Tertiary Care Hospital In Bangladesh Research Articles

Thyroid Hormone Status in Children Taking Antiepileptic Drugs (AEDs): An Experience in a Tertiary Care Hospital of Bangladesh.

Introduction: Antiepileptic drugs (AEDs) may alter thyroid hormone homeostasis at the level of biosynthesis, release, transport, metabolism and excretion of thyroid hormones. The purpose of the study was to see the thyroid hormone status in children with epilepsy treating with common antiepileptic drugs. Materials & Method: The cross-sectional study was carried out in department of pediatric neurology, National Institute of Neurosciences and Hospital (NINS), Dhaka. One hundred and sixty epileptic children aged 1 year to 14 years who were on monotherapy or polytherapy with the most commonly used Antiepileptic drugs (AEDs) for at least 6 months or more were enrolled. Serum TSH and FT4 were measured in all selected patients with early morning serum sample. Result: Nearly one third of study subjects had thyroid dysfunction, most of which were Subclinical hypothyroidism (SCH). The frequency of SCH was 29.2% in carbamazepine(CBZ), 50% in oxcabazepine (OXC), 28.6% in phenobarbitone(PHB) and 13% in valproic acid (VPA) treated epileptic children. No child was found to have subclinical hypothyroidism with topiramate and ethosuximide monotherapy. Antiepileptic drugs (AEDs) monotherapy or polytherapy had no significant difference in alteration on thyroid hormone level. Use of CBZ for long duration significantly altered thyroid function. Doses of Antiepileptic drugs (AEDs) didn’t show any significant thyroid dysfunction. Conclusion: Commonly used Antiepileptic drugs (AEDs) in children with epilepsy were associated with alteration of thyroid hormones, most commonly subclinical hypothyroidism. BANGLADESH J CHILD HEALTH 2022; VOL 46 (2) : 58-64

Outcomes of Pregnancies in Women with Congenital Heart Disease: A Study in a Tertiary Care Hospital in Bangladesh

Background: Pregnancies in individuals with congenital heart disease (CHD) frequently pose complex challenges. The presence of CHD elevates the risks not only for the expectant mother but also for the well-being of the developing fetus. Additionally, careful monitoring and specialized medical care are crucial throughout the pregnancy to ensure the best possible outcomes for both. Objective: This study was aimed to assess the outcomes of pregnancies in women with congenital heart disease. Methods: This was a cross-sectional observational study that was conducted in the Combined Military Hospital (CMH), Dhaka, Bangladesh from January 2020 to December 2021. A total 30 pregnant women with congenital heart disease were enrolled through purposive sampling. All the demographic and clinical information was recorded. Data were processed, analyzed, and disseminated by using MS Office tools. Results: Among participants, Lower Segment Cesarean Section (LSCS) was the most common delivery (43.3%), followed by vaginal delivery (36.7%). Instrumental delivery, specifically through outlet forceps, was found in 6.7% of cases. Pregnancy termination occurred in 6.7% due to inevitable abortion and 3.3% for medical reasons, resulting in one maternal death (3.3%). Perinatal outcomes included 90% live births and 81.5% with Apgar scores ≥9. Neonatal Intensive Care Unit (NICU) admission was required for 33.3%, with a 3.3% perinatal death rate. Conclusions: In pregnant women with congenital heart diseases, common delivery modes are Lower Segment Cesarean Section (LSCS) and vaginal delivery. Termination and maternal fatality rates are low. Perinatal outcomes are generally positive, with most births resulting in live infants with Apgar scores ≥9 and high newborn survival rates, although some require Neonatal Intensive Care Unit (NICU) admission. J Rang Med Col. March 2024; Vol. 9, No. 1: 50-54

6299676 Prevalence and Risk Factors for Chronic Postsurgical Pain After Cesarean Section – A Prospective Study in A Tertiary Care Hospital of Bangladesh

6299676 Prevalence and Risk Factors for Chronic Postsurgical Pain After Cesarean Section – A Prospective Study in A Tertiary Care Hospital of Bangladesh

Dengue Hemorrhagic Fever Presenting with Acute Abdomen in a Non- Government Tertiary Care Hospital in Bangladesh

A 60-year-old diabetic and hypertensive post-menopausal lady, presented at a tertiary care Hospital in Dhaka, Bangladesh with severe abdominal pain in the right middle and lower abdomen, associated with oliguria for 1 day. She also gave history of having high grade fever and headache for 3 days, which subsided 2 days ago. On examination, she was afebrile, mildly dehydrated, tachycardic (PR- 110/min), hypotensive (BP- 90/60 mm Hg), Tourniquet Test was positive. Her abdomen was tense and diffusely tender, especially in the right middle and lower parts, bowel sound was present, no organomegaly or lump was found. S. Lipase was normal, Anti-dengue Antibody IgM and IgG were positive, CBC revealed Hemoglobin – 8.6 gm/dL, Hematocrit was raised- 52%, Platelet count was 16000/ microliter, Stool for OBT was negative, RBS- 16 mmol/L and Urine RME and ketone bodies was negative. A provisional diagnosis of Dengue Hemorrhagic fever with suspected intra- abdominal bleeding was made and she was shifted to ICU.

Outcome of Surgical Intervention of Spinal Tuberculosis Patients

Background: Spinal tuberculosis is approximately 2% of all cases of tuberculosis. Both conservative and surgical management are practiced for its management worldwide. However, surgical management has excellent outcome. Objectives: The aim of the study was to document the clinical and neurological outcomes of surgical intervention of spinal tuberculosis patients getting admitted in a tertiary care hospital of Bangladesh. Materials & Method: This hospital based interventional study was conducted in the department of Neurosurgery, Chittagong Medical College and Hospital for a period of 12 months. Thirty-two cases with spinal tuberculosis underwent surgical intervention were enrolled in the study. All patients were treated with standard anti- TB drugs pre and postoperatively and were followed up regularly after surgery for 3 months. Neurological function and pain were evaluated preoperatively and postoperatively by Frankel’s grade scale and visual analogue scale (VAS) respectively. Post operative outcomes were finally assessed 3 months after operation. Results: Out of 32 cases, 2 were lost to follow up. Among the available 30 cases, 16 were men and 14 were women. The mean age was 36.10 (±13.70) years and age range were 18 to 65 years. At the final follow-up, the VAS score significantly improved from 6.97 (±1.87) preoperatively to 1.43 (±0.89) postoperatively (P < 0.001) and all patients became pain free, with final VAS score 0-3. At the final follow-up, the ESR and CRP significantly improved from preoperative status (P < 0.001). Twenty-nine (96.7%) patients improved by at least one Frankel grade and remaining one (3.3%) patient maintained their preoperative Frankel grade. Post operative deterioration was not observed in any of the included case. Out of 11 cases with bowel bladder dysfunction before surgery 10 (90.9%) recovered within three months. Conclusion: Surgical intervention was safe and had satisfactory results in terms of symptomatic and neurological improvement. Bang. J Neurosurgery 2023; 12(2): 94-101

Clinico demographic profile and short-term outcome of Pediatric Idiopathic Intracranial Hypertension in a tertiary care hospital of Bangladesh

Background: Diagnosis of IIH (idiopathic intracranial hypertension) in children is challenging. The pathogenesis of IIH is still largely unknown. The aim of this study to evaluate the clinico-demographic profile and short-term outcome of IIH among Bangladeshi children. Methodology: This observational cohort study was done in pediatric Neurology Department, National Institute of Neurosciences and Hospital Bangladesh from January 2018 to July 2019. Total 19 cases were enrolled who were clinically suspected and/or had normal CSF with opening pressure (OP) above 250 mmH2O. They were further categorized as “definite IIH”, definite IIH without papilledema, and “probable IIH”. Clinical, radiological profile and short-term outcome were analyzed by SPSS version 22. Result: Among them most were probable IIH (74%). Episodic (57.9%), moderate, diffuse headache was the predominant symptom along with vomiting, double vision, unilateral VI nerve palsy and papilledema. Obesity was found in 21% cases. Mean CSF pressure was 21.84+7.62cm H2O and found high in definite IIH. All the cases were treated with acetazolamide and serial LP was done in 4(15.8%) cases. Definite IIH requires longer hospital stay (6.42 ± 2.87days). Recurrence was observed in 10.5% cases and visual impairment was found in 15.8% cases. Conclusion: This study found wide range of diversity between clinical feature and CSF opening pressure in Pediatric IIH and diagnostic confirmation was challenging. Initial treatment response was satisfactory with a low recurrence rate. J Bangladesh Coll Phys Surg 2024; 42: 161-168

Experience of pediatric palliative care among children with cancer in a tertiary care hospital in Bangladesh

Background: Palliative care is a holistic approach which can improve patients and their family’s quality of life through the prevention and relief of physical symptoms as well as support for emotional, social and spiritual suffering. Despite the substantial need for palliative care there is very limited access in Bangladesh, with only a few palliative care services focused on children including several hospital-based services as well as home and hospice-based services, within the capital city of Dhaka. The aim of the study was to evaluate the effect of pediatric palliative care on quality of life in children with cancer. Methods: This was an institutional based descriptive study conducted in the department of pediatric hematology and oncology and pediatric palliative care unit, Dhaka medical college hospital, Dhaka, from May to August 2023. A total of thirty child and parent pairs were taken as the study population according to inclusion and exclusion criteria. Outcome was evaluated by the CPOS-2 questionnaires for symptom and Lanskys performance status scale for assessment of activity level. Results: The median age of the children were 5.7 years where 70.0% were male. The duration of disease of the patients was up to 6 months in 63.3% cases. One third of the patients had ALL, 13.3% had NHL, and 10.0% had Ewing sarcoma while another 10.0% having neuroblastoma. Conclusions: There is significant improvement in the quality of life of pediatric cancer patients and their parents, as well as the enhanced performance status of patients with cancer after receiving pediatric palliative care.

Effect of Perioperative Allogeneic Blood Transfusion in Causing Surgical Site Infection in Elective Gastrointestinal Surgeries: A Comparative Study among the Pediatric Population in A Tertiary Care Hospital of Bangladesh

Background: Allogeneic blood transfusion (ABT) has been reported as a major risk factor for surgical site infection (SSI) in patients undergoing elective gastrointestinal surgery. Objective: To find out whether perioperative allogeneic blood transfusion is a significant risk factor for surgical site infection in children undergoing elective gastrointestinal surgery. Methods: This prospective observational study was carried out at the Department of Pediatric Surgery in Dhaka Medical College Hospital, Dhaka, from January, 2021, to June, 2022, for a period of 18 months. According to CDC standards, patients who underwent elective gastrointestinal surgical procedure or clean-contaminated surgical wound (class II) were chosen as the study population. Total 256 patients were divided into two groups according to the blood transfusion as transfused and non-transfused group. Preoperative and postoperative day 1 CBC were done to observe the lymphocyte count. Blood transfusions were recorded during the perioperative period. After surgery, patients were followed up to check for surgical site infection and anastomotic leakage. Pus or wound swab for C/S was done in all the patients who developed SSI. The duration of the hospital stay after surgery was also noted. Results: Most of the study subjects in both the groups were ≤5 years(p=0.095). Males were predominant than females in both groups (p=0.014). Infection was found significantly higher among the transfused group (34.6%) than non-transfused group (14.6%) (p=0.001). In both the groups common infection was superficial SSI (12.0% in transfused group and 6.5% in non-transfused group). Among the infections, bacterial growth was 39.1% in Group A and 38.9% in Group B (p>0.786). Postoperative duration of hospital stay was 10.56 ± 4.05 days and 8.47 ± 2.67 days in Group A and Group B respectively (p<0.001). Mean lymphocyte count in Group A and group B was (2353.9±1647.7 vs 3792.5±1455.9; p<0.001). Conclusion: Allogeneic blood ........

Violence against physicians working in public tertiary care hospital of Bangladesh: a facility-based cross-sectional study

BackgroundViolence against physicians in the workplace is a prevalent global issue, and Bangladesh is no exception. Such violence significantly disrupts healthcare delivery and the attainment of universal health coverage. This...

Severity of Coronary Artery Disease by Friesinger Score Among Women With Acute Coronary Syndrome in a Tertiary Care Hospital in Bangladesh.

The chance of coronary artery disease (CAD) is much higher in women who have gone through menopause than in those who have not, owing to hormonal defense against atherosclerosis. More advanced CADand several comorbidities were observed in postmenopausal women. Nevertheless, there is a paucity of information comparing the angiographic severity of acute coronary syndrome (ACS) in premenopausal and postmenopausal women of different ages. This research sought to determine the Friesinger score's use in evaluating the degree of CAD in premenopausal and postmenopausal women with ACS. A total of 145 female patients with ACS were included in this cross-sectional observational research. Depending on the stage of menopause, they were categorized into two groups: group I (premenopausal) and group II (postmenopausal). The study examined the differences in clinical data and the severity of coronary angiographic features based on the Friesinger score between the premenopausal and postmenopausal ACS groups. A statistically significant difference (p = 0.001) was found in the mean age of premenopausal ACS patients, which was 41.53 ± 5.45 years, and postmenopausal ACS patients, which was 57.23 ± 7.45 years. Between the premenopausal group (31.4% vs. 17.1%; p = 0.04 and 31.4% vs. 15.7%; p = 0.002) and postmenopausal group (48.6% vs. 20%; p = 0.001), there was a greater prevalence of normal coronary angiography, single-vessel disease, and triple-vessel disease. Comparing the postmenopausal group to the premenopausal group, the high to intermediate Friesinger score (11-15) was found to be considerably higher (2.9% vs. 1.4%; 72.9% vs. 50%; p = 0.003). Prior to menopause, single-vessel disease and normal coronary angiography were more common, whereas postmenopausal individuals had triple-vessel disease.The postmenopausal group's CAD was found to be more severe than the premenopausal group's according to the Friesinger score used for severity evaluation.

Association of Heart Failure Admission with Age, Sex, Risk Factors and Co-Morbidities in Tertiary Care Hospital in Bangladesh

Background: Heart failure is a significant medical and societal concern worldwide. It continues to be a major source of morbidity and mortality and causes a significant and rising cost on the health care system. There is a seasonal fluctuation in the number of people who are admitted to hospitals for heart failure, with winter seeing the highest rate. Objective: To assess the seasonal variation of heart failure admission with age, sex, risk factors and co-morbidities in tertiary care hospital in Bangladesh. Materials and Methods: This cross-sectional study was carried out among the patients hospitalized with heart failure at the Department of Cardiology, Dhaka Medical College Hospital (DMCH), Dhaka, between April 2015 and March 2016. The history, clinical characteristics, and investigational data were used to diagnosis the patients. Statistical tests were used to examine the impact of seasonal fluctuation on patients admitted with heart failure. Results: In the age range of 41 to 60 years, 302 patients with heart failure at the highest level (51.7%) were hospitalized. Heart failure admission patients were 2.8 times more likely to be male than female, with a mean age of 55.18±12.42 years. Heart failure patients in the age ranges of 20 to 40, 41 to 60, and 61 to 80 years were hospitalized more frequently in the winter and post-monsoon. Seasons and gender had a statistically significant relationship (p=0.030). Smoking is the greatest risk factor compared to other risk factors in all seasons, and all risk factors were more prevalent in the winter than they were in other seasons. Conclusion: This study may help improve the healthcare system and alter how easily accessible hospital resources such as emergency rooms are throughout the winter. More information regarding the heart failure events that occur throughout the winter should be made available to patients and general practitioners.

Association of Cytokine IL-17, IL-4, IL-6, and IL-12 Gene Polymorphisms in Rheumatoid Arthritis Patients in a Tertiary Care Hospital in Bangladesh.

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that involves cytokines in its pathogenesis. This study is aimed at investigating if gene polymorphisms in cytokines like IL-17, IL-4, IL-6, and IL-12 affect RA susceptibility and severity in the Bangladeshi population. This was a cross-sectional comparative study that included 40 diagnosed RA patients according to the American College of Rheumatology (ACR) criteria 2010, who were free from other rheumatological diseases, and 40 healthy subjects for comparison. The study used PCR-RFLP to determine the IL-17, IL-4, IL-6, and IL-12 cytokine gene polymorphisms. Patients had a mean age of 37.22 ± 6.70 years. Among the patients, 31 were female and 9 were male. The mean disease duration was 18.11 ± 7.39 months. The study found that rheumatoid arthritis patients with the IL-17F (7488 A/G) polymorphism with GG genotype (P = 0.006, OR = 8.56, 95% CI = 1.77 - 41.33) and IL-12B (1188 A/C) polymorphism with AC (P = 0.012, OR = 3.69, 95% CI = 1.43 - 9.53) and CC (P = 0.013, OR = 7.58, 95% CI = 1.56 - 36.88) genotypes were significantly associated with disease risk. Furthermore, patients with the IL-17F (7488) GG genotype and IL-12B (1188) AC and CC genotypes had higher rheumatoid arthritis disease severity and activity parameters. The study found no significant association between polymorphisms involving IL-4 (590 C/T) and IL-6 (174 G/C) genes and rheumatoid arthritis disease risk in the Bangladeshi population. Gene polymorphisms in cytokines IL-17F (7488 A/G) and IL-12B (1188 A/C) can predict disease susceptibility and severity in Bangladeshi rheumatoid arthritis patients.

Antibiotic Sensitivity Patterns in Pediatric Enteric Fever: A Cross-Sectional Study at a Tertiary Care Hospital in Bangladesh

Background: This cross-sectional study aimed to investigate the antibiotic sensitivity patterns among pediatric patients with enteric fever at the Department of Paediatrics, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, during the period from July 2005 to June 2006. The primary objective was to identify the prevalent antibiotic sensitivities in order to enhance the efficacy of treatment strategies for typhoid fever in children. Methods: Ninety-eight suspected cases of enteric fever, aged between 2 and 12 years, were selected from admissions to the above-mentioned hospital. Blood culture and sensitivity testing were performed for Salmonella typhi and paratyphi. Demographic information, pre-admission antibiotic usage, and sensitivity profiles to various antibiotics, including Ceftriaxone, Cefixime, Chloramphenicol, Ciprofloxacin, Azithromycin, Amoxicillin, Imipenem, Nalidixic acid, and Ampicillin, were analyzed. Results: The majority of patients (62.2%) were in the 5-9 years age group, and males constituted 61.22% of the study population. Blood cultures revealed 71.44% sensitivity for Salmonella typhi and 28.57% for paratyphi. Among the antibiotics tested, Ceftriaxone exhibited 100% sensitivity, followed by Cefixime (80.2%), Chloramphenicol (78.57%), Ciprofloxacin (65.20%), Azithromycin (60%), Amoxicillin (54.6%), Imipenem, Nalidixic acid (Intermediate sensitive, 56.3%), Ciprofloxacin (Intermediate sensitive, 25%), and Ampicillin (Intermediate sensitive, 18.8%). Nearly half of the patients (47.3%) received antibiotics before admission, and 43.8% of culture-positive patients had a history of pre-admission antibiotic use. Conclusion: The study concludes that understanding antibiotic sensitivity patterns is crucial for successful typhoid fever treatment in children. Ceftriaxone and Cefixime emerged as highly effective, while the unnecessary use of antibiotics prior to admission may influence sensitivity patterns. This information underscores the importance of judicious antibiotic prescribing practices to ensure optimal therapeutic outcomes in pediatric enteric fever cases.
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Pattern and Predictors of Infection Among Patients With Rheumatological Disease on Immunosuppressive Medications: A Retrospective Study in a Tertiary Care Hospital in Bangladesh.

Background Immunomodulatory therapy for chronic rheumatic disease carries a risk for infectious complications. In Bangladesh, there is limited information regarding patterns and factors associated with infections among patients receiving immunosuppressive medications. Objective The present study aimed to find out patterns and predictors associated with infection among patients who were on different immunosuppressive medications due to chronic rheumatological disease. Methodology This was a retrospective study; all confirmed cases of (new and old) different rheumatological diseases on disease-modifying agents attended at the rheumatology clinic of Dhaka Medical College Hospital from January 2019 to December 2021 were enrolled. Result Among 489 cases, 90 (18.4%) patients had documented infections. The most common rheumatological diseases were systemic lupus erythematosus (28, 31.1%), ankylosing spondylitis (26, 28.8%), and rheumatoid arthritis (20, 22.2%).COVID-19 (28, 31.1%) was the most commonly occurring infection followed by urinary tract infection (14, 15.6%), fungal infection (12, 13.3%), herpes zoster (10, 11.1%), pulmonary tuberculosis (TB) (eight, 8.8%), latent TB (seven, 7.7%), community-acquired pneumonia (six, 6.6%), and sepsis (three, 3.3%). Infection was most prevalent among patients who received steroids of more than 10 mg per day (17, 18.8%) than those less than 10 mg steroid per day (six, 6.7%), Factors associated with infections were (odds ratio, 95% CI, p-value) underweight (2.3, [1.3-2.7], 0.001), anemia (1.8, [1.1-5.7], 0.01), neutropenia (1.6, [1.1-2.9], <0.002), hypoalbuminemia (3.1, [1.6-4.9], 0.001), hypovitaminosis D (1.9, [1.3-4.5], 0.001), high blood sugar (1.5, [1.1-5.3], 0.02), inadequate counseling of steroid side effect (1.7, [1.1-3.9], 0.03), prednisolone >10mg/day (2.2, [1.19-4.10], 0.001). Conclusion COVID-19 pneumonia, urinary tract infections, fungal infection, tuberculosis, herpes zoster, and community-acquired pneumoniawere commonly occurring infections among patients receiving different immunosuppressive medications. Factors like poor nutritional status, presence of anemia, leucopenia, hypoalbuminemia, hyperglycemia, and hypovitaminosis D had a significantassociation with infection. Moreover, inadequate counseling of steroid side effects andhistory of daily intake of prednisolone (>10mg/day) were also significant factors associated with infection.

Knowledge, Attitude and Practice of Prevention of Thalassaemia of the Parents of Children with Thalassaemia attending in a Tertiary Care Hospital in Bangladesh

Introduction: Inherited disorder of Hemoglobin is widely distributed throughout the world. Among them, Thalassaemia is a common disorder with widespread geographical distribution. Objectives: The objective of the study was to determine the level of knowledge, attitude and practice of thalassaemia prevention among parents of children with Thalassaemia. Methodology: This was a descriptive cross sectional study. This study was conducted in inpatient and outpatient department of paediatrics, Rajshahi Medical College Hospital over a period of July 2020 to June 2021. 45 parents of children with thalassaemia were purposively selected as study subjects. Informed written consent were obtained from the parents before enrollment in the study. Data were collected on variables of interest. All the findings were recorded and analyzed. Statistical analysis were done using statistical package for social science (SPSS) software version 21. Result: Total 45 parents of children with thalassaemia were enrolled in the study. Among the informants, 73.3% (total 33) were mother and 26.6% (total 12) were father. 77.7% (total 35) children were from rural areas and 22.22% (total 10) were from urban areas. All the study population received knowledge about thalassaemia from the physicians. Knowledge of the parents about the disease, its treatment options and methods of its prevention were assessed by likert scale questionnaire. 22.22% parents had adequate knowledge , 64.44% had average knowledge and 13.33% had inadequate knowledge about the disease. 60% parents had adequate knowledge 31.11% had average knowledge and 8.89% had inadequate knowledge about prevention of thalassaemia. Attitude of all the parents (100%) were positive. Conclusion: Most of the parents have adequate knowledge and positive attitude for thalassaemia prevention and they can serve as resource for spreading awareness about thalassaemia in community. J Bangladesh Coll Phys Surg 2024; 42: 6-11

Bacterial Isolation from Wound Swab and Pus with their Antibiotic Susceptibility Pattern in a Tertiary Care Hospital of Bangladesh

Background: Wound infection is a global health problem, plays an important role in development of chronicity, delaying wound healing associated with long hospital stay. Objective: This study was aimed to identify the bacterial pathogens present in infected wounds and characterize their resistance profile to the most common antibiotics used in the therapy. Methods: This observational study was conducted from January, 2023 to June, 2023 in a tertiary care hospital in Dhaka, Bangladesh. A total of 220 wound swabs and pus samples were collected from the outpatient and inpatient department of this hospital with skin and soft tissue infection. Samples were inoculated on appropriate media and cultured and the isolates were identified by standard procedure as needed. Antimicrobial susceptibility testing was done by disc diffusion method according to ‘The Clinical Laboratory Standard Institute Guidelines’. Results: Out of 220 cases 165(75%) were Male and 55(25%) were female. Majority of the patients 77(35%) were in the age group of 21-31 years. Of the total 220 isolates, 156(70.91%) were culture positive cases. Among the isolated organisms, predominant bacteria was Pseudomonas spp 76(48.22%) followed by Klebsiella 27(17.31%), Escherichia coli 19(12.18%), Proteus 13(8.33%), Staphylococcus aureus 12(7.69%) and Acinetobacter 9(5.77%). Among the gram negative isolates, Pseudomonas was highly sensitive to colistin(88.15%), followed by piperacillin-Tazobactam(77.63%)and Imipenem(50%) and low sensitivity found in ceftriaxone(14.47%), Amoxiclav(13.16) and Clotrimoxazole (13.16%). Klebsiella found sensitive to colistin (90.47%), Piperacillin-Tazobactam (85.71%), Imipenem (76.19%), Gentamycin (71.43%). Escherichia coli shows low sensitivity to almost all the drug except Imipenem (94.74%), Piperacillin-Tazobactam (84.21%) and colistin(84.21%). Stapylococcus aureus show sensitivity to linezolid (100%), vancomycin (91.67%) and Ciprofloxacin (61.67%). Conclusion: Antibiotic sensitivity pattern of various isolates will guide for appropriate selection of the antibiotic against wound infection and reduce the spread of resistance bacteria. Bangladesh Heart Journal 2024; 39(1): 38-43

Delirium as a presenting feature on admission in medicine unit at a tertiary care hospital of Bangladesh

Background: Delirium, a complex neuropsychiatric syndrome, poses challenges in clinical settings due to its varied aetiology and under diagnosis. This study aimed to explore the prevalence, demographic characteristics, and contributing factors of delirium as a presenting feature in the population admitted to a tertiary care hospital in Bangladesh. Limited studies on delirium in low- and middle-income countries necessitate a comprehensive investigation to inform healthcare practices in diverse settings. Methods: A prospective observational study was conducted on 102 patients diagnosed with delirium among a total of 2599 patients admitted to the medicine unit over six months. Delirium was assessed using the Confusion Assessment Method (CAM) score, with demographic variables and comorbidities analyzed. Results: The study identified a delirium prevalence of 3.8%, with stroke and poisoning as major contributors. Females (56.8%), individuals above 50 years (69.8%), and those with comorbidities (67.6%) exhibited higher susceptibility to delirium. The multifactorial aetiology included stroke (49.3%), poisoning (1.42%), electrolyte imbalance (0.76%), and others. Sedative poisoning predominated (45.9%) among poisoning cases. Conclusion: This study highlights the demographic and etiological dimensions of delirium. The significant impact of stroke, the underexplored realm of poisoning-related delirium, and the influence of age and comorbidities underscore the need for targeted interventions and increased awareness. Bangladesh J Medicine 2024; 35(1): 20-25

Predictors of poor neurodevelopmental outcomes in neonates with clinically observed seizures: A prospective observational study in a tertiary care hospital of Bangladesh

Neonatal seizures can lead to long-term neurodevelopmental problems. This study aims to identify predictors of poor developmental outcomes in neonates with seizures to aid in early intervention and referral for follow-up and rehabilitation.This observational study was conducted in the Department of Neonatology and Institute of Paediatric Neurodisorder, Bangabandhu Sheikh Mujib Medical University. Among 75 study cases of neonatal seizure, 23 died, and 46 were follow-ups at 6 and 9 months after discharge. EEGs were performed on every patient with a comprehensive neurological examination and developmental evaluation using Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III).Three-fourths of neonates were born at term (76.1 %), and over half were male (56.5 %). The majority were appropriate for gestational age (79.7 %) and had an average birth weight of 2607 ± 696 g (±SD). Over half of the neonates (52.2 %) had adverse neurodevelopmental outcomes, with global developmental delay being the most common. Recurrent seizures, the number of anticonvulsants needed to control seizures, and abnormal Electroencephalograms were identified as independent predictors of adverse neurodevelopmental outcomes.The study highlights the need for early referral for follow-up and rehabilitation of neonates with seizures having abnormal electroencephalograms, recurrent seizures and requiring more anticonvulsants to control seizures.

Hypotension in Preterm Newborns and Its Short-Term Outcome: Experience of a Tertiary Care Hospital in Bangladesh

Background: Blood pressure values of too low or too high can be related with serious morbidity and mortality. Neonatal hypotension has been found to be related with serious short term as well as significant long-term health complications. Thus, identifying this low blood pressure in preterm neonates with its impacts on neonatal health is crucial. Objectives: To evaluate blood pressure values in preterm newborn and short-term impacts of hypotension on neonatal health. Methods: This prospective observational study was conducted in Neonatal Intensive Care Unit (NICU) of Bangabandhu Sheikh Mujib Medical University a tertiary care hospital of Dhaka city after approval from Institutional Review Board for a period of one years. Neonates having gestation&lt; 37 completed weeks admitted in NICU of BSMMU were enrolled in the study after getting informed consent from the parents. Proper antenatal and postnatal history were recorded in data collection form. Blood pressure was measured by non-invasive oscillometric method in all neonates within 24 hours after birth by ideal procedure. Blood pressure was monitored at an interval of 12 hours or more frequently when required till discharge or death. Information on neonatal mortality and morbidity were recorded in data collection form. Results: A total of 114 preterm neonates were studied during the study period, among them 61 (53.5%) had normal blood pressure and 53 (46.5%) had hypotension. Among the enrolled patients, 15 (13.2%) patients died, 3 (2.6%) left against medical advice, 11 (9.6%) 96 (84.2%) were discharged with advice. Short time outcomes like culture proven sepsis, use of ionotrops, need for oxygen support and assisted ventilation, feeding intolerance, Necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity and duration of hospital stay were significantly higher in hypotensive group. Mortality was also higher in hypotensive group than normotensive group (26.4% vs 3.3%, p &lt;0.001). Conclusion: Hypotension in preterm neonates was associated with significant mortality and morbidity in early post-natal period.

Comparative Study of Postoperative Outcome between Laparoscopic Mesh Repair &amp; Open Mesh Repair of Inguinal Hernia Patient in Tertiary Care Hospital in Bangladesh

Background: Inguinal hernia repair is a commonly performed surgical procedure, and the choice between laparoscopic and open approaches remains a subject of ongoing discussion. This prospective cohort study aimed to compare postoperative outcomes between laparoscopic mesh repair and open mesh repair in inguinal hernia patients in a tertiary care hospital in Bangladesh. Objective: This study aimed to assess and compare the surgical outcomes and patient recovery following laparoscopic and open mesh repair for inguinal hernias. Methods: A prospective study was conducted by Z.H. Sikder Women's Medical College Hospital and Central Hospital Ltd Dhanmondi Dhaka in Bangladesh, spanning from 2022 to 2023. It enrolled 112 individuals, each grappling with inguinal hernias; they were divided into two groups: one undergoing the intricate ballet of laparoscopic mesh repair (n=56) and the other navigating the venerable path of open mesh repair (n=56). With precision, we charted their demographics and chronicled intraoperative nuances. We scrutinized postoperative outcomes to illuminate the interplay between modern innovation and time-tested tradition in hernia care. Results: In our comparative study involving 112 patients (99.5% male, median age 30.8 ± 10.6 years), evaluating postoperative outcomes between laparoscopic and open mesh repair for inguinal hernias in a Bangladesh tertiary care hospital, significant differences were observed. The laparoscopic group demonstrated notably shorter operative durations (p&lt;0.05), a lower incidence of wound infections (p&lt;0.05), and reduced postoperative pain with lower analgesic requirements and shorter hospital stays (p&lt;0.05). Additionally, the laparoscopic group exhibited a faster return to normal activities and Work (p&lt;0.05). However, the mean operative time was significantly longer in the laparoscopic group (20.2 minutes, p&lt;0.001), while the time to return to duty was significantly shorter (2.3 days, p=0.008). Conclusions: Laparoscopic ....