Dhaka Hospital Research Articles

MRI as a Diagnostic Tool for the Determination of Acute Ischaemic Stroke: A Study in a Tertiary Care Hospital

Background: Stroke is a prevalent and potentially fatal medical condition that affects individuals worldwide. Ischemic strokes, caused by arterial blockages, are the most common type, accounting for about 80% of all cases. Hemorrhagic strokes, on the other hand, are less frequent but can have more severe consequences. Accurate and timely diagnosis of stroke is critical for effective treatment and optimal patient outcomes. In this context, diffusion-weighted imaging (DWI) has emerged as a valuable tool for identifying and monitoring ischemic stroke. This article provides an overview of the role of DWI in stroke assessment and management, with a focus on early detection and intervention. The aim of this study is to investigate the reliability of diffusion-weighted MRI (DWI) as an imaging modality in the evaluation of acute ischemic stroke. Material & Methods: This prospective cross-sectional study was conducted at the Department of Radiology and Imaging at the Combined Military Hospital (CMH) in Dhaka, Bangladesh, between June 2020 and June 2021. The study aimed to examine 120 patients clinically diagnosed with acute ischemic stroke. Prior to the study, verbal consent was obtained from all patients. The Study subjects were identified in the emergency and casualty department and had undergone an MRI of the brain in the Department of Radiology and Imaging at CMH, Dhaka. . Data were collected on pre-designed forms, and the relevant information was compiled on a master chart for statistical analysis using SPSS software. Descriptive analysis and frequency of results were presented in the form of tables, pie charts, and bar graphs. The ethical clearance of this study was obtained from the Institutional Ethics Committee of CMH, Dhaka, Bangladesh. Results: The study included 64 males and 56 females with a mean age of 65.2 ± 7.83 years. The majority of patients had an acute ischemic lesion (88.30%) in the MCA (50.0%) with small-sized lesions (41.7%) and low ADC values (90.0%). The most common clinical presentation was hemiplegia (100%), and diffusion-weighted MRI had a high diagnostic accuracy in detecting acute ischaemic lesions (96.3%). Overall, these findings highlight the importance of MRI in the evaluation of stroke patients and can guide clinical decision-making. Conclusion: The present study concluded that DWI in conjunction with ADC map MR imaging is a gold standard diagnostic modality in the evaluation and management of acute ischaemic stroke.

Emergence of fosfomycin resistance among isolates of multidrug-resistant Enterobacter species at a tertiary care hospital in Dhaka, Bangladesh

Background: The emergence of multidrug-resistant Enterobacter species as a worrying resistant pathogen seriously threatened human health. The rising rate of resistance to commonly used antibiotics limit the choice hence it is urgent to evaluate the antimicrobial activity of older drug like Fosfomycin. Objective: The study aimed to seek the frequency of fosfomycin resistance in the clinical isolates of Enterobacter species and to detect the fosfomycin resistance gene along with antibiotic resistance pattern. Methods: This cross-sectional study was conducted in the Department of Microbiology of a tertiary care hospital in Bangladesh from July 2018 to June 2019. Enterobacter spp. was isolated from a total of 350 samples by a standard microbiological method. Antibiotic susceptibility was performed by the disk diffusion technique. Antibiotic susceptibility and minimum inhibitory concentration (MIC) of fosfomycin were determined by the agar dilution method. Fosfomycin resistance gene fosA, fosA3, fosA4, fosA5, fosB, fosB2, fosC, fosC2 and fosX among fosfomycin‑resistant Enterobacter spp detected by polymerase chain reaction (PCR) using specific primer. Sequencing of fosA and fosA₅ was performed by capillary method, and the nucleotide sequence of fosA₅ has been deposited to GenBank. Results: Out of 28 Enterobacter spp. 7 (25%) fosfomycin resistant Enterobacter spp. were detected by agar dilution method. Out of 7 fosfomycin-resistant strains, 4 (57.14%) were isolated from urine samples. Fifteen (53.57%) isolates of Enterobacter spp. were multidrug-resistant detected by disc diffusion technique. All of the fosfomycin-resistant isolates were MDR. A significant rise in the MIC was found between 256µg/ml- ≥4096 µg/ml to fosfomycin. PCR revealed that 100% of fosfomycin resistant isolates are positive for fosA, 71.43% and 28.57% were positive for fosA₅ and fosB₂ respectively. Sequencing of fosA₅ gene established the FosA family fosfomycin resistance glutathione transferase gene. Conclusion: The results of this study showed a high proportion of fosfomycin resistance among multidrug-resistant Enterobacter spp. irrespective of fosfomycin usage in Bangladesh. FosA family fosfomycin resistance glutathione transferase gene emerging in Bangladesh. Bangladesh Medical Res Counc Bull 2022; 48(3): 203-210

Open-label, randomised controlled trial found that a green banana mixed rice suji diet was most effective for persistent diarrhoea in children in Bangladesh.

Persistent diarrhoea continues for at least 14 days and kills more children than acute diarrhoea. We assessed whether rice suji, green banana mixed rice suji or 75% rice suji improved persistent diarrhoea compared in young children. This open-labelled randomised controlled trial was carried out between December 2017 and August 2019 at the Dhaka Hospital of icddr,b, Bangladesh, with 135 children aged 6-35 months with persistent diarrhoea. The children were randomly assigned to green banana mixed rice suji, rice suji, or 75% rice suji, with 45 in each group. The primary outcome was the percentage who recovered from diarrhoea by day five using an intention to treat analysis. The children's median age was eight months (interquartile range 7-10 months). By day five the recovery rate was 58%, 31% and 58% children in the green banana mixed rice suji, rice suji and 75% rice suji groups, respectively. The green banana mixed rice suji group had fewer relapses (7%) than the 75% rice suji group (24%). Enteroaggregative Escherichia coli, rotavirus, norovirus, Enteropathogenic Escherichia coli, astrovirus and Campylobacter were the major pathogens for persistent diarrhoea. Green banana mixed rice suji was the most effective option for managing persistent diarrhoea in young children.

The Effects of Hypotensive Anaesthesia on Reducing Intraoperative Blood Loss, Duration of Operation and Quality of Surgical Field During Orthognathic Surgery in a Tertiary Care Hospital

Background: Hypotensive anaesthesia is a method of reducing the blood pressure of a patient at some point of surgical treatment to reduce the quantity of blood loss. This is the most frequently used approach in microvascular surgery however it can be used in a wide range of surgeries. The efficacy of hypotensive anaesthesia is decreasing intraoperative blood loss, lowering operation time and enhancing the quality of surgery. Objectives: The aim of the study is to assess the effects of hypotensive anaesthesia on reducing intraoperative blood loss, duration of operation and quality of surgical field during orthognathic surgery in a tertiary care hospital. Methods: The study was carried out in the Anaesthesiology Department of Dhaka Dental College and Hospital, Dhaka, Bangladesh from July 2021 to December 2022. A prospective, randomized clinical research with 72 individuals was conducted. They were assigned at randomization to either a normotensive or a hypotensive anaesthesia group. Results: The mean blood loss for surgeries carried out under normotensive anaesthesia was 276.66±57.50 ml, whereas the mean blood loss for surgeries carried out under hypotensive anaesthesia was 162.50±37.25 ml. In the normotensive and hypotensive groups, the mean duration of operation was 195.83±60.44 minutes and 195±58.05 minutes respectively. Conclusions: Reducing intraoperative blood loss is really a benefit of hypotensive anaesthesia. As a standard method for orthognathic surgery, hypotensive anaesthesia can be justified for less blood loss and enhancing the quality of surgical field.

Evaluation of Reducing the Excess Abdominal Skin, Subcutaneous Tissue and Anterior Abdominal Wall Laxity: A Prospective Observational Study at Dhaka Medical College Hospital

Background: Lax abdominal muscles cause laxity or bulging. This is generally a consequence of age or post-pregnancy, causing the abdominal rectus muscles and fascia that overlies and divides them to weaken. Abdominoplasty, a popular cosmetic surgery, has improved in recent years. helped minimize abdominal fat and skin. Medical institutions are diagnosing and treating obesity at an increasing pace. Objective: The purpose of the study was reduce the excess abdominal skin,subcutaneous tissue and anterior abdominal wall laxity. Methods: The duration of this prospective observational research was from July 2014 to April 2015. The research population consisted of patients hospitalized to the Plastic Surgery Department of Dhaka Medical College Hospital and numerous private hospitals in Dhaka with extra abdominal skin and abdominal wall laxity owing to various causes, such as past pregnancy or severe weight loss. From the study population, 30 instances that satisfied the enrollment requirements were chosen. Results: The majority of patients (26, or 86.67 %) were female, and 76 % were married. At the time of surgery, the average age was 41.3 years. The total complication rate was 40%, with just four serious complications (13.33%) and the most being mild (9, 30 % ). Seroma (3, 10%), infection (2, 6.67%), hematoma (2, 6.67%), wound dehiscence (1, 3.33%), partial flap loss (2, 6.67%), umbilical stenosis (1, 3.33%), epidermolysis (1, 3.33%), DVT (1, 3.33%) were the most prevalent complications (1, 3.33 % ). Very excellent (19, 66.3%), good (9, 30%), and adequate were patients' ratings of satisfaction (2, 6 % ). No patient reported low or extremely bad satisfaction. Conclusion: Abdominoplasty may be done with little risk and provides excellent results. Patients reported relief from their symptoms and satisfaction with the result. However, there was a high rate of mild problems, most of which involved wound healing. At most cases, problems were mild and quickly treated in a doctor's office.

A Cross-Sectional Study on Factors Related to Status of Meconium Stained Liquor Labour Patients Attended at Tertiary Level Hospital in Dhaka, Bangladesh

Background: Meconium-stained liquor during labor is a common almost daily encountered problem. Objective: The purpose of the study was to find out factors related to meconium-stained liquor affecting during labor. Methodology: This is a cross-sectional, hospital-based observational study conducted in the Department of Obs & Gyne, Shaheed Suhrawardy Medical College Hospital, Dhaka. The cases with single, term pregnancy with cephalic presentation presented with meconium-stained liquor was selected. All the cases willingly participated in this study. Data collection and fetal assessment was conducted in the labor room. The meconium-stained liquor was clinically and completely in a structured questionnaire according to the events that happened pre and post-delivery including neonatal outcome data. Data was analyzed by computer using the SPSS program (Statistical Package of Social Sciences), version-22, and p value <0.05 considered as statistically significant. Result: The mean age of the study group was 32.3±6.4 years. The Level of education of the study population, illiterate 12.0%, primary school 21.0%, majority SSC 33.0%, HSC 20.0% and graduation 14.0% and the occupation of the study patients mostly housewife 65.0%, least service.10.0%, business 14.0% and other professions 11.0% and mean gestational week was 40.12±1.43. Conclusion: The meconium-stained liquor labour is a serious condition and related with some factors which can be addressed by these factors and the safety of maternal and fetal outcomes. J Shaheed Suhrawardy Med Coll 2021; 13(2): 109-112

A snap-shot of a diarrheal epidemic in Dhaka due to enterotoxigenic Escherichia coli and Vibrio cholerae O1 in 2022.

Enterotoxigenic Escherichia coli (ETEC) and Vibrio cholerae O1 are most common bacterial causes of diarrheal diseases in Bangladesh. This analysis projected distribution of ETEC and V. cholerae O1 among diarrheal patients of icddr,b, Dhaka hospital in two diarrheal peaks of 2022. Under the 2% systematic surveillance system, stool samples collected from diarrheal patients of icddr,b hospital were cultured and diagnostic testing was done for ETEC and V. cholerae O1. Comparison of positive cases was done between first peak (March-April) and second peak (October-November) in 2022. A total of 2,937 stool specimens were tested of which 12% were ETEC and 20% were V. cholerae O1. About 40% of the severe dehydration cases were infected with V. cholerae O1. Predominant ETEC enterotoxin type was 'LT/ST' (41%). The LT enterotoxin significantly increased from 13% to 28% in the second peak (p = 0.015). The predominant colonization factors (CFs) on ETEC were CS5 + CS6 (23%), followed by CS6 (15%). CF-positive isolates was significantly higher in the second peak (36%) than in the first peak (22%) (p = 0.043). Total 14% cases were co-infected with ETEC and V. cholerae O1. Significant differences in the distribution of enterotoxin types were observed (p = 0.029) among the co-infection cases. Changing patterns of enterotoxin and CFs observed in ETEC pathogens should be taken into consideration for ETEC vaccine development. Considering cholera and ETEC biannual trends in causing diarrheal epidemics and outbreaks, emphasizes the need for thoughts on combination vaccine strategies for preventing acute watery diarrhea due to the two major bacterial pathogens.

Nutritional Profiles and Zinc Supplementation among Children with Diarrhea in Bangladesh.

Zinc supplementation is an added intervention with oral rehydration solution (ORS) for treating childhood diarrhea as per World Health Organization recommendations. Our study aimed to determine the prevalence of zinc administration in addition to ORS for childhood diarrhea before hospitalization and the nutritional profile of those children admitted to the outpatient department of the largest diarrheal facility in Bangladesh. This study used a screening dataset of a clinical trial (www.clinicaltrials.gov; NCT04039828) on zinc supplementation at a Dhaka hospital (International Centre for Diarrhoeal Disease Research, Bangladesh) between September 2019 and March 2020. A total of 1,399 children aged 3-59 months were included in our study. Children were divided into two groups (one group received zinc and another did not) and were analyzed accordingly; 39.24% (n = 549) children received zinc along with ORS for the current diarrheal episode prior to hospitalization. Percentages of underweight (weight-for-age z-score < -2 SD), stunting (length/height-for-age z-score < -2 SD), wasting (weight-for-length/height z-score < -2 SD), and overweight (weight-for-age z-score > +2 SD) among these children were 13.87% (n = 194), 14.22% (n = 199), 12.08% (n = 169), and 3.43% (n = 48), respectively. In logistic regression after adjusting age, sex, and nutritional status (underweight, stunting, wasting, and overweight), association of dehydration (adjusted odds ratio [aOR]: 0.06; 95% CI: 0.03-0.11; P < 0.01), bloody diarrhea (aOR: 0.18; 95% CI: 0.11-0.92; P < 0.01), and fever (aOR: 0.27; 95% CI: 0.18-0.41; P < 0.01) were less with children who received zinc at home. Bangladesh is one of the leading zinc coverage areas globally but lags behind the target for zinc coverage in diarrheal illness among under-five children. Policymakers should scale up and formulate guidelines with sustainable strategies to encourage zinc supplementation in diarrheal episodes in Bangladesh and elsewhere.

Thyroid Dysfunction in Adults with Newly Detected Type 2 Diabetes Mellitus: A Study in a Tertiary Care Hospital, Dhaka, Bangladesh

Background: Thyroid disorders and diabetes mellitus are common endocrine disorders that often coexist and can significantly impact each other’s management. The American Diabetes Association recommends that people with diabetes be periodically screened for thyroid dysfunction due to the strong link between the two conditions. It is important for individuals to be aware of the risk factors for both conditions and to seek appropriate medical care if necessary, and for healthcare providers to consider testing for thyroid dysfunction in adults with newly detected type 2 diabetes mellitus. The aim of the study was to find out thyroid dysfunction in adults with newly detected type 2 diabetes mellitus. Material Methods: This cross-sectional, descriptive study was conducted at the Departments of Medicine and Endocrinology at Sir Salimullah Medical College and Mitford Hospital in Dhaka. The study period lasted six months, from May to October 2019. A total of 102 adult patients (above 20 years old) with newly diagnosed type 2 diabetes mellitus who were attending the Endocrinology and Medicine Outpatient Department participated in the study. Results: Out of 102 adults with newly detected type 2 diabetes mellitus, the majority (86.3%) had normal thyroid function (euthyroid), while a smaller number (13.7%) had thyroid dysfunction. The most common subgroup of thyroid dysfunction was subclinical hypothyroidism (7.8%), followed by hypothyroidism (3.9%), subclinical thyrotoxicosis (1.0%), and hyperthyroidism (1.0%). The majority of the study population was male (66%) and from urban areas (88%), with a mean age of 45.1 years, a mean BMI of 25.0 kg/m2, and a mean waist circumference of 98.4 cm. About 45% had a family history of diabetes mellitus and 37% were smokers. The blood pressure of the study population was within normal limits. A minority (30%) had co-morbidities such as hypertension, dyslipidemia, and ischemic heart disease. The predictors of thyroid dysfunction were observed Age (OR=0.785), F/H of thyroid disorder (OR=0.495) BMI (OR=1.059), Anti-TPO Ab(OR= 0.021). Conclusion: Thyroid dysfunction and diabetes are commonly associated with each other and can impact clinical presentation and laboratory results. It is important to routinely screen for thyroid function in all patients with type 2 diabetes mellitus to detect, treat, and prevent complications of both these conditions.

Features and risk factors of post-COVID-19 syndrome: findings from a longitudinal study in Bangladesh.

A comprehensive study of the post-COVID syndrome (PCS) remains scarce in low-and middle-income countries. We assessed the prevalence, incidence rate, evolution over time, and risk factors of PCS among hospitalized (HS) and non-hospitalized (NHS) COVID-19 survivors. We undertook a prospective longitudinal study of COVID-19 survivors at months 1, 3, and 5 post-discharge or post-isolation period. The study was conducted at two COVID-19-designated hospitals in Dhaka, Bangladesh, between December 2020 and October2021. 362 participants were enrolled in the study; the median time from the onset of COVID-19 to enrolment was 57 days (IQR 41, 82). At enrolment, after adjusting for potential confounders, the HS more often had one or more symptoms, peripheral neuropathy (PN), depression and anxiety disorder, poor quality of life, dyspnea, tachycardia, restrictive lung disease on spirometry, anemia, proteinuria, and need for insulin therapy than the non-hospitalized group (95% CI>1 for all). Although most of these findings decreased significantly over time in HS, PN increased in both groups. The incidence of diabetes was 9.8/1000 person-month, and the new requirement of insulin therapy was higher (aOR, 6.71; 95% CI, 2.87, 15.67) among HS than the NHS. Older age, being female, comorbidity, cigarette smoking, hospitalization, and contact with COVID-19 cases were independently associated with PCS. We observed a high burden of PCS in hospitalized and non-hospitalized survivors despite most findings' decreasing trend over time. Our results underscore the importance of continuing long-term follow-up and subsequent management. The United States Agency for International Development (USAID).

Efficacy of dopamine, epinephrine and blood transfusion for treatment of fluid refractory shock in children with severe acute malnutrition or severe underweight and cholera or other dehydrating diarrhoeas: protocol for a randomised controlled clinical trial

IntroductionDiarrhoea is one of the leading causes of under-5 childhood mortality and accounts for 8% of 5.4 million global under-5 deaths. In severely malnourished children, diarrhoea progresses to shock, where...

Evaluation of Anaesthetic Challenges in Primary Cleft Lip and Palate Surgeries in a Single Center Study

Background: One of the most prevalent congenital malformations and the most frequent craniofacial defects in children is cleft lip and palate. The aim of the study was to investigate the anaesthetic procedures employed and to determine the challenges and postoperative complications associated with cleft lip and palate surgery. Material Methods: A retrospective review of the anaesthetic procedures carried out from January 2022 to December 2022 at the Dhaka Dental College and Hospital. The hospital records were reviewed in order to learn about every occurrence of orofacial cleft surgery. In this study, a total number of 120 cases were reviewed. Results: Among 120 cases, 53 (44.2%) of the patients were female and 67 (55.8%) were male. The bulk of patients came after their first year of life. About 54(45%) of them were younger than five years old. 68(56.67%) underwent cleft lip surgery, 37(30.83%) for cleft palate surgery and rest 15(12.5%) patients under went for combined cleft lip and cleft palate surgeries. Upper Respiratory Tract Infection (URTI) was reported as the most common pre-existing morbidity. Bronchospasm was the main intraoperative complications occurred in 8 (6.67%) of the cases with URTI. After surgey 6(5%) patients experienced bleeding, 3(2.5%) patients needed to be reintubated. In addition, 2 (1.67%) instances had trouble controlling their pain, only 1(0.83%) patient had trouble swallowing and 1(0.83%) recovered slowly. Conclusion: Anaesthesia for surgical repair of cleft lip or palate in children is challenging. After a thorough preoperative evaluation, a trained anaesthesiologist should administer anaesthesia under strict supervision to minimize postoperative complications.

The Maternal and Fetal Outcome of Placenta Praevia in Term Pregnancy

Background: Placenta praevia refers to a placenta that is Inserted either completely or partially in the lower uterine segment. In placenta praevia, placenta is implanted in the lower uterine segment within the zone of effacement and dilatation of cervix, resulting in obstruction to decent of the Presenting part. The aim of this study is to find out the maternal and fetal outcome of Placenta praevia in term pregnancy. Material Methods: This is an observational study. The study used to be carried out in the admitted patient’s Department of obstetrics and gynecology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. In Bangladesh for the duration of the period from January 2013 to June 2013. The duration of the period from Data was entered in MS Excel and Statistical analysis was done using SPSS 24 version. Results: This study shows that Maternal age range was 18 to 45 years and the commonest age group of placentas previa was 25-29 years (60.0%). Four percent were between 20-24 years age group. Twenty percent were more than 35 years of age. Conclusion: The study subjects were selected only who were found high maternal morbidity and perinatal mortality which was 8% due to placenta preavia. So, the observed result of this study might not reflect the expected real outcome. In population therefore further prospective studies with a large sample should be carried out for comprehensive evaluation of placenta Preavia on maternal and neonatal outcome.

Evaluation of serum interleukin-1 receptor antagonist levels in major depressive disorder: A case-control study.

Major depressive disorder (MDD) is characterized by the occurrence of one or more depressive episodes lasting a minimum of 2 weeks and is marked by a persistently low mood and a lack of enjoyment in daily activities. The diagnosis of MDD is not possible by a well-established laboratory test or biomarker. A wide range of potential biomarkers for depression have been proposed by many studies, but none of them has adequately described the correlation between the biomarkers and depression. The purpose of this study was to evaluate serum interleukin-1 receptor antagonist (IL-1RA) levels as an early depression risk factor. The present case-control study included 88 participants. Among them, 44 MDD patients enrolled from the psychiatry department of a public hospital in Dhaka, Bangladesh, and 44 age- and sex-matched healthy controls (HCs) from various sites in Dhaka city. A qualified psychiatrist evaluated the cases and HCs based on the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5). The Hamilton depression (Ham-D) rating scale was employed to evaluate the intensity of depression. An enzyme-linked immunosorbent assay kit (Boster Bio, USA) was used to determine serum IL-1RA concentrations. We observed no marked alteration in the serum concentration of IL-1RA in MDD patients in comparison to HCs (292.81 ± 24.81 and 288 ± 24.87 pg/mL; p > 0.05). Among MDD patients, we found no noteworthy association between the severity of depression and serum IL-1RA levels. The findings of the present study imply that IL-1RA may not be identified as a promising biomarker for risk assessment of depression. However, its neuroprotective role may be taken into consideration for the understanding of pathophysiology of MDD.

Vaccination following the expanded programme on immunization schedule could help to reduce deaths in children under five hospitalized for pneumonia and severe pneumonia in a developing country.

Worldwide, pneumonia is the leading cause of mortality in children under the age of five. An expanded program on immunization (EPI) is one kind of evidence-based tool for controlling and even eradicating infectious diseases. This study aimed to explore the impact of EPI vaccination, including BCG, DPT-Hib-Hep B, OPV, IPV, and PCV-10, among children from the age of 4 to 59 months hospitalized for pneumonia and severe pneumonia. Additionally, we evaluated the role of 10 valent pneumococcal conjugate vaccines alone on clinical outcomes in such children. In this retrospective chart review, children from the age of 4 to 59 months with WHO-defined pneumonia and severe pneumonia admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) between August 2013 and December 2017 who had the information on immunization as per EPI schedule by 4 months of age were included in the analysis. A comparison was made between the children who were fully immunized (immunization with BCG, DPT-Hib-Hep B, OPV, and IPV from 2013 to 2015 and PCV-10 from 2015 to 2017) and who were not immunized (consisting of partial immunization and no immunization) during the study period. A total of 4,625 children had pneumonia and severe pneumonia during the study period. Among them, 2,605 (56.3%) had received the information on immunization; 2,195 (84.3%) were fully immunized by 4 months of age according to the EPI schedule and 410 were not immunized. In the log-linear binomial regression analysis, immunization of children from 4 to 59 months of age was found to be associated with a lower risk of diarrhea (p = 0.033), severe pneumonia (p = 0.001), anemia (p = 0.026), and deaths (p = 0.035). Importantly, the risk of developing severe pneumonia (1054/1,570 [67%] vs. 202/257 [79%], p < 0.001) and case-fatality rate (57/1,570 [3.6%] vs. 19/257 [7.4%], p = 0.005) was still significantly lower among those who were immunized with PCV-10 than those who were not. Children immunized as per the EPI schedule were at a lower risk of diarrhea, severe pneumonia, anemia, and death, compared to unvaccinated children. In addition, PCV-10 was found to be protective against severe pneumonia and deaths in vaccinated children. The overall results underscored the importance of the continuation of immunization, scrupulously adhering to the EPI schedule to reduce the risk of morbidities and mortalities in children, especially in resource-limited settings.

Stress level of nurses in tertiary level hospital in Dhaka

Stress level of nurses in tertiary level hospital in Dhaka

First Dominant Circulation of Influenza A/H3 among Patients with Acute Respiratory Tract Infections in a Tertiary Care Hospital in Dhaka 2022

The seasonal circulation of influenza viruses varies from year to year. We have retrospectively analyzed our hospital data of respiratory pathogens among patients of respiratory tract infections and extracted circulation of influenza viruses and characterized patients with influenza attended to a tertiary care hospital in Dhaka from July 2021 to September 2022. We have analyzed data of real-time reverse transcription polymerase chain reaction testing of respiratory panel done in QIAstatDx (Qiagen, Germany) using nasopharyngeal samples to identify the presence of influenza viruses and to determine the subtypes. A total of 547 patient’s data were analyzed in this study, with an influenza positivity rate of 15.62% in 2021 and 23.63% in 2022. We identified an exclusive circulation of influenza A/H3 viruses in 2022 while cocirculation of Influenza A (H1N1 pdm 09 – 10.15%, H3– 2.34%, A not subtyped – 2.34%) and influenza B (0.78%) was observed in 2021 in our cohort. Further, subtyping data showed that both Influenza A/H1N1 pdm09 and Influenza A/H3 was equally observed in influenza like illness (ILI) and severe acute respiratory infection (SARI) patients. This small study in our cohort warrants further elaborate investigation to know circulating influenza A subtyping in the country which may assist health care providers in making treatment decisions and hence, appropriate patient management. J MEDICINE 2023; 24: 37-42

Epidemiological Investigation of the 2019 Dengue Outbreak in Dhaka, Bangladesh.

Bangladesh experienced its largest dengue epidemic in 2019. Our objective was to investigate the epidemiological, clinical, and laboratory characteristics of the hospital-admitted dengue patients during this epidemic. This cross-sectional study was conducted among 369 adult dengue patients admitted to two tertiary care hospitals in Dhaka, Bangladesh, from June to September 2019. The disease severity was determined according to the WHO's 2009 classification. The average age of the patients was 33.3 (SD 14) years with a predominance of men. Almost 10% developed severe dengue (plasma leakage 67%, clinical bleeding 25%, and organ involvement 25%). Fever, headache, retro-orbital pain, diarrhea, and warning signs such as abdominal pain, clinical fluid accumulation, and persistent vomiting were the most common clinical presentations. Thrombocytopenia, leukopenia, elevated HCT levels, and ALT/AST were common laboratory findings. Severe dengue was mostly attributable to plasma leakage with warning signs, especially abdominal pain, clinical fluid accumulation, persistent vomiting, and altered hematological parameters which might assist in the early prediction of severe dengue.

Evaluation of Biological Variation of Different Clinical Laboratory Analytes in the Blood of Healthy Subjects.

Background Biological variation (BV) as a prognostic marker implies that each individual has a "subject mean"or central tendency, control level, or "set point"concentration for maintaining homeostasis regulation, which is influenced by factors such as genes, diet, exercise, and age. Uses for information on BV include determining the value of population-based reference intervals, assessing the importance of variation in serial findings, and establishing criteria for judging correct analysis. Aims We focused on the assessment of BVparameters for these elements as within-subject BV (CVW), between subject BV (CVG), the index of individuality (II), and the reference change value (RCV) of important biochemical analytes in the Bangladeshi adult population. Methodology This is a cross-sectional analytical study of a representative sample in the population of Bangladesh to determine BV in clinical laboratory analytes. For the study, 758 people were requested to take part; among those 730 (ages 18-65) apparently, healthy adults were blood donors, hospital staff, laboratory personnel, or any individuals who presented themselves for health screening at a tertiary hospital in Dhaka, Bangladesh. Results The CVW for blood sugar, creatinine, urea, uric acid, sodium, potassium, chloride, calcium, magnesium, and phosphate were calculated as 5.10 %, 4.64%, 10.72%, 5.71%, 0.69%, 4.35%, 0.75%, 3.69%, 4.57%, and 4.72%, respectively. The CVG for blood sugar, creatinine, urea, uric acid, sodium, potassium, chloride, calcium, magnesium, and phosphate was 10.70%, 21.46%, 31.47%, 23.52%, 1.95%, 9.74%, 2.56%, 4.64%, 9.96 %, and 17.45%, respectively. The index of individuality (II) for blood sugar, creatinine, urea, uric acid, sodium, potassium, chloride, calcium, magnesium, and phosphate were 0.48, 0.22, 0.34, 0.24, 0.35, 0.45, 0.29, 0.79, 0.46, and 0.27, respectively. The RCVfor blood sugar, creatinine, urea, uric acid, sodium, potassium, chloride, calcium, magnesium, and phosphate was 14.75%, 14.10%, 30.58%, 16.13%, 2.82%, 12.58%, 3.54%, 10.62%, 13.62 %, and 15.80%, respectively. Conclusions Nine serum biochemistry analytes (blood sugar, creatinine, urea, uric acid, sodium, potassium, chloride, magnesium, and phosphate) had low individuality, indicating that subject-based reference intervals are appropriate, only one analyte (calcium) had high individuality and, therefore, population-based reference intervals are more appropriate.

Demographic characteristics, clinical symptoms, biochemical markers and probability of occurrence of severe dengue: A multicenter hospital-based study in Bangladesh.

Establishing reliable early warning models for severe dengue cases is a high priority to facilitate triage in dengue-endemic areas and optimal use of limited resources. However, few studies have identified the complex interactive relationship between potential risk factors and severe dengue. This research aimed to assess the potential risk factors and detect their high-order combinative effects on severe dengue. A structured questionnaire was used to collect detailed dengue outbreak data from eight representative hospitals in Dhaka, Bangladesh, in 2019. Logistic regression and machine learning models were used to examine the complex effects of demographic characteristics, clinical symptoms, and biochemical markers on severe dengue. A total of 1,090 dengue cases (158 severe and 932 non-severe) were included in this study. Dyspnoea (Odds Ratio [OR] = 2.87, 95% Confidence Interval [CI]: 1.72 to 4.77), plasma leakage (OR = 3.61, 95% CI: 2.12 to 6.15), and hemorrhage (OR = 2.33, 95% CI: 1.46 to 3.73) were positively and significantly associated with the occurrence of severe dengue. Classification and regression tree models showed that the probability of occurrence of severe dengue cases ranged from 7% (age >12.5 years without plasma leakage) to 92.9% (age ≤12.5 years with dyspnoea and plasma leakage). The random forest model indicated that age was the most important factor in predicting severe dengue, followed by education, plasma leakage, platelet, and dyspnoea. The research provides new evidence to identify key risk factors contributing to severe dengue cases, which could be beneficial to clinical doctors to identify and predict the severity of dengue early.