadership of head nurses, marital status, educational level, and, years of work experience on job satisfaction among registered nurses at medical college hospitals in Bangladesh. Methods: Cross sectional research design was employed to inspect the job satisfaction and associated factors among registered nurses at medical college hospitals in Bangladesh. Sample size was determined by power analysis using G* Power to recruit 286 registered nurses from 8 divisional medical college hospitals. Data collection was conducted from April 2017 to September 2017, using the English version job satisfaction scale, intrinsic motivation instrument, extrinsic motivation instrument and servant leadership assessment instrument. Multiple classification analysis was used to examine the predictive powers of registered nurses’ marital status, educational level, years of work experience, intrinsic motivation, extrinsic motivation, and servant leadership of head nurses on the levels of job satisfaction among registered nurses. Results: Findings of the study revealed that extrinsic motivation and servant leadership of head nurses significantly affect registered nurses’ job satisfaction. Registered nurses who are highly extrinsically motivated and their head nurses have higher servant leadership practices tend to be highly satisfied with their job. Conclusion: The results in this study suggest that hospital administrators can promptly enhance extrinsic motivation which includes senior management, supervisor effectiveness, co-worker relationships, and satisfaction with salary and benefits. In addition, administrators should promote servant leadership of head nurses in order to enhance nurses’ job satisfaction in medical college hospitals of Bangladesh. Bangladesh Journal of Medical Science Vol. 22 No. 01 January’23 Page : 205-215

A Comparative Study of Oral Thrush and Other Oral Complications among COVID 19 Positive Patients

Background: Oral disease is a worldwide problem that causes agony, tooth loss, deformity, and death. Even though acute pseudomembranous candidiasis, or thrush, is the most common oral candidiasis, other types exist and candida infection may present as white and erythematous sores. White lesions include acute pseudomembranous and chronic hyperplastic candidiasis; red lesions include acute and chronic erythematous candidiasis, angular cheilitis, median rhomboid glossitis, and linear gingival erythema. Candida albicans is a major health hazard. This species causes a variety of ailments, from vaginal infections that affect 75% of women at least once to severe hospital infections that cause morbidity and mortality. As a consequence of the COVID-19 epidemic, several patients have suffered ARDS, which threatens superinfections. According to WHO estimates, the total number of confirmed cases will approach 240 million by October 19, 2021, and the cumulative number of fatalities would exceed 4.8 million. SARS-CoV-2 causes lung illness and systemic consequences. Respiratory and heart issues killed several. Candida strains produce invasive fungal infections. In COVID-19, invasive yeast infections (IYIs) are common. Despite COVID-19's immune system failure, no abnormalities in the cellular and humoral immune cells essential to fight Candida have been found. Oral lesion, taste loss, and tooth loss have all been linked to COVID-19. Methods: This study was comparative study. This study comprised 25–90-year-olds diagnosed with moderate to severe COVID-19 and hospitalized in covid ICU at Comilla Medical College Hospital in Bangladesh. The assessment followed inclusion/exclusion criteria. Sample size was obtained using a calculator with a 0.05 standard error and 95% confidence. Chest imaging and RT-PCR confirmed COVID-19. Comparing 100 patients with oral thrush and associated oral issues. Data entry will utilize SPSS and Excel. SPSS 23 will be used for data analysis. Excel and JASP will be available for any complications. Result: Oral thrush is the most prevalent, 61 (64.2%). Second most prevalent is inflamed gum, 26 (27.4%). Teeth mobility is the 3rd most common complication among the COVID-19 patients, 11 (11.6%). Other complication such as dental pain, foul smell, burning sensation, aphthous ulcer, teeth sensibility; 8 (8.4%), 3 (3.2%), 2 (2.1%), 4 (4.2%) and 2 (2.1%), were also present, respectively. Conclusion: In severely sick COVID-19 patients, oral thrush, loose teeth, and inflamed gums were the most often reported problems. The extended prone posture and mechanical breathing equipment utilized in the ICU environment may have contributed to these oral problems. Therefore, it is highly recommended that a multidisciplinary approach be used for the monitoring and treatment of COVID-19, which implies that nurses and oral healthcare professionals should be included in the ICU teams

Implementing midwifery services in public tertiary medical college hospitals in Bangladesh: A longitudinal study

BackgroundA necessary precursor for quality maternity care provision is high quality education. The quality of care that students are exposed to during clinical education on maternity wards shapes their competencies and professional identities. In this study, we look at the introduction of midwives educated to international standards – with facility mentorship – deployed in tertiary level teaching hospitals in Bangladesh with the intention of improving the use of World Health Organization (WHO)-recommended birth practices. AimTo examine the outcomes of introducing midwifery services into tertiary level care facilities in Bangladesh, on the use of WHO-recommended birth practices. MethodsA retrospective review of patient register data was carried out to understand level of changes in use of WHO-recommended birth practices after the introduction of a midwifery service. Multivariate linear regression was applied using an interrupted time series analysis, with and without a delayed effect, to assess both level and trend change following the introduction of the midwifery service. FindingsA significant increase (p < 0.001) in use of WHO-recommended birth practices was found, both immediately following the midwives’ introduction and after one year. Quality improvement was observed not only in births attended by midwives, but also in those attended by doctors and nurses. ConclusionBy introducing quality maternity care provision through midwives in clinical sites, especially in tertiary-level care hospitals with large numbers of students, international standard midwives can improve the quality of clinical education in maternity wards, a critical priority for maternal health worldwide.

Correlation between CRP Level and Stroke Volume

Background: Stroke is an important health issue for individuals and society. Early identification of risk factors of stroke patients helps take measures to prevent the development of further stroke. C-reactive protein is a marker of acute infection as well as acute inflammation. A high level of CRP may be associated with poor outcomes because they reflect either an inflammatory reaction or tissue damage (den Hertog HM et al., 2009). Increase in inflammatory parameters correlated significantly with lesion volume and stroke severity (Audebert HJ et al., 2004). Aim of the study: To see the Correlation between CRP level and stroke volume. And to see the CRP level as a prognostic marker in 3 months follow-ups in ischemic stroke. Methods: This was a descriptive cross-sectional study undertaken in the neurology department of a medical college hospital in Bangladesh. A total of 130 patients were included in the study group who met the inclusion and exclusion criteria. Out of 130 patients, 63 were ischemic strokes and 67 were hemorrhagic strokes. Results: In our study, the estimated level of mean CRP level in acute haemorrhagic stroke was 8.6 mg/L. and in acute ischemic stroke was 21.6mg/L. In this study, there was a statistically significant relationship between the size of the infarct and the level of estimated CRP in ischemic stroke. There was no correlation between CRP level and volume of hemorrhage in hemorrhagic stroke. In this study, the mean CRP value was 19.1 mg/L in those patients who were alive and 28.4 mg/L in those patients who died of ischemic stroke. The difference between the two groups was not statistically significant (p-value 0.30) though the mean CRP in patients who died were much higher than in those who were alive. Conclusion: In conclusion, we believe that these data support two main conclusions. First, the elevation of CRP is common in ischemic stroke. Second, advanced CRP levels were associated with larger infarct size in cases with acute ischemic stroke. These results suggest that elevated CRP levels, reflecting a large infarct size, may serve as a helpful serologic marker in the evaluation of inflexibility of acute ischemic stroke.

Satisfaction and Motivation of Nursing Professional: A Study on Rangpur Medical College Hospital

Services of nursing professional play a pivotal role in health organizations to support patients and doctors. The study was exploratory in nature with the view to observe the relationship between motivation and job satisfaction of nursing professional. It tried to unfold the underlying factors and the degree of influence of motivational factors for job satisfaction to achieve the main objective. The study used one hundred and two (102) nurses as samples from Rangpur Medical College Hospital in Bangladesh. It used Exploratory Factor Analysis (EFA) and Structural Equation Model (SEM) to reach to a meaningful conclusion. The paper found that the intrinsic factors affect the behavioral actions of the nurses towards job satisfaction. It also revealed that nurses face some significant problems relating to promotion, training, career development, workload etc. Enhancing job satisfaction to improve performance, efficiency, productivity of the nurses’ hospital management authority is urged to look into the motivational factors more closely suggested in the study. The study may assist the policy makers, administrators, and human resources experts to search for new opportunities and policies to encounter job satisfaction for nursing professionals.