Shaheed Suhrawardy Medical College Research Articles

Outcome of Transanal suture haemorrhoidopexy and Stapled haemorrhoidopexy -A prospective observational study

Background: Transanal suture haemorrhoidopexy is the preferred treatment due to its low cost, less post operative complication and decreased chance of recurrence in grade II and grade III Hemorrhoids. Objective: To compare the post-operative outcome of transanal suture haemorrhoidopexy and stapled haemorrhoidopexy in patients with grade II and III haemorrhoids. Methods: This study was conducted in the Department of Colorectal Surgery, Shaheed Suhrawardy Medical College hospital over a period of one-year. Sixty-two patients with haemorrhoids were enrolled in this study according to selection criteria. Data were collected, compiled and tabulated according to key variables. Qualitative data were expressed as frequency with percentage and quantitative data as mean with standard deviation. Quantitative data were analyzed by student’s t-test and qualitative data by Chi-square test. Data were processed and analyzed by using software SPSS 22.0. For all analyses p-value <0.05 was considered statistically significant. Result: Mean age of the patients was 49.38 ± 7.17 years and 52.45 ± 6.17 years in Stapled hemorrhoidopexy and Trans anal suture hemorrhoidopexy group respectively (p>0.05). Males were predominant in both the two groups. In stapled hemorrhoidopexy group, grade of hemorrhoids was II (51.6%) and III (48.4%) whereas in Transanal suture hemorrhoidopexy group, grade of hemorrhoids was II (38.7%) and III (61.3%) (p>0.05). Operative time was lower in Stapled hemorrhoidopexy (26.93 ± 1.59 min) than Transanal suture hemorrhoidopexy (27.74 ± 1.63 min). Per operative bleeding was found more in stapled group. Most of the patients stayed in the hospital only one day in both the two groups. Only four patients in Stapled hemorrhoidopexy group and one patient in Transanal suture hemorrhoidopexy group stayed more than one day. Post-operative pain according to VAS was lower in Stapled hemorrhoidopexy group (1.90 ± 0.54) than Transanal suture hemorrhoidopexy group (2.09 ± 0.30) after 24 hours of the surgery. But there was no significant difference in pain after 7 days of surgery between the two groups. Post-operative complications were more in stapled hemorrhoidopexy than Trans anal suture hemorrhoidopexy, but not statistically significant. Recurrence (bleeding & prolapse) found more in stapled group than suture hemorrhoidopexy group. Treatment cost was significantly lower in trans anal suture hemorrhoidopexy. Conclusion: Based on this study, transanal suture hemorrhoidopexy showed less intra and post-operative hemorrhage, shorter duration of hospital stay, lower post-operative complications, and lower recurrence rate when compared to stapled hemorrhoidopexy. However, these differences were not statistically significant. The only statistically significant difference was in the operative cost, which was in favor of transanal suture hemorrhoidopexy. J Shaheed Suhrawardy Med Coll 2023; 15(1): 45-49

Comparative Study of Olmesartan versus Telmisartan, in Patient with Stage I Hypertension

Background: Hypertension is one of the most common diseases in the world. It is defined as sustained increase in blood pressure ≥ 140/90 mmHg. The risk of both microvascular & microvascular complications including stroke, coronary artery disease, peripheral vascular disease, retinopathy, nephropathy & possibly neuropathy increases with hypertension. Olmesartan medoxomil is a non-peptide angiotensin II receptor antagonist. The drug acts by selectively blocking angiotensin II type 1 receptor. Telmisartan is angiotensin receptor blocker shows high affinity for the angiotensin II type 1 receptors. Objective of the study is to compare the efficacy of Olmesartan and Telmisartan in Patient with stage –I hypertension. Materials and methods: This was a randomized, open‑label, parallel‑group, comparative study conducted in 120 patients of Stage I hypertension carried out from January 2021to June 2022. Patients were recruited from the cardiology outpatient department (OPD) of Shaheed Suhrawardy Medical College hospital.Results: In olmesartan group there were 39 male and 21 female patients and in telmisartan group there were 36 male and 24 female patients. Both Olmesartan and Telmisartan are effective in lowering systolic & diastolic BP at different intervals of 2nd, 4th, 8th and 12th week. There was a statistically significant decrease in mean blood glucose level after 12 weeks of treatment in telmisartan group when compared to baseline. Serum total cholesterol, triglycerides, and low‑density lipoproteins decreased significantly after 12‑week treatment with olmesartan and telmisartan. Conclusion: Olmesartan and telmisartan are equally efficacious in reducing DBP. Olmesartan, when compared to telmisartan is more efficacious in reducing SBP. Whereas Telmisartan shows the most favorable effects on FBG and lipid profile. J Shaheed Suhrawardy Med Coll 2023; 15(1): 8-12

Pancreaticogastrostomy: A Safe and Effective Reconstruction Method After Pancreaticoduodenectomy: A Short Observational Study

Background: Pancreaticoduodenal resection is usually performed in patients with a localised small carcinoma in the head of the pancreas, at the lower end of the common bile duct or at the ampulla and occasionally for chronic pancreatitis.The mortality following pancreaticoduodenal resection has fallen and is now below 5% 1-6 .However, leakage from the anastomosis between pancreas and the jejunum has been and remains, one of the most worrying complications of the operation. The data from papers published in the last 8 years show that the incidence of pancreatic leak is 14% and the mortality of this complication 24%3,4,6-16 .Pancreaticogastrostomy is a potentially safer alternative to pancreaticojejunostomy in the reconstruction following Whipple's operation. Aim: The aim of the study was to observe pancreaticogastrostomy is a potentially safer alternative to pancreaticojejunostomy after pancreaticoduodenectomy. Methods: This prospective observational study was conducted at the Department of Surgery in Shaheed Suhrawardy Medical College Hospital, for One year (August 2021 to July 2022). Patients with a localised small carcinoma in the head of the pancreas, at the lower end of the common bile duct or at the ampulla, and occasionally for chronic pancreatitis admitted in the department of surgery were approached for inclusion in the study. Total 41 patients were selected according to inclusion and exclusion criteria. Informed written consent was taken from each patient. All patients underwent pancreaticogastrostomy. Detail clinical and demographic history was taken along with thorough physical examination relevant investigations. All patients were evaluated preoperatively and post operatively at discharge, 1 month and 3 months. Outcome was assessed post operatively. Collected data were checked and analysed in SPSS 23. Results: Two patients died within 30 days of the operation (mortality 4.9%), one from perioperative haemorrhage and another from septicaemia due to a biliary infection, which may have resulted from preoperative transhepatic biliary drainage. Both operations were carried out for carcinoma of the head of the pancreas. One patient developed a biliary leak which closed in 6 days. A postoperative pancreatic leak occurred in one patient with carcinoma of the ampulla; the fistula closed after 5 mdays, and did not delay his discharge from hospital. This patient remains well 36 months after operation, although he has now developed mild diabetes.One other patient developed diabetes mellitus postoperatively. This woman had evidence of obstructive pancreatitis at operation. She died 6 months later of recurrent carcinoma of the head of the pancreas. One patient with chronic pancreatitis has uncontrolled steatorrhoea, with up to four bowel movements a day. Four other patients take regular pancreatic supplements together with H2 receptor antagonists in order to maintain normal defaecation. There has been no case of stomal ulceration. None of the patients were lost to follow-up. The median survival for patients operated on for carcinoma of the head of the pancreas was 13 months, and for patients with carcinoma of the bile duct, 14 months. Median survival of patients with ampullary carcinoma was 38 months. Conclusion: Seventy two percent of patients had good outcome after Pancreaticogastrostomy(PG). Significant relief in symptoms of pain were noted after PG. Further larger study is recommended to validate this findings. J Shaheed Suhrawardy Med Coll 2023; 15(1): 66-72

Association of Dairy Foods in Acne Vulgaris

Background: Acne vulgaris is one of the most commonly found skin problems affecting teenagers and adolescents. Dietary foods particularly dairy products consist of milk or any of its food made from milk are frequently regarded by patients and clinicians as a cause or aggravator of acne. As there are very limited studies found on this regard, this study was aimed to find the association of dairy foods in acne vulgaris. Methods: This wasa cross-sectional analytical study and was carried out in the Dermatology and Venereology department of Shaheed Suhrawardy Medical College Hospital. Total 260 patients were selected by appropriate inclusion criteria equally into two groups: Group A (diagnosed with acne vulgaris, n=130) and group B (patients not having acne vulgaris, n=130). A thorough history of every patient and face to face interview was taken by a predesigned questionnaire after getting the written informed consent of the patient. Data were collected in predetermined data collection form. Result were subjected to standard statistical evaluation and were analyzed by SPSS-24. Results: According to the age group, majority of the acne patients were between 10-20 years (75.4% in group A and 63.8% in group B, p<0.05), though mean age in both groups were statistically similar (18.53±5.78 and 17.29±4.59 years, respectively). Also, female respondents were predominant in both groups (80.8% and 72.3%). The risk was increased in those with a family history of acne in siblings (OR2.449, p=0.021;95% CI,1.145-5.238) and the risk was reduced in subjects doing physical exercise. Papules (35.4%) and comedones (27.7%) were most common lesion and mostly found in forehead (74.6%) and left (68.5%) and right (63.1%) cheeks. According to global acne severity grading, majority had mild form of acne (83.1%) and use of cosmetics (43.8% vs. 30%), topical steroid (34.6% vs. 16.9%), taking fastfood (24.6% vs. 14.6%) and less water intake (36.9% vs. 18.5%) also significantly higher among acne patients. Multivariate regression analysis showed, dairy products such as whole milk (OR 1.984, p=0.022), chocolate (2.490, p=0.004), chips (OR 3.207, p<0.001), Pizza (OR 2.388, p=0.021) and red meat (OR 3.055, p=0.009) were significant risk for developing acne vulgaris. Also, whole milk (3.050, p=0.01), chocolate (3.817, p=0.004) and pizza (3.822, p=0.005) were independent risk factors for moderate to severe acne. Conclusion: This study found an association between high dairy product consumption and acne in adolescents, indicating that dairy consumption may be a contributing factor for developing acne vulgaris. J Shaheed Suhrawardy Med Coll 2022; 14(2): 25-33

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.

Nursing stress and associated factors during covid-19 pandemic: findings of a cross-sectional study at tertiary hospitals in Bangladesh

Background: The COVID-19 epidemic has posed an unparalleled obstacle to healthcare systems worldwide. Particularly in the pandemic period, nursing is seen as a demanding profession with high standards. This study was conducted to assess the level of nursing stress and to identify the factors related to high nursing stress among nurses working in dedicated COVID-19 hospitals. Methods: The cross-sectional study was conducted from selected three dedicated COVID-19 public hospitals in Dhaka city of Bangladesh named Dhaka Medical College Hospital, Shaheed Suhrawardy Medical College, and Hospital, Dhaka North City Corporation dedicated COVID-19 hospital from 1st July 2021 to 30th June 2022. Total respondents were 368 who had working experience more than 6 months in above mentioned hospitals. Data were collected by face-to-face interview through pre-tested semi-structured questionnaire. Nursing stress was assessed by Nursing Stress Scale (NSS) and categorized as low (≤39), moderate (40-62), and high (>62) stress score. Data analysis was carried out by using SPSS version 26. Results: The mean age of the respondents was 30.8±7.8 years, wherein highest number of respondents were in age group 20-30 years (50.3%). Among the respondents 86.7% were female, 83.4% were married and average monthly family income Tk. 53839±28587.7 taka. About 63% respondents had diploma degrees, 77.4% worked in different wards, and mean working hour per week was 51.9±5.6 hour. Overall, maximum 52.2% had moderate stress, while 39.4% had high stress and only 8.4% had low stress. Age >30 years, male, marital status, working place, having senior citizen (>60 years) and feeling stressed for isolation were the significant risk factors for having high stress level. Conclusion: Occupational health education, training programs, stress relieving programs, and motivational programs must be implemented in tertiary level hospitals. Special attention should be given on older aged married male nurses, having elderly family members and feeling stressed for isolation. JOPSOM 2023; 42(1):54-61

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.

Level of Knowledge of Medical Practitioner of Diagnosing and Managing Swallowing Difficulties in Hospitalized Setting of Dhaka City

Aim: To have a clear idea and explore the existing practice of medical practitioner about the proper diagnostic system and management of patient with adult dysphagia in a hospitalized setting. Materials and Methods: This is a quantitative type of cross sectional survey study where 60 samples were assigned purposively from in Dhaka Medical College Hospital, Shaheed Suhrawardy Medical College Hospital, Enam Medical College Hospital, BRB Medical College Hospital. The self-modified a questionnaire was used for the study. Statistical analysis: Data was analyzed by using descriptive statistical analysis (SPSS= Statistics package for social science) method. Results: On average, most of the participants 67% (40) are males and 33% (20) are females. The maximum number participants, 82% (49) in the age range (23-34) years. The researcher has showed the area of specialty of the respondents according to the inclusion criteria. In the study 11.7% (7) participants are gastroenterologist, 10% (6) are orthodontist, 16.7% (10) are ENT, 41.7% (25) are medicine specialist and 20% (12) are neurologist. Maximum number of participants working station 46% (28) are in Dhaka Medical College Hospital. The duration of the study of the respondents on dysphagia out of the 60 respondents 30 studied for 2-3 hours. The respondents first encounter a patient with dysphagia. 46.7% (28) have seen in the period of 2012-2016. The frequency of the participants dealing with a patient having dysphagia the responses were categorized 46.7% (28) responded sometimes. The participants understand the role of SLT on diagnosing and managing dysphagia 52% (31) responded with yes. Conclusions: Dysphagia has emerged as a common complication due to stroke. More than 50% persons are affected by dysphagia after stroke (Smithard et al., 2007). This study consisted with medical practitioner from neurology, medicine, ENT, orthodontics and gastroenterology department. Both specialist and interns were part of this study. The referral level to SLT is also not satisfactory. Among 60 participants only 11 refer to SLT whereas 49 never or seldom refer to SLT. This showcases the lack of awareness on the role of SLT in diagnosing and managing of dysphagia. So, the proper collaboration of medical practitioner and SLT should be made so that the patient can get a proper treatment that will improve their condition.

Epidemiological Features of Chronic Low-Back Pain

Introduction: Chronic low back pain (LBP) is a major cause of abstinence from work in the world. Objective: The aim of the present study was to assess the epidemiological features of chronic low back pain patients in tertiary care teaching hospital. Materials and Methods: A descriptive cross sectional study was conducted from January 2018 to June 2018 among 70 patients attending at Physical Medicine and Rehabilitation outpatient department of the Shaheed Suhrawardy Medical College and Hospital after obtaining requisite consent from the patients. Data were collected through interviewing of the patients. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the epidemiological features of chronic low back pain patients. Results: In a pool of 70 patients, most of the patients (n=34, 48.5%) belong to 31-40 year age group. In a pool of 70 patients, Male patients (52.85%) were more than the female patients (47.14%) at the Shaheed Suhrawardy Medical College and Hospital. In occupational status, most of the patients were Housewife (n=19, 27.14%) followed by service-holder (n=17, 24.28%). In a pool of 70 patients, most of the patients BMI were normal (n=49, 70%). Conclusion: Epidemiological features were characterized by male patients, as from the 31-40 years of life and housewife. Physical functional profile was primarily characterized by patients with normal BMI and overweight. Medicine Today 2024, Vol.36 (2): 107-109

Clinical and Audiological Outcome of Surgical Treatment in Patients with Adenoid Hypertrophy

Background: Adenoid hypertrophy is a common condition in childhood, which may be associated with recurring acute otitis media, otitis media with effusion (OME), and obstructive sleep apnoea syndrome. There is close relationship between adenoids and possible middle ear pathology leading to conductive deafness. Objective: To find out the outcome of surgery regarding clinical features and hearing status in children with adenoids. Methods: This hospital based prospective study was conducted at the Department of Otolaryngology& Head-Neck Surgery, Shaheed Suhrawardy Medical College & Hospital, for a period of 6 months following approval from IRB. Patients having enlarged adenoids with or without OME of 3-12 years and both sex group were approached for inclusion of the study. Informed written consent was taken from the guardian. Proper surgical intervention was chosen according to condition of the child. Before and after intervention, data were collected by the researcher himself. Data were recorded into the case record form. Following collection, data were analyzed by the SPSS 26 (SPSS Inc, Chicago, IL, USA). Results: Among 100 patients, 66% were males and 34% were females. Mean age was 7.2±2.34 SD (years). Of all, 60% underwent adenoidectomy (AT), 20% underwent adenoidectomy with myringotomy (AM), and remaining 20% underwent adenoidectomy with myringotomy with grommet insertion (AMG). The PTA findings (baseline) of adenoidectomy, adenoidectomy with myringotomy, and adenoidectomy with myringotomy with grommet insertion group were 15.466±1.395, 37.8±3.349 and 38.2±3.548 db, respectively. Similarly, significant improvement was noticed in all of the three groups as evidenced by PTA value in three groups were 11.91±1.12, 18.65±.933 and 17.45±1.31 db, respectively (p<0.05). Improvements in PTA among different groups also showed significant changes following operation (p<0.05). Conclusion: Clinical improvement are noticed following surgical intervention in both ............

Endoscopic Sinus Surgery in the Management of Inflammatory Sinonasal Disease

Background: Inflammation of the nose and paranasal sinus is a clinical problem frequently encountered in the practice of otolaryngology in our country. Endoscopic sinus surgery is a minimally invasive technique for the evaluation and treatment of inflammatory sinonasal disease. Endoscopic sinus surgery is used to restore sinus ventilation and normal function of sinuses.Objectives: To see the outcome of endoscopic sinus surgery associated with inflammatory sinonasal diseases.Materials and Methods: It is a prospective observational study carried out in ENT &Head Neck Surgery of Shaheed Suhrawardy Medical College Hospital Dhaka from April 2016 to September 2016.Fifty(50) patients were enrolled in this study. Data was collected by Structural Questionnaire.Result: The majority of patients were 21-30years age group. The mean age group was 35.32 years, Male: male-to-female ratio was 1.3:1. The Majority of cases were antrochoanal polyps followed by an ethmoidal polyp, chronic maxillary sinusitis, and fungal rhinosinusitis. The majority of patients came with nasal obstruction and nasal discharge. Polyp was found in the majority of cases. A major complication was found in hemorrhage. Symptomatic improvement was found following endoscopic sinus surgery. KYAMC Journal Volume: 14, No: 04, January 2024: 226-233.

Effectiveness of Segmental Thoracic Spinal Anaesthesia in Breast Surgery: An Observational Study

Effectiveness of Segmental Thoracic Spinal Anaesthesia in Breast Surgery: An Observational Study

Outcome of Myringoplasty with Temporal Fascia and With Sliced Tragal Cartilage Graft-A Comparative Study

Introduction: Myringoplasty is the surgical procedure to repair tympanic membrane perforations and thereby improving hearing, providing a dry ear, and reducing susceptibility to infections. Although there are many kinds of techniques and graft materials used, no methods have proven indisputably superior to the other. Therefore, to find out the outcome of myringoplasty using temporal fascia and sliced tragal cartilage in chronic inactive mucosal otitis media was set as an objective of the study. Materials and Methods: This cross-sectional observational study was conducted at the department of Otolaryngology & Head-Neck surgery, Shaheed Suhrawardy Medical College Hospital (ShSMCH) for six months from July 2018 to December 2018, after acceptance of the protocol and approval from IRB. Patients attending in the ShSMCH with complaints of chronic inactive mucosal otitis media were approached for inclusion of the study and final selection were done in according to the selection criteria. Ethical issues were ensured properly throughout the study period and inclusion was confirmed following signing written informed consent. All patients were randomly allocated into two groups where one group were received myringoplasty with temporalis fascia graft and another group received sliced tragal cartilage. Total 50 patients (25 patients in each group) were included, and they were subjected to details history taking, physical examination and necessary investigations. The researcher conducted all the interview and collected data were recorded into a case record form for each patient. Data analysis was done by SPSS 17. Results: Of total, 50 study population, mean age of the 32.30±10.93 SD (years) with 58% male and 42% females respectively. No significant age and gender difference is noted across the group (p>0.05). Patients having temporal fascia graft had significantly higher proportion of graft uptake in comparison to patients having sliced tragal graft (p<0.05). Both groups of the patient improve significantly in term of hearing after operation (p<0.05 in each group) but comparison in between groups showed that the improvement was significantly higher in temporal fascia graft group (p<0.001). Conclusion: Myringoplasty with temporal fascia graft could be a better option than sliced tragal cartilage graft in our population. However, further larger study with longer follow up is necessary to finalize the comment. Medicine Today 2023 Vol.36 (1): 50-54

Detection of tetracycline and ampicillin resistant E. coli and Salmonella species from hospital wastewater

Escherichia coli (E. coli) and Salmonella spp. were found in hospital wastewater. The highest (E = (6.2 ± 1.8) x 109; S = (4.3 ± 2.2) x 109) and lowest (E = (1.4 ± 1.2) x 109; S = (1.1 ± 1.8) x 109) Total Viable Count (TVC) were in Shaheed Suhrawardy Medical College Hospital (SSMCH) and National Institute of Ophthalmology Hospital (NIOH), respectively. The overall occurrence of E. coli and Salmonella spp. was 80% and 87%, respectively, with 100% occurrence in SSMCH and National Institute of Cardiovascular Diseases Hospital (NICVDH) for Salmonella spp. (p ≤ 0.036). Prevalence of E. coli was low (72%) in winter (November - February). Both types of bacteria were resistant to Tetracycline whereas and 97.5% of E coli were resistant to ampicillin. Gentamycin was more effective than other antibiotics. Rational use of antibiotics is suggested, and hospital management practice should be followed as defined by the Joint Commission International for Hospital Accreditation.
 Bang. vet. 2023. Vol. 40, No. 1 – 2, 16 – 24

Prevalence, Risk Factors and Perceived Effects of Workplace Violence on Nurses.

Background: Workplace violence (WPV) in healthcare settings is a significant global occupational and mental health concern, which is a major stressor for nurses, particularly in middle-income and low-income countries. It has serious negative consequences for the physical and mental well-being of healthcare workers and threatens the workplace environment for providing healthcare services.Objective: To determine the prevalence, risk factors, and perceived effects of workplace violence on nurses in a purposively selected medical college hospital situated in Dhaka, Bangladesh.Materials and Methods: A hospital-based cross-sectional study was initiated to determine the prevalence, risk factors, and perceived effects of workplace violence among the 220 nurses working in the Shaheed Suhrawardy Medical College Hospital.Results: Most of the nurses (50.5%) faced violence in their workplace, or outside of the workplace or both. Among them 45.9% faced violence in their workplace alone, 38.8% faced violence in both places and 15.3% faced violence on the way to their workplace in terms of violence outside the workplace alone. Regarding the type of WPV and violence outside the workplace (VOW), the majority of the nurses experienced psychological violence (93.6% and 81.7%, respectively). Nurses' age, marital status, work experiences, and workplace distance from residence all had a statistically significant (p<0.05) relationship with their experience of violence. The sex of the nurses and the distance of their workplace from their residence were similarly statistically significant (p<0.05) about the place of occurrence of the incident. In addition, Nurses' age and marital status were statistically related (p<0.05) to different types of workplace violence.Conclusion: Workplace violence has a negative impact on both the health and productivity of nurses. Workplace regulations and protocols focusing on safety in the workplace, reporting and surveillance, and education for all employees and management on how to avoid and handle violence are required. The hospital administration has also prioritized initiatives to minimize violence. KYAMC Journal Volume: 14, No: 03, October 2023: 120-129.

Outpatient Service Provision In Tertiary Hospital During Covid-19 Pandemic

Background: The COVID-19 pandemic was a challenge for healthcare professionals globally. The outpatient department is an important part of the hospital. Service providers were facing tremendous difficulties and challenges due to sudden thrust of the pandemic. Despite these challenges service providers had to give service during COVID-19 pandemic. The purpose of this study to assess the state of outpatient service in tertiary hospital during COVID-19 pandemic.
 Methods: This cross-sectional study was conducted among conveniently selected 203 service providers including 156 doctors and 47 nurses. Data were collected through face-to-face interview using semi-structured questionnaire and observation checklist. The study was conducted at medicine, surgery, paediatric and family planning outpatient department of Shaheed Suhrawardy Medical College Hospital, Dhaka Medical College Hospital, and Bangabandhu Sheikh Mujib Medical University during the period from January to December 2021.
 Results: Among 203 service providers, 76.8% were doctors and 23.2% were nurses. All health services were available during COVID-19 pandemic in outpatient departments (OPDs) of the selected hospitals. At outpatient department there was separate entry-exit door, thermal scan was available at entry point, Patients and visitors are restricted. Number of patients were decrease in outpatient department. Among the three hospitals facility of flu-corner and triage in the OPD of ShSMCH. For the DMCH and BSMMU, flu-corner and triage center were situated at other premises of the hospitals. Outdoor surgery, vaccination service and shishu bikash kendro were open during COVID-19 pandemic. About 80.8% respondents mentioned about availability of adequate amount of personal protective equipment, 42.9% respondents mentioned about proper ventilation, 57.1% respondents said had not. About 32.5% respondent said about availability of N-95 mask and 57.6% said had not. Among the respondents 67.0% said they maintained physical distance during consult with the patients. 57.6% respondents said about lack of manpower. 61.6% respondents said about felt anxiety and high-risk during service.
 Conclusion: For more improvement of outpatient service during COVID-19 pandemic, the authority should pay special attention, to increase manpower, arrange frequent training for service providers.
 JOPSOM 2021; 41(2):20-27

The Role of Courtyard to Improve the Physical Environment of Inpatient Wards: A Case Study of Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh

This research investigates the role of a courtyard to improve the physical environment of inpatient wards at Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh. The objective is to investigate the luminous, thermal and acoustic conditions and identify if courtyard has improved the ward’s physical environment. Both qualitative and quantitative survey have been conducted to measure the light, temperature, humidity, ventilation and sound among experimental group (wards beside courtyard) and control group (wards away from courtyard); and interviews from patients to get their experiences. The findings demonstrate that the presence of the courtyard positively influences wards’ physical environment. Patients also express higher levels of satisfaction with the courtyard. The wards beside courtyards have a higher level of light, ventilation rate and lower level of sound rate and the wards away from courtyard have a lower level of light, ventilation rate and higher level of sound rate. The outcome underscores the importance of incorporating nature into healthcare facilities and provide valuable insights for healthcare authorities to create patient-centered and sustainable healing environments in hospitals in context of Bangladesh.

Motivation and Job Performance among Nurses at Public Hospital in Bangladesh

Background: The performance of nurses plays a crucial role in achieving positive outcomes for healthcare organizations. Performance is directly related to motivation; as higher motivation leads to better performance. Motivated nurses tend to have a strong sense of organizational belonging, resulting in improved work quality, increased productivity, and enhanced job performance. Objective: The study aims to examine the relationship between motivation and job performance among nurses at public hospital in Bangladesh. Methods: A descriptive correlational study was conducted at Shaheed Suhrawardy Medical College Hospital. A total of 112 nurses were selected using a convenience sampling technique. Data were collected from February 2023 to March 2023 using a structured questionnaire. The instrument consisted of three parts: Part I, the Socio-Demographic Questionnaire (SCQ-10); Part II, the Nurses' Motivation Measurement Questionnaire (NMMQ-32); and Part III, the Nursing Job Performance Related Questionnaire (NJPQ-52). Descriptive and inferential statistics were used to analyze the data. Results: The average age of the participants was 37.3 years (SD = 57.102). Among them, 94.6% were female, 97.3% were married, and 75% identified themselves as Muslims. The mean score of motivation was 3.43 (SD = 0.660), indicating that nurses were motivated. The mean score of job performance was 2.78 (SD = 0.640), indicating that nurses had good job performance. The results also showed that more than half of the nurses expressed dissatisfaction with their remuneration. There was a significant positive correlation between motivation and job performance (r = 0.725, p = 0.000). Conclusion: The present study found that motivation and job performance strongly correlate with each other. Although the participants were motivated and had a good performance, there is still a lack of a fair performance evaluation system and proper resources for better job performance. Based on these findings, the researchers recommended that further study be conducted with a larger sample size and in multiple healthcare settings to allow the generalizability of the findings and provide a more diverse and comprehensive understanding of the relationship between motivation and job performance.

Maternal Cardiac Functional and Structural Changes in Preeclampsia: an Echocardiographic Study

Background & objective: Preeclampsia is a pregnancy-induced multi-organ syndrome of acute cardiovascular manifestations with significant short and long-term sequelae. However, there is a relative lack of knowledge with respect to cardiac functional and structural changes in women with preeclampsia Therapeutic interventions used in the management of preeclampsia may cause iatrogenic adverse consequences due to this lack of knowledge. The present study was therefore designed to evaluate the echocardiographic changes in cardiac structural and functional indices in pregnant women with PE. Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynaecology Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH), and Shaheed Suhrawardy Medical College Hospital (SSMCH) in collaboration with National Institute of Cardiovascular Diseases (NICVD), Dhaka over a period of one year from July 2013 to June 2014. A total of 30 single-tone pregnant women of 20-40 weeks gestation with preeclampsia were taken as cases. An equal number of gestationally-matched healthy pregnant (HP) women of similar age cohorts having no history of preexisting hypertension were included as controls. Preeclampsia was defined as SBP ≥140and/or DBP ≥ 90 mmHg after 20 weeks gestation in a woman with previously normal blood pressure and with proteinuria≥1 + in the dipstick test. Pregnant women with systolic and diastolic blood pressures within the normal range (< 140mmHg and > 90 mmHg respectively), trace or absence of proteinuria by dipstick test were defined as controls. All thesubjects were investigated with ECG, standard two-dimensional, M-mode, and Doppler transthoracic echocardiography. The cardiac functional and structural changes were measured in terms of interventricular septal thickness (IVSTd),posterior wall thickness (PWTd), left ventricular internal diameter at the end of diastole (LVIDd), ejection fraction (EF), transmitral velocity (MV E/A ratio), MV deceleration time (MV DecT). Result: Half of the women with preeclampsia were primigravidae and there was no association between gravidity and the occurrence of preeclampsia. Prepregnancy overweight or obesity (in terms of BMI) was found to be strongly associated with preeclampsia. One in 10 PE women had a previous history of preeclampsia as opposed to none in the HP women. A substantial proportion (56.7%) of PE women had a family history of hypertension in comparison to healthy pregnant women (16.3%). The women with PE had significantly higher SBP, DBP, & MAP than the HP women. Parameters of diastolic dysfunction, like mitral E/A ratio was reduced and deceleration time was prolonged in PE with diastolic dysfunction (mean E/A ratio < 0.73 and mean DceT >178 ms respectively) than those in PE with normal diastolic function (mean E/A ratio 1.2 and mean DceT 192.4 ms respectively) healthy pregnant women (mean E/A ratio 1.3 and mean DecT 186.5 ms respectively). Over one-third (36.7%) of women with PE met the criteria of diastolic dysfunction compared to none in healthy pregnant women. The LVH appears to be a frequent occurrence in pregnancies complicated by preeclampsia (43.3%) as compared to none in healthy pregnant women. In the present study, the systolic function was assessed with the help of EF, which was well-preserved both in PE and HP with no significant intergroup difference. Conclusion: Preeclampsia is associated with left ventricular diastolic dysfunction and hypertrophy preserving the systolic function. These structural and functional changes are primarily adaptive in nature for maintaining cardiac systolic function. Ibrahim Card Med J 2022; 12 (2): 32-39

Myositis : Rare Presentation of Dengue, not Uncommon in Children

Dengue myositis is a recently recognized category of idiopathic inflammatory myopathies manifested as symmetric proximal muscle weakness with severe limb pain and high serum creatine kinase (CK) levels, in dengue patient (NS1 positive or IgM positive). A total 4 cases of dengue myositis were admitted at Shaheed Suhrawardy Medical College during the period from August to October, 2023. All were male & they presented mainly with severe limp pain with inability to walk they were diagnosed as dengue fever serologically. Two cases presented during febrile phase & two following fever. Their S. CPK level were high with mildly low platelet count. None of them developed shock or hemorrhagic manifestation. They were treated supportively and all 4 cases recovered without any sequelae. Dengue myositis in children is usually benign and is differentiated from other causes of flaccid paralysis by tenderness of calf and thigh muscles and raised CPK levels with other normal neurological findings. But sometimes it may result in serious consequences, so all children with dengue infection should be followed up carefully with S.CPK level J Bangladesh Coll Phys Surg 2023; 41: 101-104