Dhaka Hospital Research Articles

Comparison of Physical Growth Between Low Birth Weight and Normal Birth Weight Babies Aged Between 24-36 Months Born in a Selected Hospital of Dhaka, Bangladesh

This study investigates the physical growth disparities between Low Birth Weight (LBW) and Normal Birth Weight (NBW) babies aged 24-36 months in a selected hospital in Dhaka. The research sample comprised 200 babies, evenly split between LBW (birth weight < 2500 grams) and NBW (birth weight ≥ 2500 grams) groups. Physical growth parameters including weight, height and head circumference were measured and analyzed using descriptive statistics and comparative tests. The findings reveal significant differences in all measured parameters between LBW and NBW infants. LBW babies exhibited lower mean values in weight (11.5 kg vs. 13.0 kg), height (85.0 cm vs. 89.0 cm) and head circumference (48.0 cm vs. 49.0 cm) compared to NBW babies. Statistical analyses confirmed these differences to be significant (p < 0.05), highlighting the persistent impact of birth weight on early childhood growth. These results underscore the importance of targeted healthcare interventions for LBW infants to mitigate growth disparities and promote optimal development. Early childhood growth failure in LBW infants has long-term implications for health and developmental outcomes, necessitating comprehensive healthcare strategies that include nutritional support, growth monitoring and developmental assessments. By addressing these challenges, healthcare providers and policymakers can improve the long-term health and well-being of LBW infants, ensuring they have the opportunity to achieve their full developmental potential. This study contributes valuable insights to the field of maternal and child health in Bangladesh, guiding future research and healthcare initiatives aimed at supporting LBW infants and reducing health disparities.

Risk of Association of Placenta Praevia with History of Uterine Scar

Background: In Placenta Previa the placenta is implanted in the lower uterine segment in pregnancy with previous Caesarian Section there is risk of placenta being adherent with the scar, leading to devastating hemorrhage. The aim of this study was to find out the risk of association of placenta praevia with history of uterine scar. Methods: It was a hospital based observational cross-sectional study and was carried out in Department of Obstetrics and Gynecology. Dhaka Medical College and Hospital, Dhaka from May 2013 to October 2013. Total 50 patients were enrolled as diagnosed case of placental praevia. Patients clinical condition and course of management, perinatal outcome were observed, recorded & categorized Data were analyzed using computer with Statistical Package for Social Sciences (SPSS) software for Windows version 20. Results: This study shows commonest age group was 26-30 years, which included 46%, 36% belonged to 31-35 years age group. The average age was 29.80 years. Most (94%) of the patients were multigravida Maximum (54%) number of cases were admitted during the gestational period of 35-38 weeks. Common clinical presentations were anaemia (80%) and per vaginal bleeding (84%). Regarding management, 76% patients were managed actively and 24% patients were managed expectantly. It was observed that placenta praevia with uterine scar is seen more frequently (66%) in cases of previous caesarean sections. Among 30 patients, 84% were live births, 10% were still births and 6% were neonatal deaths. No maternal death was observed in this study. Conclusion: This study shows strong association between previous caesarean section, uterine curettage and hysterotomy and placenta praevia. Most of the patients were provided with active modality of management. Hence the study advocates the use of contraceptive, advanced antenatal care & early referral to hospital and expectant management of patients after proper selection to reduce the premature birth.

The Impact of Laparoscopic Treatment on Fertility Outcomes in Patients with Severe Endometriosis

Background: Endometriosis, a prevalent gynecological disorder affecting women of reproductive age, is a significant cause of infertility, especially in severe cases involving extensive adhesions, endometriomas, and deep infiltrating lesions. In Bangladesh, the delay in diagnosis and limited access to advanced treatments, including laparoscopic surgery, poses challenges to improving fertility outcomes for women with severe endometriosis. Objective: This study aimed to assess the impact of laparoscopic treatment on fertility outcomes in patients with severe endometriosis, particularly in a resource-limited healthcare setting in Bangladesh. Methods: This retrospective cohort study included 78 women with severe endometriosis from tertiary hospitals in Dhaka and Khulna, Bangladesh. All participants had previously experienced unsuccessful in vitro fertilization (IVF) attempts and subsequently underwent laparoscopic surgery between 2015 and 2024. Data collection involved reviewing primary and secondary data from these tertiary hospitals, including medical records and operative reports, and was supplemented by follow-up interviews for comprehensive analysis. Variables such as patient age, infertility duration, previous IVF cycles, operative findings, and postoperative fertility outcomes were analyzed using SPSS, with statistical significance set at P < .05. Results: The mean age of patients was 34.3 years, and the average duration of infertility was 52.9 months. Post-laparoscopic surgery, 42.3% (33/78) of women successfully delivered, with 7% achieving spontaneous conception. Younger age, fewer prior IVF cycles, and a normal uterine appearance on transvaginal ultrasound were significantly associated with improved fertility outcomes. Salpingectomy was more common among those who delivered (70%), though the removal of ovarian endometriomas did not significantly impact fertility success. Conclusion: Laparoscopic treatment significantly improves fertility outcomes in Bangladeshi women with severe endometriosis, even in a resource-limited setting. Age, normal ovarian function, and uterine appearance were key factors influencing reproductive success. These findings underscore the importance of timely surgical intervention for endometriosis-related infertility, highlighting the need for improved access to laparoscopic surgery in low-resource healthcare systems.

Point of care lactate for differentiating septic shock from hypovolemic shock in non-ICU settings: a prospective observational study

BackgroundSeptic shock and hypovolemic shock are life-threatening illnesses that necessitate immediate recognition and intervention, as they can result in deadly consequences. While the underlying processes may vary, both entities can exhibit hypotension and organ dysfunction. No studies have been conducted on bedside testing to differentiate between these illnesses. Lactate measurement has been established as a viable option for early detection of septic shock. However, its role in diagnosing hypovolemic shock has yet to be evaluated. The aim of the study was to investigate alterations in lactate levels among diarrheal patients with septic shock and hypovolemic shock following the administration of first fluid resuscitation. MethodsWe conducted a prospective observational study in critically ill diarrheal adults aged ≥18 years in the emergency ward in Dhaka Hospital of icddr,b from 21st October 2021 to 31st May 2023 (total 19 months). The enrollment process was operational between 8:30 AM and 5:00 PM. Diarrheal adults with a diagnosis of sepsis with shock featured with poor peripheral perfusion (characterized by cold periphery and weak or absent pulse and capillary refill time >3 sec) or hypotension (characterized by mean arterial pressure <65 mm-Hg) were enrolled as cases and consecutive diarrheal patients without any obvious features of sepsis with hypovolemic shock (due to severe dehydration) comprised the comparison group.POC lactate test was done at hours 0, 1st and 6th by StatStrip Lactate meters (Nova Biomedical, US) to all enrolled patients. For comparison of POC lactate levels, we used paired t-test for comparing the lactate samples drawn at hour 0, hour 1 and 6 with the septic shock and hypovolemic shock group. Odds ratio (OR) and their 95% confidence intervals (CIs) were used to demonstrate the strength of association. The study was registered at Clinicaltrials.gov (NCT05108467) and received institutional ethical approval (PR-21097). FindingsOf 435 patients, 135 had septic shock and 141 had hypovolemic shock, rest 41 patient responded with fluid bolus. 25% (34/135) of the people in the septic shock group died whereas there is no mortality in the hypovolemic shock group. The number of patients visiting from outside Dhaka city had more septic shock than from inside were higher in comparison with (55% vs. 28%; p <0.001). Statistically significant difference was observed between septic shock and hypovolemic shock group for a median POC lactate in 0, 1st and 6th hours with an OR of 1.07 (95% CI: 0.99, 1.17; p=0.039); 1.48, (95% CI: 1.28, 1.70; p<0.001) and 2.36 (95% CI: 1.85, 3.00; p<0.001), respectively. The gradient of 1st to 2nd sample between septic shock and hypovolemic shock was found to be significantly different (OR:0.74, 95% CI: 0.64, 0.85; p<0.001). InterpretationPOC lactate test can detect septic shock by differentiating hypovolemic shock in diarrheal patients. By providing quick, reliable and accurate result this test can help clinicians quickly diagnose and treat time-sensitive condition, like septic shock. FundingThe study was funded by Global Affairs of Canada (GR-01726). The donors had no role in the design, implementation, analysis, data interpretation or writing manuscript, or decision to publish. The corresponding author had access to all data and takes responsibility for the final approval and submission of the manuscript.

Assessing the Predictive Capabilities of Autoregressive Integrated Moving Average and Linear Regression Models for Acute Changes in Clinical and Selected Laboratory Parameters in Children After Cardiac Surgery in the ICU

(1) Background: The main objective of this research was to assess the clinical factors related to the condition of pediatric patients with congenital heart defects after they underwent intensive care unit surgery. The information was gathered from the Congenital Heart Disease Surgery Unit at the National Heart Foundation Hospital and Research Institute in Dhaka, Bangladesh. We gathered and examined data from 288 ICU patients. Patients under the age of twelve who required more than a 24-h ICU stay were selected. (2) Methods: The dependent and independent variables were chosen in advance based on expert opinion. The relationships between these pre-specified ICU parameters were determined using the Pearson correlation model and assessed through linear regression and ARIMA modeling to predict subsequent acute changes in the patients’ ICU statuses. (3) Results: A statistically significant relationship (p value &lt; 0.001) was found between CVP and BP (95% CI = 0.2113; 0.353 r = 0.2841249) and between PEEP and FiO2 (95% CI = 0.6992; 0.770 r = 0.7367744). Although the relationships between pH and PO2 were minor (95% CI = 0.161; 0.308 r = 0.2362575), they were statistically significant. The parameters considered statistically significant (p &lt; 0.001) were chosen for forecasting. In this work, the linear regression model and the ARIMA model used the parameters BP, FiO2, and PO2 for prediction. We forecasted the patients’ statuses for the next hour. It was found that the ARIMA model had a lower error rate than the linear regression model. (4) Conclusions: This study helps identify the important parameters for predicting and monitoring patients’ statuses in the ICU, with the ultimate goal of providing physicians with an early warning system to anticipate deterioration in clinical and biochemical parameters. The ability to accurately forecast future patients’ conditions can enable proactive, targeted interventions, potentially improving outcomes and reducing the risk of adverse events.

Socio-economic profile and prevalence of hypertension among type 2 newly diagnosed diabetes mellitus patients attending a tertiary hospital in Dhaka

Introduction: Untreated coexistence of hypertension and diabetes mellitus (DM) may result in more severe complications. The implementation of earlier intervention to prevent these complications can be facilitated by earlier identification of the conditions and their associated factors. Methods: This cross-sectional research was conducted at Sir Salimullah Medical College, Dhaka, between June 2020 and July 2021. Following the diagnosis of DM in the symptomatic patients, SPSS V 25 was utilized to collect socioeconomic history and blood pressure data for further analysis. Results : 271 (40 %) of the 542 diabetic patients were between 33 to 47 years of age. Most (332, 60.9%) were females. A majority of the patients (302.55.7%) belonged to lower socioeconomic classes, with incomes ranging from 1 thousand to 14 thousand taka. 253 patients (46.7%) had a familial predisposition to diabetes. Concurrent hypertension was observed in 193 (35.6%) diabetic patients; this was substantially correlated with advancing age, lower socioeconomic status, and higher body mass index (p&lt; 0.05). Result: Diabetic hypertensive patients were more prevalent among those with lower socioeconomic status, a demographic that is least likely to pursue and adhere to treatment. Therefore, it is necessary to develop and execute policies that guarantee their appropriate treatment and avert subsequent complications. Conclusion A significant percentage of the participants simultaneously presented with diabetes mellitus and hypertension, both of which are life-threatening conditions if left untreated. The majority of patients belonged to the lower socioeconomic class, which increases the likelihood of inadequate diagnosis and treatment. It is imperative to develop policies that facilitate their convenient access to healthcare services, thereby enabling them to obtain appropriate treatment and prevent any subsequent complications. J Shaheed Suhrawardy Med Coll 2023; 15(1): 55-58

Kawasaki Disease: A Single-Center Study from a Tertiary Care hospital in Dhaka, Bangladesh

Background: Kawasaki Disease (KD) is recognized as the leading cause of acquired heart disease in children in developed countries. This is a pioneer study from Bangabandhu Sheikh Mujib Medical University (BSMMU), documenting the common epidemiological, clinical, laboratory and echocardiographic findings, including management and immediate outcome of KD children. Method: This retrospective study includes all patients with a diagnosis of KD, who attended the pediatric rheumatology division at BSMMU from January 2015 to December 2019. Data were collected from medical records at diagnosis and immediately after management. Relevant statistical tests were done and a p value &lt; 0.05 was considered as statistically significant. Result: A total of 129 cases were diagnosed with KD, among them complete KD cases were 62% and incomplete KD was 38%. The mean age at onset was significantly higher in incomplete KD than complete KD. The majority of the cases (67%) were between 1 to 5 years of age and male (72%) children were predominant. Fever was the most common presenting feature (100%), followed by bilateral conjunctivitis, mucosal involvement, rash, changes in extremities, cervical lymphadenopathy and others. Coronary artery dilatation was present in 30.5% cases with no significant differences between complete and incomplete KD cases. Aspirin was given to all the cases and IVIG was given to only 46.6% children. Rests of the children were treated with methyl prednisolone. All the cases improved after treatment and there was no immediate mortality. Conclusion: It seems that KD is not an uncommon disease and incomplete KD cases are relatively more prevalent. About 30% KD cases had coronary artery abnormalities. Immediate outcome of management is excellent but needs long term follow-up. BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 9-16

Disclosure of true medical information: the case of Bangladesh

BackgroundTruth-telling in health care is about providing patients with accurate information about their diagnoses and prognoses to enable them to make decisions that can benefit their overall health. Physicians worldwide, especially in the United Kingdom (U.K.) and the United States (U.S.), openly share such medical information. Bangladesh, however, is a Muslim-majority society with different social norms than Western societies. Therefore, we examined whether Muslim culture supports truth disclosure for patients, particularly how and to what extent medical information about life-threatening diseases is provided to patients in Bangladesh.MethodsThis was a phenomenological qualitative study. We conducted thirty in-depth interviews with clinicians, nurses, patients and their relatives at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. We also used observations to explore interactions between patients, families and healthcare professionals regarding their involvement in medical decisions and truth disclosure issues. NVivo software was used to identify common themes, and a thematic analysis method was utilised to analyse the datasets.ResultsThis study identified three recurring themes relevant to the ethics and practice of truth disclosure: best interest rather than autonomy, the ambivalent value of deception and who understands what. The participants revealed that physicians often withhold fatal medical prognoses from terminally ill patients to ensure the best healthcare outcomes. The results indicate that deception towards patients is commonly accepted as a means of reducing burden and providing comfort. The participants opined that true medical information should be withheld from some patients, assuming that such disclosures may create a severe burden on them. Whether or to what extent medical information is disclosed primarily depends on a family’s wishes and preferences.ConclusionsWhile truth disclosure to patients is considered an ethical norm in many cultures, such as in the U.K. and the U.S., the practice of concealing or partially revealing severe medical prognoses to patients is an actual medical practice in Bangladeshi society. This study emphasises the importance of recognising a patient’s active involvement and respecting the cultural values that shape family involvement in medical decision-making. These findings may have significant policy and practical implications for promoting patient autonomy within Bangladeshi family dynamics and religious-based cultural values.

Incidence Pattern and Outcome of Diseases in Patients Admitted in Coronary Care Unit in a Tertiary Care Hospital in Dhaka - A 3 Year Retrospective Study

Background: Cardiovascular disease (CVD) is the leading causes of death globally. Like other countries, CVD prevalence is also rising among the adults in Bangladesh. Most of the cardiac emergencies and acute ailments are preferably managed in a specially designed place of a hospital called Coronary Care Unit, which has better facilities of monitoring, care and support. In every day-to-day practice a proportion of diabetic patients need to admit in CCU for different life threatening crisis. For better understanding of such CVD prevalence scenario, we conducted this retrospective observational study. Aim of the Study: Our objective was to assess the pattern and incidence of CVD admitted in CCU with their outcomes among the population using the data from the record book. Methodology: This is a retrospective observational study carried out in the Coronary Care Unit (CCU) of BIRDEM Hospital Dhaka Bangladesh from 2017-2019. Total 1069 patients (861 were Diabetic and rest were non diabetic) who were admitted to the CCU of this Institute from 2017-2019 were studied and evaluated to see the pattern of cardiac emergencies in diabetic population. Results: Among 1069 patients, 57.2% were male and 42.8% were female. Majority (80.54%) of them were diabetic. Most of the patients belonged to age 50 years and above. Seven hundred and one (65.57%) patients were admitted due to Ischemic Heart Disease (IHD) in different forms. Among the Acute Coronary Syndrome, most prevalent one was NSTEMI (354). Among NSTEMI group, where 50.37% were male and 50.67% were female, 102 patients had Unstable Angina and 73 had STEMI. Eighty nine patients were admitted after intervention (PCI or CABG) and 61 patients had Ischemic Dilated Cardiomyopathy (IDCM) due to some complications. Four hundred and twenty patients admitted due to Heart Failure and 137 patients were admitted due to different forms of Shock. Cardiac function was assessed (by Teichholz method and Biplane Simpson's method) among the admitted patients and 57.31% of patients had moderate LV dysfunction, 29.26% had severe systolic dysfunction and remainder 13.43% found to have mild LV systolic dysfunction. Mean hospital stay was assessed and it was found to be gradually declining from 13.33 in 2017 to 9.23 in 2019 (p=0.041*). Outcome of the study population shows that ~ 66% were transfer to general ward or cabin of the department of cardiology after initial stabilization, 17.3% were discharged directly from CCU, and 5.42% patients were transferred to other department after recovery. About 5.5% were become critically ill for which they need to transfer under care of ICU, 2.5% were transfer for intervention (to other institutes according to patient’s economical ability and preference for CABG, Pace maker implantation, PTCI etc.) and 3.3% patients were expired. Conclusion: In this study, incidence of IHD found higher than other cardiac diseases. NSTEMI is about three times more than Unstable Angina and about five times more prevalent than STEMI for the reason of admission in CCU. Diabetes Mellitus was found in majority of the admitted patients in CCU and the number of diabetic population is increasing which may also responsible for leading more coronary heart disease in our country in future. 88.7% of study population was shifted to general ward after initial stabilization after acute crisis, 2.5% required further cardiac intervention and 5.5% become critical and required ICU support. Only 3.3% of total population expired after all possible support. Bangladesh Crit Care J September 2024; 12 (2): 125-131

Study of Association of PPH due to Uterine Atonicity and Serum Calcium levels

Background: Uterine atonicity stands out as a primary and leading factor contributing to maternal morbidity and mortality. Postpartum hemorrhage (PPH) resulting from uterine atony poses a life-threatening risk. Oxytocic drugs, by elevating intracellular calcium, enhance uterine tonicity, with optimal calcium levels playing a crucial role in facilitating effective uterine contractions. The study aimed to explore the relationship between the concentration of calcium in the bloodstream and the occurrence of PPH associated with inadequate uterine contractions admitted during the 1st and 2nd stages of labour at a tertiary care facility such as the Combined Military Hospital in Dhaka. The study likely involved analyzing data to identify any patterns or connections between serum calcium levels and the incidence of uterine atony-related PPH. Methods: The study follows a randomizing controlled trial (RCT) design within the Department of Obstetrics and Gynecology at Combined Military Hospital, Dhaka. The study duration spans from January 2016 to January 2019, involving a total of 306 subjects. Group A includes those with serum calcium levels between 8-10.4 mg/dl without uterine atonicity, while Group B comprises individuals with serum calcium levels below 8 mg/dl experiencing uterine atonicity, either post cesarean or vaginal delivery. Atonicity features include a soft, distended uterus with a lack of muscle tone. Results: A total of 306 patients were included in the study, with 153 having serum calcium levels exceeding 8 mg/dl and another 153 having levels below 8 mg/dl. Among women with serum calcium levels below 8 mg/dl, 37 patients experienced uterine atonicity. In contrast, it was observed that among women with serum calcium levels exceeding 8 mg/dl, only one patient experienced uterine atonicity. This highlights a potential association between higher serum calcium levels and a reduced likelihood of developing uterine atony in the studied population. Conclusions: The study findings indicate a strong association between low calcium levels and reduced uterine tonicity, establishing low calcium as a significant risk factor for uterine atony. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 28-34

Clinico-Radiological Outcome of Percutaneous Vertebroplasty in Dorso-Lumbar Osteoporotic Vertebral Compression Fractures (OVCFs)

Introduction: Vertebral compression fractures (VCFs) are the most common complication of osteoporosis where Percutaneous vertebroplasty is thought to immediately improve the pain and disability status via stabilization and reinforcement of the fractured body with polymethylmethacrylate (PMMA) injection. Purpose: To evaluate the clinical and radiological outcome of Percutaneous vertebroplasty in osteoporotic VCFs in Dorso-Lumbar (DL) Spine. Materials and methods: It is a prospective study carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU) and different private hospitals in Dhaka, from January 2010 to March 2023. Total number of patients was 121 i.e., 92 female 29 male patients (167 treated vertebrae), age ranged from 65-85 years with mean age 73.40 years. 10 cases at D10 and D11 each, 26 cases at D12, 21 cases at L1, 15 cases at L2, 16 cases at D12-L1, 03 case at D9,12, 05 cases at D10,11, 07 cases at L1,2 and 03 case at D9,12L1 and 05 cases at D12,L1,2. Follow up ranged from 24 to 36 months and outcome assessed regarding neurological status (Radiculopathy and Myelopathy), pain [Visual Analogue Score (VAS)] and disability [Oswestry Disability Index (ODI) questionnaire]. Radiological assessment of the treated spine was done to identify any vertebral height gain (McKiernan method), kyphosis correction (Cobb`s method). Results: The mean age was 73.40 ± 03.75 years. 74(60.97%) patients were in 65-74 years age group. 105(63.41%) cases had single vertebral level, 49(29.26%) with 02 levels and 12(07.32%) with 03 levels involvement. D12 (n=53, 31.17%) and L1 (n=52, 31.13%) were most frequent. The age, sex, occupation, and the level of involvement had no significant difference (p&gt;0.05, chi-squared test). VAS for pain had significantly improvement (p&lt;0.05, paired t test) from preoperative 08.50±0.50 to 03.50±0.30 postoperatively and 02.80± 0.50 at 1 year. The preoperative ODI 71.11±09.69 improved significantly (p&lt;0.05, paired t test) to 17.34±04.11 postoperatively and 09.76± 04.83% at 1 year. The kyphotic angle was corrected to 05°±02.50° at the 12 months follow up radiograph. One level (02.30%) had cement leakage which was evident on postoperative X-ray but was asymptomatic even on the last follow up. Conclusion: Percutaneous Vertebroplasty is a significantly effective technique for immediate and short-term pain relief, disability status improvement in Vertebral Compression Fractures (VCFs) with satisfactory radiological outcome in DL spine.

Improving Post-discharge Weight Gain Among Neonates received Kangaroo Mother Care: Two Years Experience of a Tertiary Care Hospital in Dhaka, Bangladesh

Background: “Kangaroo Mother Care” is an effective alternative care strategy for preterm and low birth weight babies. It also causes substantial reduction of neonatal mortality due to hypothermia. Objective: To observe the status of ongoing kangaroo mother care service in a tertiary care hospital and its outcome. Material and method: This retrospective study was carried out over the period of 1st July 2020 to 30th June 2022. Newborns who received kangaroo mother care in neonatal intensive care unit and postnatal ward of Bangabandhu Sheikh Mujib Medical University, Dhaka during the study period, were enrolled in this study. Results: A total of 384 (97% of eligible candidates) newborn received kangaroo mother care. Kangaroo mother care was provided both in Neonatal intensive care unit (86% of total admission) and also in the postnatal ward. Mean gestational age was 32.02+2.85 weeks (28 weeks-41 weeks) and mean weight of starting KMC was 1367.48 g (730 g – 1970 g). Average age of initiating KMC was 6 days (ranging from 1 to 13 days of age). Mean duration of providing KMC was 6 hours and 50 minutes. More than two third (74.4%) patients came for follow up. During each follow up, an increasing trend was observed regarding weight gain and mean weight gain was 15.9+1.2 g/ kg/day. Conclusion: Kangaroo mother care was provided to most of the eligible patients and persistent weight gain was observed among all KMC candidates after discharge.

Association between Exposure to Smokeless Tobacco Consumption and Carcinoma of Cervix

Background: Cervical cancer is the most destabilizing cancer that grows increasingly prevalent worldwide. The Southeast Asia region has the greatest incidence and mortality rates due to widespread use of smokeless tobacco (SLT) products, a lack of screening programmes, and immunization against cervical cancer. Objective: To assess the association between smokeless tobacco consumption and carcinoma of cervix. Methodology: A case-control study was conducted with 272 women aged 18-49 years, conveniently selected from both outpatient and inpatient settings at the National Institute of Cancer Research and Hospital (NICRH) in Dhaka, Bangladesh. The selection of NICRH was purposive. Participants underwent interviews using a pre-tested, semi-structured questionnaire between January and December 2019. Results: The mean age of cases was 49.8±8.8 years, while the mean age of controls was 48.5±9.3 years. In comparison to controls (52.2%), the majority of patients (65.4%) consumed SLT throughout their entire lives. A significant relationship was found between SLT use and the development of cervical cancer (p&lt;0.05). Those who have consumed any SLT in their lives are 1.7 times more likely to develop cervical cancer than those who have not taken any SLT. Cases (22.8%) used betel quid with jorda &gt;5 times, compared to controls (14.7%), and intensity of Gul used ≤5 among cases (9.6%) than controls (2.9%). Compared to controls (56.3%), the majority of cases (76.4%) had been using SLT for more than 10 years, with a statistically significant difference (p&lt;0.05). Cases used SLT for a longer time (19.2±10.3) compared to controls (15.6±11.1), with a significant association (p&lt;0.05). Conclusion: The study revealed a significant association between the risk of cervical cancer and the extent and duration of exposure to SLT. To minimize the risk of cervical cancer, contemplate restricting SLT production and utilization. Journal of Monno Medical College June, 2024; 10 (1):17-22

Chronic kidney disease and risk factors among Type 2 Diabetic patients in selected hospitals in Dhaka, Bangladesh

Chronic kidney disease (CKD) may be defined as abnormalities of kidney function or structure present for more than 3 months. Around 10% of people worldwide have CKD. The data about chronic kidney disease among diabetics in Bangladesh is inadequate, and very few studies have been done on specific populations, i.e., male or female. Thus, the study aims to determine the prevalence of CKD and its risk factors among diabetic patients in selected hospitals in Dhaka city. The specific objectives of the study were to assess the participants through physical and laboratory evaluations, categorize them into the different stages of CKD, analyze their socio-demographic characteristics, and determine the association between CKD and various risk factors. This is a cross-sectional study. The study population consisted of different outpatient diagnostic centers and outpatient and indoor patients of Shaheed Suhrawardy Medical College and Hospital. The sample size of the study is 369. The Modification of Diet in Renal Disease equation was used to calculate eGFR. This study revealed that in Dhaka, 18.2% of Type 2 Diabetic patients had CKD. Most of the participants were between 46 and 65years old. Most of the CKD patients had a low education level and a lower family income. Having diabetes for more than 3 years and hypertension for more than 5 years were associated with a higher risk of developing CKD, especially among individuals who consumed added salt in their diet.

The Prevalence Pediatric Patients Attending in A Tertiary care Hospital in Dhaka, Bangladesh

Introduction The incidence of skin conditions in young people typically varies between nations and within a single nation’s regions based on social, economic, racial, and environmental factors. A significant public health issue is the morbidity that skin diseases cause in children. There is a dearth of research on this pediatric issue in our nation, which is either centered on a condition, a community, or a particular population group. Objective To evaluate the dermatological complaints of the pediatric patients attending a dermatology outpatient department in a tertiary care hospital. Materials And Methods We retrospectively analyzed a total of 2472 pediatric patients who were in age range 0-18 years and came to the OPD of dermatology &amp; venereology department of Ibn Sina Medical College Hospital, Dhaka, Bangladesh, over a period of 1½ year from January, 2020 to June, 2021. Data were collected on special proforma and analyzed with appropriate method. Results Among 2472 patients 1157 (46.8%) were male and 1315 (53.2%) were female and most of the patients belonged to the age group 12-18 year (52.6%). Male female ratio was 0.88:1. All diseases were broadly classified into noninfectious (71.2%) and infectious dermatoses (28.8%). Dermatitis (38.9%), infections (28.8%) and acne (14.44%) came out to be the top most common cause for OPD attendances. For the specific skin diseases, 20.1% were atopic dermatitis, 14.44% were acne, and 11.8 % were fungal infections. Atopic dermatitis was the most common condition below 12 years of age. In 12-18 years of age group, the most common condition was acne; females were more affected than males. Among the viral infections, wart was the most common (22.1%). Conclusion Atopic dermatitis was found to be the most common noninfectious disease and fungal infection was the most common infectious disease in all age groups and genders. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1054-1059

Response Of Radiation Therapy Between 30 Gy In 10 Fractions Versus 20 Gy In 5 Fractions In The Management Of Bony Metastasis

Background: Bone metastases are a common complication of advanced-stage cancers, particularly affecting patients with lung, breast, and prostate cancers. Palliative radiotherapy is a primary modality used to alleviate pain and improve quality of life. This study aimed to compare the efficacy and toxicity of two radiotherapy fractionation schedules—20 Gy in 5 fractions versus 30 Gy in 10 fractions—in managing bone metastases in a resource-limited setting. Methods: This prospective, quasi-experimental study was conducted at the National Institute of Cancer Research and Hospital in Dhaka, Bangladesh, from July 2014 to December 2014. A total of 60 patients were divided into two arms: Arm A received 20 Gy in 5 fractions, and Arm B received 30 Gy in 10 fractions. Radiological and laboratory investigations were conducted pre- and post-treatment, and toxicity was monitored. Patient responses were assessed using RECIST version 2.0 criteria. Results: Complete response was achieved in 60.00% of Arm A patients and 66.67% of Arm B patients. Partial responses were observed in 36.67% of patients in Arm A and 33.33% in Arm B. Genitourinary toxicity was significantly higher in Arm A (p = 0.003), while skin toxicity resolved in all patients after 3 months. SGPT levels were significantly higher in Arm B both after 1 month (p = 0.001) and 3 months (p = 0.001). Conclusion: Both fractionation schedules were effective in managing bone metastases, with comparable pain relief and response rates. However, toxicity profiles differed, highlighting the importance of individualized treatment planning, especially in resource-limited settings.

Trends in Antimicrobial Resistance of Uropathogens Isolated from Urinary Tract Infections in a Tertiary Care Hospital in Dhaka, Bangladesh.

Background/Objectives: Urinary tract infection (UTI) is a prevalent microbial infection in medical practise, leading to significant patient morbidity and increased treatment costs, particularly in developing countries. This retrospective study, conducted at a tertiary care hospital in Dhaka, Bangladesh, aims to examine the antimicrobial resistance (AMR) patterns of uropathogens and evaluate whether these patterns are influenced by demographic factors such as gender, age, or patient status. Methods: Standard microbiological techniques were used to identify uropathogens, and AMR patterns were determined using the Kirby-Bauer disc diffusion method. Results: Out of 6549 urine samples, 1001 cultures were positive. The infection was more prevalent in females compared to males. The incidence of UTIs in children aged 0-10 years accounted for 12.59% of the total cases, with this age group also exhibiting the highest rate of polymicrobial infections. Among the bacterial uropathogens, 71.19% of isolates were multidrug resistant (MDR) and 84.27% were resistant to at least one antibiotic. Escherichia coli (n = 544, 73.90% MDR) and Klebsiella species (n = 143, 48.95% MDR) were the most common Gram-negative uropathogens, while Enterococcus species (n = 78, 94.87% MDR) was the predominant Gram-positive isolate in this study. Our results indicate that most uropathogens showed resistance against ceftazidime, followed by cefuroxime, trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, and netilmicin. Moderate levels of resistance were observed against ciprofloxacin, levofloxacin, aztreonam, and cefpodoxime. Conclusions: Amikacin was observed to be effective against Gram-negative uropathogens, whereas cefixime was more active against Gram-positive microorganisms, such as Enterococcus species. Moreover, a principal coordinate analysis (PCoA) depicted no significant influence of gender, patient status, or age on AMR patterns. For the continued usefulness of most antibiotics, periodic analysis of the AMR patterns of uropathogens can help assess the rise of MDR bacteria, and therefore guide the selection of appropriate antibiotic treatment strategies.

Role of physical activity for glycemic control among patients with type 2 diabetes mellitus

Background: Lifestyle modification and physical activity are very important parts of diabetes management. Regular physical activity has been shown to improve glycemic control through increased insulin sensitivity and glucose tolerance. The aims of this study were to assess the glycemic level and pattern of physical activity among type 2 diabetic patients. Methods: This hospital-based cross-sectional study was carried out from July 2022 to October 2022 among 305 purposively recruited diabetic patients who came to receive care at the outpatient department of a teaching hospital in Dhaka, Bangladesh. A semi-structured questionnaire was used to describe socio-demographic information. Physical activity was assessed using the validated version of international physical activity questionnaire short form/ global physical activity questionnaire (IPAQ/GPAQ). Glycemic control was measured by HbA1C report done within 120 days of the interview. Blood pressure and body mass index were also measured at the time of inclusion. The physical activity level was categorized according to IPAQ scoring protocol as high level, moderate level and low level. Chi square test was carried out to determine the association of physical activity with type-2 DM, body mass index, glycemic and blood pressure control. Statistical significance was defined as p&lt;0.05. Results: Among the participants only 0.3% had high level of physical activity. Moderate level of physical activity was found among 32.8% and low level of physical activity has been found among 66.9%. Among the participants 92.1% spent their time sitting during the weekdays while the time spent at home, at work, while doing course or class and during leisure activities. Among them 21% had the maximum 10 hours sitting time during the last week. The study showed that the persons who spent walking on at least 7 days has negative correlation with blood glycemic level and among them who spent time on sitting has positive correlation with blood glycemic level. Nearly two thirds of the respondents were female. The mean age was 53.09 ± 12.15 years. Majority of the participants were from urban area (69.83%) and the rest are from rural (21.31%) and sub urban (8.2%) area. There was no significant relation of level physical activity with any sociodemographic factors except monthly income, which showed low monthly income was associated with higher level of physical activity. Conclusion: The findings of our study focus on developing more awareness and providing facilities for physical activity to achieve the glycemic goal. BIRDEM Med J 2024; 14(3): 143-150

Health-Related Quality of Life among Elderly Patients in Urban Bangladesh: A Cross-Sectional Study.

Quality of life (QoL) focuses on a person's ability to live a fulfilling life. It helps in determining successful aging in the elderly population. Because of a scarcity of information regarding predictors of QoL in the elderly population in developing countries, this study was undertaken to assess the overall QoL and its predictors in the elderly population in an urban setting of Bangladesh. In this cross-sectional study, 275 participants were enrolled by systematic sampling at the outpatient department of a tertiary care hospital in Dhaka, Bangladesh. Data were collected by using a pretested semi-structured standard questionnaire for QoL (OPQOL-35). Pearson's correlation was used to assess the association between QoL and sociodemographic factors. Multivariate linear regression was conducted to identify predictors of QoL, after controlling for potential confounders. The median age of the participants (n = 275) was 65 years (range, 60 to 85; 25th and 75th percentile, 60 and 68, respectively). The majority (78%) of them were married, and 20% were widowed or divorced. The median score of QoL was 113 (25th and 75th percentile, 101 and 124, respectively). Most of the participants had very poor (bad as can be) or poor (bad) QoL. Only 7.3% were observed to have "good" QoL (scores 140 or more). Females had significantly poorer QoL scores compared to males (p < 0.001). Age, gender, educational status, smoking, and sleep duration significantly predicted QoL in a multiple regression analysis. In conclusion, the QoL of the elderly individuals in Bangladesh was very poor or poor. Future research should focus on service-oriented interventions, especially targeting women. Counseling elderly people to enhance their quality of life may include improving sleep patterns, healthy diets, regular exercise, and caring for their mental health.

Predictors and Outcome of Surgical Repair of Obstetric Fistula at a Private Hospital of Dhaka City

Background: Obstetric fistula remains a significant public health issue in low-resource settings, with high prevalence in countries like Bangladesh. The condition often results from prolonged, obstructed labor, compounded by socio-cultural factors such as early marriage, financial constraints, and lack of access to skilled birth attendants. This study aimed to explore the socio-demographic characteristics and surgical outcomes of women undergoing fistula repair at a private hospital in Dhaka, Bangladesh. Methods: This observational descriptive study included 62 women who underwent obstetric fistula repair between September 2010 and September 2012. Data were collected on socio-demographic characteristics, fistula details, and surgical outcomes through a structured booklet completed at various stages of patient care. Surgical success, complications, and post-operative outcomes were analyzed to identify factors influencing recovery and success rates. Result: The study found that 100% of participants were married at an early age, with significant financial barriers reported by all. A majority (87.10%) had home deliveries attended by unskilled birth attendants. Surgical repair was successful in 88.71% of cases, with a small proportion (11.29%) of unsuccessful repairs. Residual stress incontinence was noted in 4.84% of participants. The mean hospital stay was 17.52 days, with 95.16% of participants requiring continuous catheterization for 7 to 10 days. Conclusion: The high success rate of surgical repairs is promising, but the persistence of socio-cultural barriers and residual complications highlights the need for improved access to maternal healthcare and enhanced post-operative care. Addressing these issues is critical for reducing the burden of obstetric fistula and improving outcomes for affected women.