Dhaka Medical College Hospital Research Articles

P19-4 A cross-sectional study and awareness of breast self-examination of Bangladeshi women at Dhaka Medical College Hospital

Breast cancer is the leading type of cancer among women in Bangladesh, accounting for 6.3% of the mortality rate of all types of cancers. The lack of awareness and self-screening of breast leads to the late presentation at an advanced stage, and therefore, breast cancer is one of the foremost causes of a large number of deaths. This research aimed to understand the awareness of breast cancer symptoms, frequency of breast self-examination (BSE), and breast cancer risk factors of Bangladeshi women.

Immunophenotypic Patterns of Childhood Acute Leukemia in Dhaka Medical College Hospital

Background: Leukemia is the most common malignancy at the age of under 15 years. Main subtypes of leukemia found in children are Acute Lymphoblastic Leukemia (ALL), with a percentage of 80%. Acute lymphoblastic leukemia (ALL) is one of the most common malignancies of childhood. Aim of the study: The aim of this study was to investigate the immunophenotyping profiles of childhood acute leukemia in Dhaka Medical College Hospital, Dhaka. Methods: This Cross-sectional study was conducted in the department of paediatrics in Dhaka Medical College Hospital, Dhaka, Bangladesh. A total 80 patients were selected as the study subjects. Immunophenotyping allowed classification into acute myeloid leukemia (AML) and ALL (B-lineage and T-lineage ALL). Result: Among of 80 samples, where we found maximum 51(63.75%) were Male and 29(36.25%) were Female. In age distribution, where maximum 38(47.5%) were (0-5) years of age, 32(40%) were (6-11) years of age, 10(12.5%) were (12-15) years of age, respectively. We have found, 57(71.25%) were B lineage ALL, then 10(12.50%) were AML, 9(11.25%) were T Cell ALL, 2(2.50%) was CML, 1(1.25%) was Mixed, 1(1.25%) was Aplastic. Conclusion: Immunophenotyping in a cross-sectional study proved feasible and appears particularly important for prognostic assessment of childhood leukemia in low-income countries such as Bangladesh.

Neonatal Outcome of 100 Cases of Term Pregnancy Having Meconium Stained Liquor in a Tertiary Level Hospital

Background : Presence of meconium in amniotic fluid is potentially a serious sign of fetal compromise and associated with an increased perinatal mortality and morbidities.Meconium stained amniotic fluid is considered a harbinger of fetal compromise because of its direct correlation with fetal distress and increased likelihood of aspiration of meconium with resultant deleterious effects on the neonatal lung. The purpose of the study was to find the neonatal outcome of pregnancy associated with meconium staining amniotic fluid. Outcome variable were birth weight, Apgar score, admission in NICU, neonatal complications, neonatal mortality and morbidity.
 Materials and methods : The present prospective observational study was conducted in the Department of Obstetrics and Gynaecology in Bangabandhu Sheikh Mujib Medical University, Dhaka and Dhaka Medical College Hospital. A total of 100 pregnant women admitted in the labour ward with meconium stained liquor were the study population.
 Results : Nearly three-quarter (72%) of the patients were between 20 – 30 years followed by 17.2% more than 30 years and 10.8% below 20 years old. Over half (52.2%) of the neonates needed resuscitation and 58.7% had to be admitted in ICU. More than 90% of the neonates had normal birth weight and only 9.7% were of low birth weight. Over half (51.1%) of the neonates developed meconium aspirate syndrome and 10.5% respiratory distress syndrome. Neonatal jaundice and neonatal sepsis were observed in 5.4%, 4.3% neonates respectively. Ten neonates (10.5%) died early in the neonatal life, while 1(1.1%) was still-born. low APGAR score (< 7) at 1 and 5 minutes of birth was found in 63.6% and 53% of the cases respectively with thick meconium stained amniotic fluid as opposed to 26.3% and 17.7% of the cases respectively having thin meconium stained amniotic fluid (p = 0.002 and p = 0.014 respectively). Thick meconium tend to be associated with meconium aspiration syndrome (p < 0.001). Neonates needing immediate resuscitation and admission in ICU was staggeringly higher in the former group than those in the latter group (p < 0.001). The incidence of perinatal death was significantly higher in patients with thick meconium stained fluid than that in patients with thin meconium (p = 0.029).
 Conclusion : The study concluded that meconium stained amniotic fluid is associated with low APGAR score, higher incidence of MAS, ICU admission and perinatal death and their severity depends on the concentration of meconium.
 JCMCTA 2022 ; 33 (1) : 15-20

Risk Factor Stratification in Patient with Recurrent Stroke in Bangladesh

Background: Stroke is a non communicable disease of increasing importance. Stroke is a major cause of death and disability in the world. Individual who suffered from stroke are at high risk of suffering recurrent stroke. So it is important to establish the risk factor for secondary prevention. The aim of this study is to find out the association of risk factor of recurrent stroke and it helps to take steps to reduce recurrent stroke. Materials and methods: This is a cross sectional observational case control study was conducted at Dhaka Medical College Hospital during 1st January to 31 December 2011. Definition was followed by WHO stroke manual. Results: In this study two leading risk factors were found hypertension and smoking respectively 78% and 72%. Among risk factors others were diabetes 56%, dyslipidemia 24%, cardiac diseases (AF, IHD, Valvular heart disease) 22%, Mean age of patient 61.09. Ischemic stroke found in 68% and haemorrhagic in 32% of patient. Conclusion: The common risk factors of stroke are also attributed to risk factor of stroke. Noncompliance to drug and life style modification also important cause of recurrent stroke. JCMCTA 2022 ; 33 (1) : 93-96

Cardiovascular Risk Factors among Patients with Systemic Lupus Erythematosus Presented in a Tertiary Care Hospital

Background: Risk factors for cardiovascular disease are particular habits, behaviors, circumstances or conditions that increase a person's risk of developing cardiovascular disease, including lack of exercise, unhealthy eating, smoking, diabetes, age and family history. Cardiovascular risk factors were observed and compared to find out their contribution among patients with SLE.
 Materials and methods: In this case control study, consecutive patients with SLE attending the Department of Medicine Dhaka Medical College Hospital (DMCH) were studied. The control population was recruited from subjects attending the other departments of the hospital and healthy attendants. The prevalence of classic Framingham cardiovascular risk factors, lipid profile, other metabolic risk factors, lifestyle variables, and demographic characteristics were compared between the 2 groups.
 Results: 80 SLE patients and 80 age and sex matched controls were studied. Patients with SLE had significantly high BMI and waist circumference (p_0.012 and p_0.001 respectively). Hypertension, diabetes were significantly more common among the SLE patients (31.29% versus 11.25%, p_0.023 and 13.75% versus 3.75, p_0.03). In comparison with control, patients with SLE had no significant difference in mean total cholesterol (193.92±23.65 versus 183.66±11.39, p_0.41) and triglyceride (174.77±60.06 versus 149.15±28.68, p_0.11), but had significantly higher low density lipoprotein (120.77±16.07 versus 108.17±11.68, p_0.00) and lower high-density lipoprotein cholesterol (41.37±4.52 versus 43.51±3.34, p_0.00). 
 Conclusion: Patients with SLE have a range of detectable and significant cardiovascular risk factors.
 JCMCTA 2022 ; 33 (1) : 160-165

The Functional Outcome of Single Stage Multi-Level Surgery of Spastic Cerebral Palsy

Introduction: Cerebral palsy is a heterogeneous disorder that makes the child handicapped. The incidence is about 2 per 1000 live births with the highest rates in premature babies and those of multiple births. It should be treated in a multi-disciplinary approach with the combination of a pediatrician, neurologist, or orthopaedic surgeon & physiotherapist. Aim of the study: The aim of the study was to assess the outcome of single-stage multilevel surgery of spastic Cerebral Palsy (CP). Methods: This prospective Experimental Study (quasi experimental Study) was conducted from July 2012 to June 2014 at the Department of Orthopaedics, Dhaka Medical College Hospital, and different clinics in Dhaka city. Twenty patients with diplegic and hemiplegic spastic cerebral palsy were recorded. Preoperative and post operative GMFCS and gait pattern of each patient were recorded for evaluation of results. Among them 12-patient were diplegic and 08 patients were hemiplegic. Data was collected and recorded sequentially and analyzed by SPSS computer software program, version 20 and MS-Excel 2016. Results: Mean follow up time was 13 months. There were 15 (75%) excellent, 5 (25%) good results assessed clinically by comparing preoperative and post operative gait pattern and GMFCS scoring system. Complications including superficial skin infection in 4 cases. There was no recurrence. Conclusion: Single-stage multilevel soft-tissue surgery in the lower limb(s) in children with spastic CP yields good results for locomotion and good trunk control.

Microalbuminuria and the Presence of Hypoxemia in Patients with Chronic Obstructive Pulmonary Disease

Introduction Worldwide, the Chronic Obstructive Pulmonary Disease (COPD) is a major public health concern; On the basis of epidemiologic data, by 2020, COPD will be the third leading cause of death worldwide. Objective To assess the frequency of Microalbuminuria and the presence of Hypoxemia in patients with COPD. Materials and Methods Study Design Cross-sectional observational study. Place of Study Department of Medicine & Respiratory Medicine in Dhaka Medical College Hospital (DMCH). Study Period Six months after approval of the protocol Study Population Patient suffering from COPD and admitted in Department of Medicine & Respiratory medicine, DMCH, Dhaka, Bangladesh. Total 100 samples were included in this study. COPD usually presents with a history of chronic cough with sputum production or exertional breathlessness which may be associated with relevant clinical findings and a post-bronchodilator FEV1/FVC less than 0.7. In most cases it is associated with smoking Results Total 100 patients of COPD were included in the study. Mean age was 58.16±5.4 years ranging from 50 to 74 years. Out of 100 patients, majority (42%) were from age group 55 to 60 years. Among all, 82% patients were male and 18% were female, of 100 patients, majority (30%) were day laborer. Only 2% were unemployed. The percentage of housewives was 18%. Other 34% were businessman and service holders. COPD severity was assessed using GOLD guideline. Out of 100 COPD patients, 38% had severe COPD (GOLD stage III). 16 % patients were in mild (Stage I) and 32% patients were in moderate stage (Stage II). The condition was very severe for 14% patients (Stage IV). Of 100 COPD patients, 30% had microalbuminuria. Among 100 COPD patients, chance of microalbuminuria increases among COPD patients with the increase of age significantly. There is smoking history of 36 pack year for COPD patients with microalbuminuria. Of 100 patients 26% were hypoxemic. The average forced expiratory volume (FEV1%) was 37.40 with standard deviation 14.48 for patients with microalbuminuria. The PaO2 and PaCO2 is 63.06 with standard deviation 7.09 and 46.09 with standard deviation 2.43 for COPD patients with microalbuminuria respectively. All of these characteristics are significant with p-value 0.00. However, the body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not found significant. The patients who had PaO2 less than 70 mmHg were considered hypoxemic. The patients who had microalbuminuria among them 87% were hypoxemic. Only 13% patients were free from hypoxemia who had microalbuminuria. Patients without microalbuminuria had no history of hypoxemia. There is significant relation exists between hypoxemia and the presence of microalbuminuria (p<0.5). Conclusion In this study, about one-fourth of the patients have hypoxemia and more than one fourth of the patients have microalbuminuria. Stage III was more frequent among the study population but there was no association between severity grading and presence of microalbuminuria. However, significant relation is found between co-existence of both microalbuminuria and hypoxemia in COPD patients.

Role of Imprint Cytology in Diagnosis and Assessment of Surgical Margin Clearance of Tumours Compared to Frozen Section

Introduction: Touch imprint cytology is an economical, simple and quick intraoperative diagnostic procedure with good cytological clarity but cannot provide information on the depth of invasion. Frozen section is the standard method but is limited by its cost, need of qualified technical staff and the freezing arte facts. Thus, both the techniques have their own limitations and the combination of these two methods helps in achieving high diagnostic accuracy rates. Objectives: To assess the combined role of imprint cytology and frozen section in the diagnosis of tumours and surgical margin clearance of various organs and to compare the diagnostic accuracy of imprint cytology to frozen section individually verified by subsequent histopathological examination. Material and Methods: The present study was done in the pathology department of Dhaka Medical College Hospital for a period of one year. A total of 72 surgical specimens from various organs were received for imprint cytology and frozen section. The results of both the techniques were verified by the subsequent histopathological diagnosis as “gold standard’’. Results: Out of 72 cases, majority were ovarian neoplasms comprising of 29(40.3%) cases followed by soft tissue tumours (16.7%), breast (9.7%) and brain (8.3%) neoplasms. The majority of the cases were malignant (70.83% including metastatic) followed by benign (20.83%), and borderline (8.33%). The overall diagnostic accuracy of imprint cytology and frozen section in various organs were 95.8% and 97.2% respectively. The combined diagnostic accuracy was 98.6%. The combined accuracy of surgical margin clearance in epithelial tumours was 91.66% and it was higher than the accuracy of 66.66% in non-epithelial tumours. Conclusion: The combination of imprint cytology and frozen section helps in achieving high diagnostic accuracy rates in distinguishing benign and malignant lesions and the accuracy rate for assessment of surgical margin clearance is higher in epithelial neoplasms than that in non-epithelial neoplasms in intraoperative diagnosis.

Customer Relationship Management in Selected Public and Private Tertiary Hospitals of Dhaka City

Introduction: Customer relationship management (CRM) is a strategy that helps organizations to build long-term relationship with customer and increase profit through a proper management system. Objective: To understand the present state of CRM in tertiary level public and private hospitals in Dhaka City, by identifying customers’ profile, customers’ expectation, and by assessing customers’ satisfaction. Material and Methods: This cross sectional descriptive study was conducted in two tertiary level hospitals of Dhaka city, from July 2018 to June 2019 among 220 samples from each hospital, by convenience sampling. Data were collected by interview using semi structured questionnaire and reviewing of check list. Results: Among service receivers, high monthly income (>30000 Taka) prefer Uttara Adhunic Medical College Hospital (UAMCH) (23%) than Dhaka Medical College hospital (DMCH) (5%). Doctors explained health condition to patient or relatives in 64% cases in DMCH and 82% cases in UAMCH. Nurses attention for privacy and courtesy towards patient was 75% and 31% in DMCH which was 86.4% and 50% in UAMCH. About 59% and 20% service receivers from public and private hospital respectively were of the view that pharmacy staffs did not explained properly about safe methods of taking drugs. The overall patient satisfaction was found 63.7% and 69.4% in DMCH & UAMCH by using The Patient Satisfaction Questionnaire Short Form (PSQ- 18 scale). Conclusion: All these findings suggest that people are satisfied more with service quality of private hospitals than the public hospitals. Private hospitals trying to fulfill the requirements of the patients according to their service quality demand, in contrast, public hospitals are fighting hard to fulfill patients demand with limited resources. JAFMC Bangladesh. Vol 17, No 2 (December) 2021: 61-64

Platelet Refractory Cases after Transfusion of Fresh and Stored Platelet in all Children

Introduction: Acute leukemia is the most common form of cancer in children, platelet transfusion is needed for the chemotherapy of acute lymphoblastic leukaemia children. Platelets are transfused for therapeutic and prophylactic purposes. Transfusion of stored platelet concentrates (up to 5 days) has been demonstrated to be as effective as transfusion of fresh platelet concentrates (upto 24 hours). Platelet refractory cases were also observed in this study that was detected by Corrected Count Increment (CCI) and Percent Platelet Recovery (PPI) at 1hour and 24 hours. Aim of the study: The aim of this study was to observe the platelet refractory cases after transfusion of fresh and stored platelet in acute lymphoblastic leukemia (ALL) in a tertiary care hospital, Dhaka. Methods: A cross-sectional study was conducted in the Department of Clinical Pathology, Paediatric Haematolo- Oncology and transfusion Medicine BSMMU, Department of Haematology and Paediatric Haemato-Oncology in Dhaka Medical College Hospital from March 2010 to February 2011 where 81 children diagnosed with acute lymphoblastic leukaemia were taken as the study population. Non probability purposive sampling was used by fulfilling the inclusion criteria. Ethical consideration was taken by the BSMMU ethical review committee. A data sheet with two parts (Part A and Part B) was designed with a view to collect data from the patients to be enrolled in the study. Data were analyzed using the SPSS version 25.0. Results: Out of 81 in 47 children with acute lymphoblastic leukemia (ALL), fresh platelet concentrates (FPC) (upto 24 hours) or day-0 platelets were transfused. In 34 children, stored platelet concentrates (SPC) (days 1–5) were transfused. In 27 cases, platelet concentrates were transfused both fresh and stored. In FPC and SPC, the corrected count increment at one hour (CCI 1h) was 20.5×109/L and 18.9×109/L respectively. FPC and SPC values for the mean corrected count increment at 24 hours (CCI 24h) were 15.5×109/L and 13.8×109/L respectively. Platelet refractory cases were 15(18.5%) out of 81 cases transfused. Platelet refractory cases were 7(15%) out of 47 cases transfused with FPC and 8(23%) out of 34 cases transfused with stored platelet concentrate (SPC). There were no significant differences (P<0.05) between FPC and SPC according to platelet refractoriness. Conclusion: In vivo quality of freshly generated platelet (upto 24 hours) versus stored platelet concentrates (up to 5 days) were determined after 1 hour and 24 hours. 1-5 day’s stored PRP-PCs are as effective as fresh PRP-PCs for sufficient platelet increment.

Efficacy of nebulized hypertonic saline versus normal saline and salbutamol in treating acute bronchiolitis in a tertiary hospital: a randomized control trial

Background: Bronchiolitis is an acute seditious lesion of the lower respiratory tract. Further, than 70 cases are caused by a respiratory syncytial virus (RSV); other less common pathogens include parainfluenza, influenza, rhinovirus, adenovirus, mortal metapneumovirus, mortal Boca contagion and mycoplasma pneumonae. The aim of the study was to evaluate the efficacy of nebulized hypertonic saline in children with acute bronchiolitis in the improvement of clinical features and decreasing length of hospital stay.Methods: The study was a randomized control trial carried out in the department of paediatrics, Dhaka medical college hospital (DMCH), Dhaka between January to December 2013. A total of 100 children from 1 month to 24 months of age irrespective of sex with clinical presentation of bronchiolitis admitted in the paediatric wards of DMCH were included in the study and were randomly assigned to either 4 ml 3% hypertonic saline nebulization (group I=50) or to 4 ml normal saline and 0.4 ml salbutamol respiratory solution nebulization (group II=50). The therapy was repeated 8 hours every day for 120 hours.Results: The clinical severity scores (CS) based on respiratory rate, wheezing, chest retraction and general conditions at baseline on the first day of treatment were 9.0±1.0 in group I and 9.3±1.8 in group II (not significant). The study demonstrated that clinical severity score improved by three days but the improvement was more significant in children who received nebulized hypertonic saline (1.7±1.2) compared to those who received nebulized normal saline and salbutamol (3.5±1.8). The cases of group I required a shorter duration of oxygen therapy compared to those of group II (15±6.0 hours versus 26.4±5.4 hours; p<0.05). Forty-seven patients (94%) were discharged within 72 hours of treatment in group I and 29 patients (58%) in group II. The length of hospital stay was shorter in group I 58.1±22.0 hours compared to group II 74.7±27.2 hours. None of the cases of any group encountered any side effects due to study drugs.Conclusions: 3% hypertonic saline nebulization significantly reduces clinical severity and length of hospital stay of children suffering from acute bronchiolitis in comparison to those treated by normal saline and salbutamol nebulization.

Snake Envenomation in the Intensive Care Unit of a Tertiary Care Hospital, Dhaka, Bangladesh: A Prospective Cohort Study

Background: Snake bite and the subsequent envenomation is an important health hazard which may lead to fatality in rural areas of Bangladesh.
 Objective: This study was conducted to evaluate the epidemiology, clinical profile, treatment and outcome for patients with snake bite admitted in the intensive care unit of Dhaka Medical College Hospital, Bangladesh.
 Methodology: This prospective cohort study was conducted in the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine, Dhaka Medical College, Dhaka, Bangladesh from May 2019 to April 2020 for a period one year. The patients of snake bite were treated in the Intensive care unit, Dhaka Medical College Hospital, Dhaka, Bangladesh. A questionnaire, containing information on bite, physical examination and identification of snake was used.
 Results: A total number of 23 patients of snake bite were treated in the Intensive care unit. Among the patients, 16 (69.56%) were bitten by cobra, 2 (8.6%) were suspected to be bitten by krait and 5(21.7%) cases had Russel viper bite. Tight tourniquet was used in 15(65.21%) cases. Among the patients 18(78.26%) patients were observed with the features of neurotoxicity with or without local envenoming. Among all patients, one patient required two doses of ASV, another patient needed 3 doses; but the other patients were found to be improved after getting a single dose of ASV. However, 15 patients needed ventilator support. The mean duration of ventilator support was 4.8 days. The mortality was 30.43% (7 patients). Out of these 7 patients, 4 patients died due to acute renal failure with DIC.
 Conclusion: Neuroparalytic Cobra envenomation is accounted for the highest incidence of venomous bites in the present study.
 Journal of Current and Advance Medical Research, January 2022;9(1):48-55

Clinico-Demographic Study of Chronic Renal Disease Patients Presenting with Congestive Cardiac Failure at a Tertiary Level of Hospital in Dhaka City

Background: Heart failure (HF) is a major public health issue, and it is associated with a high rate of mortality, morbidity,
 Objective: The purpose of the present study was to assess the demographic and clinical characteristics of the chronic renal disease patient with congestive cardiac failure (CCF).
 Methodology: This cross-sectional study was carried out in the Department of Medicine and Department of Cardiology in Dhaka Medical College Hospital, Dhaka, Bangladesh for six months after approval of the protocol on patients suffering from CCF. Study population was selected in the study group based on age more than 18 years of both sex and diagnosed case of CCF.
 Results: A total 100 patients were included and among them majority of the patients were aged between 51 to 60 years (32.0%). Among them 70.0% cases were male and 30.0% cases were female. About 58.0% cases were living in rural area and 46.0% cases of total subjects had a family income of 20,000-40,000 BDT. Co-morbidities of CCF patients of the study population showed that 53% had hypertension, 48% had ischemic heart disease, 34% had DM, 20.0% had dyslipidaemia, 16% had anaemia, 14.0% had asthma or COPD and rest 8% had history of atrial fibrillation. About 100.0% patients had shortness of breath along with 92.0% bilateral basal crepitation on auscultation; 80.0% had orthopnoea and 66.0% had raised JVP with 64.0% bilateral ankle edema.
 Conclusion: In conclusion males with hypertension and sedentary life style suffer from kidney diseases.
 Journal of Current and Advance Medical Research, January 2022;9(1):21-25

Analysis of Medical and Social Causes of Obstructed Labour

Background: Obstructed labour is one of the major causes of maternal mortality (8%) in Bangladesh. It is also responsible for high rate of maternal and fetal morbidity. If we can identify the medical and social causes of obstructed labour in our country it may be helpful to find out the way to prevent this disease. Objectives: This study was to find out the medical and social causes of obstructed labour in our country. It also finds out the cause of delay in seeking care.Material & Methods:This study is a prospective observational study has been done in Dhaka Medical College Hospital, Dhaka from August 2004 to December 2005. One hundred patients who were admitted with obstructed labour during study period were included in this study.Results:In this study prevalence of obstructed labour was 3.59%. Among the patients who were admitted with obstructed labour 52% were within 20 to 25 years of age, 55% were primigravida, only 30% were on regular antenatal checkup. The medical causes of obstructed labour were cephalopelvic disproportion in 30%, malposition and malpresntation in 69% and cervical fibroid in 1 %. In this study 72% of study population had monthly income below 3,000 BTD, 27% had 3,001 – 5,000 BDT and only 1 % had above 5,000 BDT. Among them 8% patient had crossed the primary level of education and 35% were illiterate. The patients who were admitted with obstructed labour could not utilize the health facility in time and they had to go for trial of home delivery first. In 25% cases their husband and family members did not agree to bring them to hospital, 31.3% was because of ignorance, 14% was due to economic constraints, 13.3% wanted to avoid operative delivery, 9.4 % patient herself did not agree to come to hospital because it would disrupt house hold work and the rest 7% could not come due to long distance between home and health center and tertiary hospital. Modes of delivery were LSCS in 85%, craniotomy in 9% and evisceration in 4%. Maternal outcome was WF in 7% and puerperial sepsis in 18%. Perinatal death was 45%, MMR was 3% due to obstructed labour.Conclusions:SThe causes of obstructed labour are not only due to medical causes but also have social causes. The social causes depend on the socio-economic status and the level of education.

Role of External Ventricular Drainage (EVD) in Treating Spontaneous Intraventricular Haemorrhage

Background: There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral haemorrhage (ICH) and the benefits of external ventricular drainage (EVD). This study is planned to describe the role of external ventricular drainage in treating patients of spontaneous, either primary or secondary, intraventricular haemorrhage with hydrocephalus.Material & Methods:A hospital based prospective interventional study was conducted in the Department of Neurosurgery of Dhaka Medical College Hospital, which is a tertiary level hospital, from April 2016 to September 2017.Total 42 patients of spontaneous intraventricular haemorrhage, either primary or secondary, with hydrocephalus were selected for this study. All the collected data were entered into IBM SPSS software, Version 24. For statistical analysis, paired t-test to compare the preoperative GCS with postoperative GCS at 24 hours was done.Results:Among 42 patients, age range was 26-75 years with the mean age 65.2 ± 10.87 years. Male were 26 (61.9%) and female were 16 (38.1%). Male-Female ratio was 1.625:1. No patient needed conversion of EVD into VP shunt. EVD drain became blocked in 5 cases which were managed accordingly. 5 patients developed ventriculitis among which 2 patients died and rest 3 improved with antibiotics.Conclusions:The results of present study shows that EVD has a good role in the treatment of spontaneous IVH with hydrocephalus when ICH volume is low (<30ml) and modified Graeb Score is low (≤10 found in this in this study. Preoperative higher GCS or initial improvement in GCS or initial improvement in GCS at 24 hours positively correlates with Glasgow outcome scale which is an indication of good function outcome.

Virucidal Effect of Povidone Iodine on SARS-CoV-2 in Nasopharynx: An Open-label Randomized Clinical Trial.

To assess the virucidal effect of povidone iodine (PVP-I) on severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) located in the nasopharynx and suitable dose-formulation for nasal application were the purpose of this clinical trial. This single-center, open-label randomized clinical trial with a 7-arm parallel-group design was conducted in Dhaka Medical College (DMC) Hospital. A total of 189 reverse transcription-polymerase chain reaction (RT-PCR)-confirmed SARS CoV-2 positive cases aged 12–90 years with symptoms was sequentially enrolled following randomization. Nasopharyngeal clearance of SARS-CoV-2 was tested against PVP-I nasal irrigation (NI) at diluted concentrations of 0.4%, 0.5% and 0.6%, and PVP-I nasal spray (NS) at diluted concentrations of 0.5% and 0.6%. All groups were compared to the corresponding controls (distilled water). Written informed consent was ensured before participation. All procedures were conducted in after ethical clearance from the Ethical Review Board and in accordance with the Declaration of Helsinki. Viral clearance in a repeat RT-PCR (qualitative) was the primary outcome, and occurrence of any adverse event following administration of testing drug was considered as the secondary outcome. Analysis was performed using SPSS (Version 26). All cases were randomized into seven groups and each group consists of 27-patient. Mean age of the cases 43.98 ± 12.67 years (SD). All strength of NI were effective in nasopharyngeal clearance compared to the control (0.4%, p = 0.006; 0.5%, p < 0.001; and 0.6%, p = 0.018). Similarly, all strength of the NS is also effective than control (0.5%, p = < 0.001; and 0.6%, p ≤ 0.001). Highest nasopharyngeal clearance was observed in patients using 0.5% NI (n = 25, 92.6%, p = 0.018). Nasal irritation was the single most adverse event recorded in this trial and found in two patients using 0.4%, and 0.6% PVP-I NI, respectively. Both PVP-I NS and NI are effective for nasopharyngeal clearance in-vivo. However, further community trials are needed to repurpose these solutions as preventive agents against SARS-CoV2. Ethical clearance memo no ERC-DMC/ECC/2020/93.Trial registration NCT Identifier number NCT04549376.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12070-022-03106-0.

Nutritional Status and Severity Correlation Of COPD Patients Admitted in Tertiary Care Hospital

Background: Malnourishment is highly prevalent among COPD patients. The study was carried out to assess the nutritional status of hospital admitted COPD patients to evaluate the relationships between the nutritional indices and the pulmonary function parameters with severity correlation. Methods: A cross-sectional observational study was done constituting 50 spirometryproven COPD patients admitted at Dhaka Medical College Hospital. Lung function was measured by routine spirometry. Anthropometric measures, biochemical parameters, and Mini Nutritional Assessment (MNA) score were used for nutritional assessment. Results: Mean age of study population was 64.31 years.22% (n = 11), 42% (n = 21) 32% (n = 16) &amp; 4% (n = 2) of the patients were of stage I, II, III and IV of COPD respectively.According to MNA scalethe study population were malnourished 46% (n = 23), at risk of malnutrition 40% (n = 20) and normal nutritional status 14% (n = 7).13 patients were found malnourished according to BMI scale and were in stage I COPD 15.38% (n = 2), stage II 38.46% (n = 5), stage III 38.46% (n = 5) and stage IV 7.69% (n = 1). Mid arm circumference (MAC), mid-calf circumference (MCC), MNA scale score and BMI score showed a significant decline of mean value with increasing severity of stages of COPD. The correlation between BMI and FEV1 (R2 = 0.087 and p value= 0.038), body weight and FEV1 (R2 = 0.173 and p value= 0.003), MUAC and FEV1 (R2: 0.202, p value = 0.001) and MNA scale and FEV1 (R2 = 0.144 and p value= 0.007). All correlations were statistically significant. Conclusion: The high prevalence of malnutrition among hospitalized COPD patients is related to their lung function. Weight, mean MNA, and BMI score decrease with increasing severity of COPD. Bangladesh J Medicine 2022; 33: 186-192

Pattern of ENT Emergencies in Tertiary Level Hospital

Background: Emergencies in ENT practice has a wide spectrum and management of each condition requires specialized skills. Crucial decisions are necessary to save patients life in hurried situations.&#x0D; Objectives: This study is carried out with an objective to find out pattern of ENT emergencies in tertiary level hospital.&#x0D; Methods: This is a cross sectional study was done in two major tertiary level hospitals (Dhaka Medical College Hospital, Sir Salimullah Medical College Mitford Hospital) of Dhaka, Bangladesh. This study was conducted in a period of six months and took into account all inpatient and outpatient emergencies in this period. These included 496 patients either admitted as emergency or took emergency treatment without admission from department of ENT and Head-Neck surgery of two tertiary level hospitals.&#x0D; Results: 496 patients of between age ranges 2 months-80 years with a mean age 26.3 years were included. Male female ratio was 1.9:1.55.65% patients are from rural area. The total throat related cases were maximum (40.52%) in comparison to ear (32.26%) and nose (27.22%). Inflammatory condition in pharynx (46.27%) is the most common among throat related emergencies, followed by foreign body in throat (32.26%). Fish bone impaction is the most common (33.36%) emergencies among foreign body in throat. Foreign body in throat was mostly seen in 0 to 10 age group. Acute upper respiratory tract infection is the highest (27.96%) among the pharyngeal emergencies. Laryngeal emergencies with stridor were most common (47.62%) among laryngeal, tracheal and bronchial emergencies other than foreign body. Among the otological emergencies external ear emergencies other than foreign body (40%) was most common. Vegetables foreign body in the ear was most common (40%) among the foreign body in ear. Foreign body in ear mostly found in 0 to 10 age group. Traumatic injury to external ear is the most common (18.75%) among external ear emergencies other than foreign body. Among the sinonasal emergencies epistaxis was most common (39.26%). Most of the cases were managed surgically (71.97%) 87.5% cases were recovered from emergencies with overall mortality of (1.21%).&#x0D; Conclusion: Epistaxis emerged as the leading cause of ENT emergencies followed by foreign body in ENT region. Most of the ENT emergencies were managed surgically under local anaesthesia. So, presence of otolaryngological department in thana and district level hospital could avoid unnecessary referral.&#x0D; Sir Salimullah Med Coll J 2022; 30: 67-74

Genomic Insights Into the Mechanism of Carbapenem Resistance Dissemination in Enterobacterales From a Tertiary Public Heath Setting in South Asia.

10.6% patients were CRE positive. Only 27% patients were prescribed at least 1 antibiotic to which infecting pathogen was susceptible. Burn and ICU admission and antibiotics exposures facilitate CRE acquisition. Escherichia coli ST167 was the dominant CRE clone. Given the high prevalence of multidrug resistance (MDR) across South Asian (SA) hospitals, we documented the epidemiology of carbapenem-resistant Enterobacterales (CRE) infections at Dhaka Medical College Hospital between October 2016 and September 2017. We enrolled patients and collected epidemiology and outcome data. All Enterobacterales were characterized phenotypically and by whole-genome sequencing. Risk assessment for the patients with CRE was performed compared with patients with carbapenem-susceptible Enterobacterales (CSE). 10.6% of all 1831 patients with a clinical specimen collected had CRE. In-hospital 30-day mortality was significantly higher with CRE [50/180 (27.8%)] than CSE [42/312 (13.5%)] (P = .001); however, for bloodstream infections, this was nonsignificant. Of 643 Enterobacterales isolated, 210 were CRE; blaNDM was present in 180 isolates, blaOXA-232 in 26, blaOXA-181 in 24, and blaKPC-2 in 5. Despite this, ceftriaxone was the most commonly prescribed empirical antibiotic and only 27% of patients were prescribed at least 1 antibiotic to which their infecting pathogen was susceptible. Significant risk factors for CRE isolation included burns unit and intensive care unit admission, and prior exposure to levofloxacin, amikacin, clindamycin, and meropenem. Escherichia coli ST167 was the dominant CRE clone. Clustering suggested clonal transmission of Klebsiella pneumoniae ST15 and the MDR hypervirulent clone, ST23. The major trajectories involved in horizontal gene transfer were IncFII and IncX3, IS26, and Tn3. This is the largest study from an SA public hospital combining outcome, microbiology, and genomics. The findings indicate the urgent implementation of targeted diagnostics, appropriate antibiotic use, and infection-control interventions in SA public institutions.

Molecular and genetic characterization of emerging carbapenemase-producing Acinetobacter baumannii strains from patients and hospital environments in Bangladesh

SummaryBackgroundCarbapenemase-producing multidrug-resistant (MDR) Acinetobacter baumannii is a global health care problem. MDR A. baumannii has emerged as an important nosocomial pathogen, costing many lives worldwide including Bangladesh.AimTo investigate the detailed molecular epidemiology of carbapenem-resistant A. baumannii (CRAB) both from patients and the hospital environment, to shed light on genetic characteristics and transmission dynamics.MethodsA set of 49 clinical A. baumannii strains collected during early 2015 was received from the clinical microbiology laboratory of Dhaka Medical College Hospital (DMCH) in Bangladesh. Additionaly, 100 environmental samples were also collected from the hospital surfaces of Dhaka Medical College Hospital and analyzed for carbapenamase-producing A. baumannii. CRAB were identified by culture on selective plates, biochemical testing and MALDI-TOF. All isolates were characterized by susceptibility testing, realtime-PCRs, conventional PCR, MLST and sequencing.FindingsClinical A. baumannii were resistant to ciprofloxacin (100%), imipenem (91.8%), meropenem (91.8%), gentamicin (91.8%), amikacin (87.7%), and trimethoprim-sulfamethoxazole (61.2%). The majority (59%) of the isolates were MDR. All environmental A. baumannii (n=10) were resistant to imipenem, meropenem, gentamicin, amikacin, and ciprofloxacin. Strains carried the following antibiotic resistant genes; blaOXA-23,blaOXA-58,blaPER-7,qnrB1, qnrC1, aac(6′)1b-cr and armA. A total of 36 different clones were identified by rep-PCR and common clonal clusters were found both in patients and hospital environments. MLST analysis revealed different sequence types (ST2, ST10, ST149, ST575, ST1063 and ST1065). In clinical and environmental settings. A. baumannii ST2 dominated in both clinical and environmental settings. Both clinical and environmental A. baumannii strains with known STs carried several biofilm-related genes; bap, csuE, and pgaB.ConclusionWidespread dissemination of MDR A. baumannii in the DMC hospital of Bangladesh is a serious problem.