Tertiary Care Hospital In Dhaka Research Articles

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.

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

Informal Caregiver’s Burden of Stroke Patients at Tertiary Care Hospitals in Dhaka

Informal Caregiver’s Burden of Stroke Patients at Tertiary Care Hospitals in Dhaka

Exchange Transfusion in Neonatal Hyperbilirubinemia: Experience of A Tertiary Care Hospital in Dhaka

Background: Hyperbilirubinaemia is a benign condition in newborn babies in some infants may become severe, progressing to kernicterus with substantial risk of neonatal mortality and long-term neurodevelopmental impairments. Among many treatment options exchange transfusion (ET) is the standard method for treatment of severe hyperbilirubinemia.
 Objectives: To investigate the frequency of primary risk factors for neonatal hyperbilirubinemia leading to ET, to evaluate the complications and immediate outcome of ET.
 Methods: This was an observational cross sectional study conducted in Dr. MR Khan Shishu Hospital and ICH, Dhaka. Frequency of primary risk factors for severe neonatal hyperbilirubinemia leading to ET, characteristics of babies undergoing ET, complications and immediate outcome of ET were analyzed among the neonates admitted between January 2017 to February 2021.
 Results: Among 61 neonates 49.18% were male and 50.82% were female, 65.57% of neonates were term and 34.43% pre term. The mean gestational age was 37.00 ± 1.50 weeks and mean birth weight was 2619±50gm. The leading causes of jaundice requiring ET were sepsis 31.17%, ABO incompatibility 24.59%, Rh incompatibility 14.75%, PT LBW with sepsis 14.75%, Infant of diabetic mother (IDM) 6.55%, PT LBW 6.55%, and neonatal sepsis with Down syndrome with congenital hypothyroidism 1.63%. Twenty (32.79%) neonates presented with signs of Kernicterus. Seven neonates (35%) presented with lethargy/poor feeding or hypotonic posture, 4(20%) patients had opisthotonus posture/hypertonia, and 9(45%) had convulsion. Nineteen (31.14%) neonates had complications related to ET. The most frequent complication was bradycardia (16.34%), then Catheter block (9.83%), apnaea (6.55%), cardiac arrest (6.55%), hypothermia (4.92%), NEC after ET (1.64%). Immediate outcome was good in 72.13% patients with smooth recovery, 14.75% had neurological deficit and 1.64% died. Among 20 neonates who presented with signs of Kernicterus 35% patients discharged with good recovery, 45% had neurological deficit.
 Conclusion: The common causes of exchange transfusion in neonatal jaundice were sepsis, ABO incompatibility, PT LBW, and infants of diabetic mothers. Overall outcome was good few developed neurological deficit.
 DS (Child) H J 2022; 38(2): 89-95

Detection of Carbapenemase Genes by Molecular Method among Gram-Negative Bacilli Isolates from Tertiary Care Hospital in Dhaka, Bangladesh

Background: Imipenem resistance in Gram-negative bacilli is a global epidemic that is increasing day by day.To warn this global epidemic, identification and ongoing surveillance of carbapenem-resistant genes among Gram-negative bacilli needed.Objectives: This cross-sectional study was performed todetect the imipenem resistant genes among Gram-negative bacilli isolated from different samples in Dhaka medical college hospital.Methods: About 300 samples (wound swab, urine, endotracheal aspirate, blood, and sputum) were collected from July 2015 to June 2016. Among them, 204 isolates were Gram negative bacilli. Eighty imipenem resistant Gram-negative bacilli were isolated by disc diffusion method. Among them, carbapenem resistant genes (blaNDM-1, blaKPC, VIM, IMP) were detected by PCR.Results: A total 300 samples were analyzed. Out of 204 Gram negative bacilli,80 (39.21%) imipenem resistance was detected by the Disc Diffusion method. Out of 80 imipenem resistant organisms, 42 (52.5%) were positive for blaNDM-1, 6 (7.34%) were positive for blaKPC, 29 (36.25%) were positive for VIM, 13 (16.25%) were positive for IMP.Conclusion: This study illustrates the emergence of carbapenemase genes producing Gram negative bacilli isolates from patients. Close surveillance across all hospitals in Bangladesh is required. J Shaheed Suhrawardy Med Coll 2022; 14(1): 3-7

Abstract #1606661: Assessment of Vitamin D Levels in Female Patients With Type 2 Diabetes Mellitus Attending A Tertiary Care Hospital in Dhaka, Bangladesh

Abstract #1606661: Assessment of Vitamin D Levels in Female Patients With Type 2 Diabetes Mellitus Attending A Tertiary Care Hospital in Dhaka, Bangladesh

Dengue Fever Presenting with Concomitant Acute Coronary Syndrome (ACS) - A Series of 5 Cases At A Tertiary Care Hospital In Dhaka

Dengue fever may present with many cardiovascular manifestations contributing to death and disability. Acute Coronary Syndrome (ACS) during dengue is rare but poses important management dilemma. Here we present a series of 5 patients with dengue fever who developed different types of ACS during the ongoing dengue endemic in Bangladesh. Five patients admitted with dengue fever and who developed ACS between 1st July to 30th September 2023 at Medicine Department of Uttara Adhunik Medical College, Dhaka, Bangladesh were studied. All the patients had some co[1]morbidity like diabetes, hypertension, or both. Treatment of ACS was tailored according to their CBC report, most importantly, platelet count, and hematocrit. Four out of the 5 patients responded well to anti-ischemic therapy, even though anti-platelet and anti-coagulants could not be given in all cases. There was 1 fatality, but that was due to ARDS consequent due to severe bilateral pneumonia. Management of ACS in dengue is challenging. Physicians should have appropriate preparedness to deal with these cases. J Bangladesh Coll Phys Surg 2023; 41: 82-87

Emergency Peripartum Hysterectomy and its Outcome in a Tertiary Care Hospital in Dhaka City, Bangladesh

Introduction: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. EPH is a challanging but life saving obstetric procedure performed when medical and surgical conservative measures fail to control postpartum haemorrhage .The present study aimed to review the peripartum hysterectomies and to compare the incidence, indications and outcome of EPH. Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Dhaka, Bangladesh. Total 62 cases have taken, who had hysterectomy that was performed in Obstetric and gynaecology department of Addin Womens Medical College Hospital during the period between January 2020 and December 2022. Result: There were total of 36371 deliveries over the study period and EPH was performed in 62 cases making an incidence of 0.408. In this study 33.8% patients were between 35 to 39 years. Here 45.16% had their parity between 2nd and 3rd child. Here 61.2% had previous history of caesarean section, 24.19% had previous history of antepartum haemorrhage, 74.19% cases intrapartum operation had done. Among 62 cases of EPH 77.4% cases subtotal hysterectomy had done. Here, among 62 cases of caesarean section 35.48% had placenta accrete and 20.96% had history of placenta previa with haemorrhage and 12.9% had severe PPH due to atony of uterus. 22.5% cases had fetal outcome of still born but 32.25% baby born alive. In this study 51.6% cases patients develop haemorrhage as perioperative complication, 19.5% develop shock but 100% required blood transfusion among which 50% were in post operative period. Here 6 out of 62 cases had bladder injury, 5 patients needed relaparotomy due to haemoperitoneum caused by vaginal cuff bleeding. Mortality rate was 4.83%. Conclusion: Now a days the indication of EPH has changed from uterine atony to abnormal placentation. It is a most important obstetric surgery performed in life threatening haemorrhage. Involvement of an experienced obstetrician at an early stage of management and efforts should be taken to reduce morbidity and mortality. Sir Salimullah Med Coll J 2023; 31: 107-111

Assessment of Risk Variables in the Post-Anesthesia Care Unit of a Tertiary Care Hospital in Dhaka

Background: In a location apart from the regular intensive care unit (ICU), the postanaesthetic care unit (PACU) provides postoperative high-dependency or intense care for high-risk surgical patients. Therefore, it meets the population's well-documented need for better postoperative care. Objectives: The aim of the study was to Assess the risk variables in the post-anesthesia care unit of a tertiary care hospital in Dhaka. Methods: This cross-sectional descriptive study was carried out in the Department of anesthesiology, Uttara Adhunik Medical College Hospital, during October 2020 to September 2021. A total of 100 patients were participate in this study. Patients underwent tonsillectomy, hysterectomy, caesarean section, and laparoscopic cholecystectomy, both male and female were included in this study. Patients who have not given consent to participate in the study were excluded from the study. Statistical Packages for Social Sciences (SPSS-26), where required. Results: About 40% patients were male and 60% were female. 80% of the patients were under ASA classification-1, 15% under ASA classification-2 and 5% were under ASA classification ≥3. Here, 22.22% patients had pre-exixting co-morbidity of respiratory, CVS neurological disease respectively. 30% had DM. Only 3.33% and more than 1 pre-exixting co-morbidity. 94.20% patients had no risk of surgery and only 5.80% patients were under risk of surgery. About 40% patients stayed 60-120 minutes in the post anesthesia care unit, 30% patients stayed 120-180 minutes in the post anesthesia care unit, 20% patients stayed 180-240 minutes in the post anesthesia care unit and 10% patients stayed ≥240 minutes in the post anesthesia care unit. 5% patients had develop complication in the post anesthesia care unit for 1-2 hours, 32% for 2-3 hours, 20% for 3-4 hours and 25% for more than 4 hours. Conclusion: The main reasons for a prolonged stay in the post-anesthesia care unit are perioperative cardiovascular and respiratory ....

Sleeping Disturbance and its Associated Risk Factors Among Type 2 Diabetes Mellitus Patients Attending in a Tertiary Level Hospital in Dhaka City Bangladesh

Objective: Poor sleep quality is an unreported and unrecognized problem which can affect the prognosis of diabetes patients. The aim of this study was to assess the prevalence of poor sleep quality and its associated factors among patients with diabetes mellitus in a tertiary care hospital in Dhaka. Methods: A hospital-based cross-sectional study was conducted among 343 diabetes mellitus patients at the Razarbagh Central Police Hospital from October 2021 to March 2022. A convenience sampling method was used to reach the study subjects. An interviewer-administered questionnaire was used for data collection. Pittsburgh sleep quality index was used for assessing sleep quality. Result: The overall prevalence of poor sleep quality was 81.85%. Multivariable analysis of the factors found that married person (AOR: 6.10, 95% CI: 1.03-35.93, p= 0.04), alcohol consumption (AOR: 12.11, 95% CI: 1.39-65.53, p= 0.02), no physical exercise (AOR: 11.99, 95% CI: 1.26-78.93, p= 0.03), HbA1c (AOR: 3.48, 95% CI: 1.21-21.71, p= 0.01) and low HDL (AOR: 18.60, 95% CI: 6.73-94.56, p= 0.04) were significantly associated with poor sleep. Conclusion: In this study, more than 80% patients had poor sleep quality. Drinking alcohol, smoking type 2 diabetes mellitus, and poor glycemic control were factors in poor sleep quality.

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

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

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

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

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

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

Characterization of COVID-19 infection in children: A 6 months experience in a tertiary care hospital in Dhaka, Bangladesh

Background: Corona virus disease is a global health crisis, a surprising feature of the disease reflects that children might be less affected in the initial stage. Previous studies suggest that COVID-19 more likely to infect adults, but paediatric patients are on the rise. In most of the cases children have mild or moderate symptom of COVID-19, but another new serious presentation emerged named Multisystem inflammatory syndrome in children (MIS-C) which includes features like Kawasaki disease or toxic shock syndrome. The past few months we have seen a lot of findings and variation regarding the COVID-19 illness. As childhood presentation are variable analyzing the pattern of disease in children helps the policy makers to make the better strategies and health care givers to serve better.
 Objectives: This study was conducted to assess the age and sex distribution, clinical presentations, morbidity, mortality pattern in children with COVID-19 infection.
 Methods: This descriptive study conducted in the Outpatient Department of Pediatrics and dedicated COVID-19 unit of Anwer Khan Modern Medical College Hospital, Dhaka, Bangladesh from May 2020 to November 2020. 24 children with RT-PCR positive for COVID-19 were included in this study. Medical records of these patients were reviewed and data were analyzed using SPSS software version 20.
 Results: The total number of children with RT-PCR positive for COVID-19 during the study period was 24. The male female ratio was 1.4:1. Most of the patients were aged over 10 years 9(37.5%). Fever (92%), cough (75%) and headache (50%) were the most common clinical features. A total 10 (41.7%) patients presented with mild clinical symptoms, 6 (25%) were severe to critical state and 2(8.3%) patients found with features with MIS-C. No mortality was observed.
 Conclusion: The paediatric patients with COVID-19 had mild illness and had good prognosis. The child with MIS-C need early intervention for better outcome.
 AKMMC J 2021; 12(1) : 45-51

Clinical characteristics of children with infantile epileptic spasms syndrome from a tertiary-care hospital in Dhaka, Bangladesh

BackgroundWe describe patient characteristics and response to initial treatment in a large case series of children presenting with infantile epileptic spasms syndrome to a tertiary-care hospital with a pediatric neurology service in Bangladesh. The purpose of the study was to add to the growing body of literature on infantile epileptic spasms syndrome in low- and middle-income countries. MethodsWe enrolled 212 infants with new-onset infantile epileptic spasms syndrome (IESS) at the time of initial presentation to the National Institute of Neurosciences and Hospital (NINS) in Dhaka, Bangladesh, between January 2019 and August 2021. We collected data about seizure type and frequency, etiology, medication dosage, and available neuroimaging. ResultsMedian age at initial presentation to NINS was 9 months. Developmental delay and regression prior to presentation were found in 83% and 36%, respectively. Prior to their presentation at NINS, 197 (93%) patients had received anti-seizure medication to treat spasms, of whom only 8 (4%) had received standard therapy with ACTH, prednisolone, or vigabatrin. At NINS, 207 (98%) of patients received standard therapy, most frequently ACTH in 154 (73%). Median time between seizure onset to receipt of first-line therapy was 5 months. Of the 169 patients who were seen in follow-up at average of 5 weeks, 92 (54%) reported absence of clinical epileptic spasms. No serious adverse events requiring hospitalization were reported. ConclusionsThis study highlights the long lead times to treatment for IESS in a low- and middle-income country, and the need for early referral of children with suspected epileptic spasms to epilepsy care centers.

Epidemiology and Antibiogram of Clinical Staphylococcus aureus Isolates from Tertiary Care Hospitals in Dhaka, Bangladesh

Background: This study aimed to investigate the epidemiology and antibiogram of clinical Staphylococcus aureus isolates from three tertiary care hospitals in Dhaka , Bangladesh. Methods: A total of 185 clinical S. aureus isolates were studied from March 2016 to February 2017 and identified by standard microbiological methods and an antibiogram was determined by disc diffusion method. A duplex polymerase chain reaction (PCR) assay was performed on all isolates to detect femA and mecA genes of S. aureus. Results: Among the 185 isolates, all (100%) were positive for the femA gene, 76 (41.1%) were methicillinresistant S. aureus (MRSA), and 109 (58.9%) were methicillin-susceptible S. aureus (MSSA). The highest and the lowest frequency of both MRSA were isolated from pus and urine specimens, respectively. All 185 S. aureus were 100% sensitive to both vancomycin and linezolid and were highly sensitive towards rifampicin (94%), meropenem (87%), gentamicin (85.4%), and cotrimoxazole (82.2%), whereas the highest resistance was against penicillin G (94.6%) followed by amoxicillin/clavulanic acid (82.7%), azithromycin (72.4%), amoxicillin (66.5%), and ciprofloxacin (63.2%). After vancomycin and linezolid, MRSA showed good susceptibility to rifampicin, cotrimoxazole, and gentamicin, while MSSA exhibited high sensitivity toward rifampicin, gentamicin, cefoxitin, meropenem, cloxacillin, ceftriaxone, and cotrimoxazole. Furthermore, MRSA was significantly more resistant to antibiotics than MSSA (P value<0.05), and the majority of S. aureus (81.1%), MRSA (97.4%), and MSSA (69.7%) were multidrug-resistant (MDR). Conclusion: Our findings can guide physicians to provide effective antibiotic therapy, implement monitoring and control strategies to reduce antimicrobial resistance, and prevent the dissemination of MRSA and MDR in the environment.

#1324169: HbA1c Thresholds for Initiating Insulin Therapy in Patients with Type 2 Diabetes Mellitus Attending A Tertiary Care Hospital - An Observational Study

Insulin therapy is often eventually required to maintain optimal glycaemic control for the patients with type 2 diabetes mellitus (T2DM). An ongoing challenge is to take the decision to initiate insulin in the management of type 2 diabetes in terms of selection of ideal regimen and glycaemic targets. Insulin initiation is an important transition of care from the perspective of both providers and patients. We characterize the level of glycaemic control at which insulin was initiated in patients with T2DM attending a tertiary care hospital in Dhaka , Bangladesh.

Abstract #1325773: A Comparative Study on Postmenopausal Symptoms in Diabetic and Non-Diabetic Women Visiting a Tertiary Care Hospital in Dhaka, Bangladesh

Menopause is a natural phenomenon occurring as women approach middle age. It is characterized by declining of ovarian function and onset of the last menstrual period and subsequent 12-month cessation of menstruation. Menopause is associated with somatic, vasomotor, psychological, and sexual complaints that may affect quality of life. The presence of menopausal symptoms significantly reduces the quality of life, and with more severity, worsens the quality of life. Due to a growing aging population and longer life expectancy, Bangladeshi women will spend a significant portion of their lives in postmenopause.

Evaluation of Blood Requisition Forms Submitted to Transfusion Medicine Department of a Tertiary Care Hospital in Dhaka, Bangladesh

Introduction: Blood requisition form (BRF) analysis is one of the most efficient and effective approaches to assess and monitor rational use of blood and its product. BRF is the first line of communication between the clinicians and transfusion medicine specialists which helps to recognize and evaluate inappropriate use of blood. This issue is frequently underrated by the clinicians which results in increased risk of inappropriate transfusion. The current study is aimed to examine the pattern of completion of blood requisition forms and to ensure safe blood transfusion. Materials and methods: This cross sectional prospective study was conducted from January 2020 to December 2021, at the Department of Transfusion Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh. A total of 32,133 blood requisition forms that were submitted during the study period were compiled and reviewed anonymously. The data were analyzed using Microsoft Excel. Results: During the study period, a total of 32,133 Blood requisition forms were analyzed. Only 15.2% of these forms were duly completed. Rest of the forms had one or more important parameters left blank. The most common incomplete BRF items were the clinical history or differential diagnosis of the patient (52.66%), presumed date and time of transfusion (95.19%), previous transfusion history (95.9%), and referring doctor’s name and designation (88%). Blood requests were more for females (52.02%) than males (47.98%) during the period. Requisitions were more for adults (90%) than pediatric patients. Conclusion: The current study provides evidence that the rate of completion of BRFs is not satisfactory. The request forms evaluated were not covering acceptable demographic and clinical data of the patients. Both the Hospital Transfusion Committee (HTC) and the Department of Transfusion Medicine can help to improve and standardize transfusion practice by working together. Sir Salimullah Med Coll J 2022; 30: 142-147

Microbial Pattern and their Sensitivity of Ventilator Associated Pneumonia in an Intensive Care Unit of a Ter-tiary Care Hospital in Dhaka

Background: ICU admission imposes great risk of nosocomial infections on the patients due to various invasive interventions. Patients treated in these units receive invasive procedures such as endotracheal intubation and mechanical ventilation which predispose to a nosocomial pneumonia of a special entity named as ‘Ventilator Associated Pneumonia’. Almost half of all the cases of hospital acquired pneumonia are due to VAP and about half of all antibiotics administration in ICU are for treatment of Ventilator Associated Pneumonia. Objectives: objective of the current study was to study the local microbiological profile of ventilator associated pneumonia and their sensitivity pattern in the Critical Care department of BIRDEM general hospital. Design: Cross-sectional study. Setting: ICU of an academic tertiary care hospital in the period of July 2017 to June 2018. Methods: All consecutive patients who were intubated and mechanically ventilated for a period of at least 48 hours within the study period were evaluated for the selection criteria of the study. The included study participants were followed up daily for signs of development of VAP. Once VAP was suspected pertinent investigations were sent to confirm the diagnosis. Tracheal aspirate was collected using conventional specimen trap and aseptic endotracheal suctioning technique and sent for Gram staining and culture and sensitivity testing. Results: In this study total 92 patients out of 625 intubated patients during the study period after fulfilling the inclusion criteria were selected as study participants. 35 participants out of 92developed VAP. Only 1 (2.9 %) patient did not yield any microbial growth in the tracheal aspirate sample and 34 (97.2 %) participants had growth of organisms in their tracheal aspirate samples. Total growths of 45 organisms were found in respiratory secretions of 34 VAP patients. The commonest organism was Acinetobacter which was grown in 21 (46.7%) samples followed by Pseudomonas in 10 (22.2%) samples; Klebsiella in 8 (17.8%) samples; Staphylococcus aureus in 3 (6.7%) samples; Candida in 2 (4.4%) and Enterococcus in 1 sample (2.2%). Most of the bacteria grown in the tracheal aspirates of VAP positive participants were sensitive to less than three antibiotic classes. Conclusion: Multidrug resistant organisms are mostly responsible for both early and late onset VAP in ICU. Bangladesh Crit Care J September 2022; 10(2): 122-126