Tertiary Care Hospital In Bangladesh Research Articles

Pattern of Rapidly growing Mycobacteria (RGM) species isolated from clinical samples: A 10-year retrospective study in a tertiary care hospital of Bangladesh.

Infections caused by rapidly growing mycobacteria (RGM) are increasing worldwide. The study was conducted in a microbiological laboratory of Bangladesh to determine the pattern of detection of RGM from clinical samples. All laboratory culture records of RGM from 2012 to 2022 were collected retrospectively and analyzed. A total 62 RGM infected patients with surgical site infection (74.1%), injection site and skin abscess (9.7%), septicemia (4.8%) and UTI (1.6%) were identified. The annual isolation frequency of RGM increased 4.8% to 29.1% in between year 2012 and 2022. RGM infected patients (14.5%) were mistakenly treated with first line anti tubercular drug before correct microbiological diagnosis (median, IQR; 3, 2-5 months). Out of 23 RGM isolates, 86.9% were M. abscessus and rest 13.1% were M. fortuitum. Most of them (≥95%) were sensitive to amikacin, linezolid, clarithromycin where as 27.1% to imipenem and ciprofloxacin, 40% to cefoxitin, 35.3% and 1.7% to doxycycline and co-trimoxazole respectively. Misdiagnosis or delay in diagnosis and erroneous treatment with first line anti tubercular drug may cause prolong morbidity and therapeutic failure to patients with RGM infection. So, early and appropriate diagnosis is crucial for successful outcome.

The Clinical and Biochemical Profiles and Outcomes of Dengue Fever and Dengue Hemorrhagic Fever in Children During a Dengue Outbreak in 2022 at a Tertiary Care Hospital in Bangladesh

This study aims to determine the analysis of the influence between the level of knowledge on the behavior of using paracetamol syrup in parents in the community and health care facilities in the city of Bandung. The research method used was analytic-correlation in a cross sectional approach. The sampling technique used was accidental sampling. Data collection was carried out using a questionnaire with data analysis using the Spearman Rank correlation test. The results showed that the level of knowledge of parents or guardians in the community (community) and three health care facilities in Bandung City (Pharmacy, Clinic, Puskesmas) the majority had high knowledge (65.13%). The behavior of using paracetamol syrup in parents or guardians in the community (community) and three health care facilities (Pharmacies, Clinics, Puskesmas) the majority had very good behavior (67.58%). In this study, the level of knowledge affects the behavior of paracetamol syrup use in the community (community) and three health care facilities in Bandung City (Pharmacies, Clinics, Puskesmas). So that the better the knowledge, the better the behavior of using paracetamol syrup.

Frequency of Surgical Site Infections Following Emergency Non-Traumatic Abdominal Operations- A Study in a Tertiary Care Hospital in Bangladesh

Frequency of Surgical Site Infections Following Emergency Non-Traumatic Abdominal Operations- A Study in a Tertiary Care Hospital in Bangladesh

Pattern of Onychomycosis among Diabetic and Non-Diabetic Patients at a Tertiary Care Hospital in Bangladesh

Any fungal infection affecting the nail apparatus is referred to as onychomycosis. Onychomycosis is a prevalent nail infection worldwide and is more common among patients with diabetes. A variety of fungus species are responsible for onychomycosis. The purpose of this study was to determine the pattern of onychomycosis among patients with and without diabetes at the Department of dermatology and venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, Bangladesh. In this study, a total of 87 clinically diagnosed patients of onychomycosis with diabetic or non-diabetic were included purposively. The infected nail materials were scraped and then processed in Sabouraud's dextrose agar media (SDA) and Dermatophyte test media (DTM) for microscopy and culture. Clinical features, microscopic examination findings and culture interpretations were recorded and compared between the groups. Out of 87 patients of onychomycosis, 54 patients had diabetic and 33 patients were non-diabetic. Growth of fungus was found significantly higher among diabetic patients (85.19% versus 57.58%, p= 0.004). Dermatophytes were more frequent in diabetic patients, but Candida albicans and non-albicans Candida species were more common in non-diabetic patients. Trichophyton rubrum, and Trichophyton mentagrophytes were found in 24 (44.44%) and 19 (35.18%) diabetic patients. On the other hand, Candida albicans 8 (24.24%) and non-albicans candida species 8 (24.24%) were found majority of the non-diabetic patients. Nail discoloration and disfigurement of nails are the common presentation of onychomycosis. Dermatophytes are significantly more frequent among diabetic patients. The clinical presentation of onychomycosis in patients with diabetes differed from that in non-diabetic subjects.

Epidemiology of Sexually Transmitted and Dermatological Diseases among Patients in 250 Bedded General Hospital, Jamalpur, Bangladesh

Background: Skin diseases are widespread in developing nations. It is commonly acknowledged that the occurrence and characteristics of skin and venereal diseases vary across countries and even within different regions of a single country. These variations are influenced by a complex interplay of social, economic, racial, and environmental factors. Objective: To assess the epidemiology of sexually transmitted infections and skin illnesses among patients visiting the outpatient department of a tertiary care hospital in Bangladesh. Methods: This study was conducted at the outpatient department of skin and venereal diseases at the 250-bedded General Hospital in Jamalpur. The study took place from January 2023 to June 2023 and used a descriptive cross-sectional design. A total of 150 patients, spanning all age groups and presenting with various skin and venereal diseases, were included as the study sample from the 250-bedded General Hospital in Jamalpur during the study period. Data collection was conducted using the purposive sampling method. Results: The study findings revealed that a significant proportion of the patients (28%) fell within the age range of 20-29 years, with 23.3% and 18.7% falling within the age ranges of 10-19 years and <10 years, respectively. A mere 7.3% of individuals were encompassed within the age bracket of 50 years and older. Out of the 150 patients, a majority (54.70%) were male. In the study it was discovered that a noteworthy 14% of the patients were affected by venereal diseases and 86% of the patients were affected by skin diseases. It was particularly noteworthy that the highest prevalence of these venereal diseases was concentrated within the 20-29 years age range, affecting approximately 14.29% of individuals within this group. Specifically, 19.51% of males in the study were found to have venereal diseases, in contrast to a lower prevalence of 7.35% among females. Non-Gonococcal Urethritis (NGU) was a notable condition observed ...

Relationship Between Gross Motor Function and Nutritional Status of Children with Cerebral Palsy-A cross-sectional study in a Tertiary Care Hospital of Bangladesh

Background: Cerebral Palsy (CP) is one of the most common causes of chronic disability in children. Childhood malnutrition is a major public health issue in low- and middle-income countries. The gross motor function of children with CP can easily be assessed by the tool Gross Motor Function Classification System- Expanded &Revised (GMFCS-E&R). This study aimed to determine the relationship between GMFCS and nutritional status in children with cerebral palsy. Method: This cross-sectional observational study was conducted in the Department of Pediatric Neurology, IPNA, BSMMU from October 2019 to August 2020. All the patients aged 2-12 years were diagnosed as CP by clinical criteria and classified by GMFCS. Nutritional status (weight for age, height for age, weight for height, BMI) is assessed and classified according to the World Health Organization growth charts. Then linear and multinomial logistic regression methods to determine the associations between GMFCS and nutritional status. The correlation between motor function and nutritional status was assessed. Results: Among the 50 children 68% were male and 32% were female. The mean age of the CP children was 4.90±3.05 years. Most patients (66.0%) came from poor families followed by 24% from the middle class. Functionally majority of patients were in GMFCS level IV (28.0% ) and level V (20.0%). Maximum patients in spastic quadriplegia 42%, spastic hemiplegia 16%. The level of GMFCS was associated with nutritional status, as determined by anthropometry. Moderate and severe underweight significantly related with GMFC level IV and V. Moderate and severe stunted was significantly related with IV and V GMFC level. Moderate wasted was significantly related to GMFC levels III and IV. Mild malnutrition was significantly with GMFC level II and III. Severe malnutrition is significantly related to GMFC level IV and V. Conclusion: This study showed majority of cerebral palsy cases had severe functional gross motor disability and also severe grade of malnutrition. A significant association between severe grade of malnutrition and severe grade of motor disability was found. J Bangladesh Coll Phys Surg 2024; 42: 342-349

Pattern of Surgical Antibiotic Prophylaxis in a Tertiary Care Hospital of Bangladesh

Background: Surgical Site Infection (SSI) is a common form of hospital-acquired infection and major cause of postoperative illness accounting for approximately a quarter of all nosocomial infections. As a result, surgical antibiotic prophylaxis is now considered essential to conventional surgical procedure in order to reduce surgical site infections and improve postoperative recovery. The misuse and overuse of antibiotics has led to an increase in treatment costs and the emergence of antimicrobial resistance. The goal of the study is to identify the pattern of prophylactic antibiotic prescriptions for different surgical operations. Materials and methods: A retrospective observational study was conducted among 600 patients undergoing different surgeries in a tertiary care hospital of private setting in Dhaka, Bangladesh from July 2023 to December 2023. The demographic data, types of surgery, types of therapy, choice of antibiotic along with dosage formulations were collected. Results: Out of 600 patients, 245 (41%) were male and 355 (59%) were female. Highest bulk of patients were from Department of General Surgery (47.5%), followed by Department of Obstetrics & Gynecology (24.16%) and Department of Otolaryngology (16.7%). Surgical prophylactic antibiotic was used in all 600 patients, and all antibiotics were given in intravenous route (100%). Almost 505 patients (84.2%) had received ceftriaxone as antimicrobial agent. Ceftriaxone with metronidazole or gentamicin and Cefuroxime with metronidazole or amikacin drugs combination were given to 75 (12.5%) and Cefuroxime, Amikacin, Metronidazole drugs combination were given to 20 patients (3.3%). 3rd generation cephalosporin, Ceftriaxone, was the most commonly prescribed antibiotic as monotherapy (94.3%), followed by 2nd generation cephalosporin, cefuroxime (4%). Conclusion: Ceftriaxone was the preferred antibiotic for surgical prophylaxis. Existence of an antimicrobial guideline along with antibiotic stewardship program in every hospital could be helpful for prescribers to play role in containment of antimicrobial resistance. EWMCJ Vol. 12, No. 1&2, January-July 2024: 70-74

Pattern of Birth Defects, Association And Their Outcomes Among Neonates In A Tertiary Care Hospital In Bangladesh

Introduction: Birth defects are one of the major cause of stillbirths and neonatal mortality in developed and developing countries. The prevalence of birth defects varies in different parts of the world. In many cases, the causes are unknown; however, several factors known to be associated are genetic factors, maternal age, health, dietary factors, maternal infections, geographical factors, drugs, smoking and irradiation. Objectives: To identify the pattern of birth defects, association and their outcomes among neonates Methodology: This observational cross-sectional study was conducted in the department of neonatology, Dhaka Medical College Hospital, Dhaka from 1st July 2019 to 30th June 2021. Sample was collected by purposive sampling technique. Total 407 babies were enrolled. Out of them 207 babies were with birth defects in group-A and 200 babies had no birth defects in group-B. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigations were done. Data processing work consist of registration schedules, editing computerization, preparation of dummy table, analyzing and matching of data. Results: In this study the two study groups were almost similar with respect to their demographic characteristics like sex, residence, place of delivery, mode of delivery, gestational age, parity and maternal age. The total number of admission during this period was 3050 and total number of birth defects was 207 (6.78%0). In this study on evaluation of maternal risk factors, group-A maternal high blood pressure were in 25.12% cases( OR=1.62;p=.002), maternal diabetes were in 15.46% cases( OR=1.12;p=.001), poor maternal nutritional status was 14.50%( p=.001), history of taking folic acid was 9.66%(OR=0.10;p=.001), 5.80% of the patient had history of exposure to antenatal radiation(OR=.06;p=.001), 4.43% had history of consanguinity(OR=.05;p=.001), 2.420% of women noticed that exposure to pesticides(OR=.025;p=.001), H/O of taking anticonvulsant was 2.420%(OR=.025;p=.001). Group-B was maternal high blood pressure in 7.25% cases(OR=.078;p=.001), maternal diabetes were in 6.28% cases(OR=.067;p=.001), poor maternal nutritional status was 5.80%(p=.001), history of taking folic acid was 4.83% (OR=.051;p=.001), 1.45% of the patient had history of exposure to antenatal radiation(OR=.015;p=.001) and 0.97% had history of consanguinity(OR=.01;p=.001). In this study pattern of birth defects summarized as the cardiovascular system defects was the most commonly affected(26.57%), followed by defects in the head, neck ear,- and eye(19.32%), Syndromes(14.50%), gastrointestinal defects(12.56%), musculoskeletal system defects(10.14%), central nervous system defects (8.70%) and genitourinary system(4.83%) of total defects. In group-A 78.26% of the patients recovered and 23 patients expired during hospital stay (p=.001). In group-B 85.99% of the patients recovered and 17 patients expired. Conclusion: Congenital cardiac defects were the most prevalent anomaly detected. Maternal high blood pressure and diabetes are the risk factors of birth defects in neonates. Antenatal diagnosis and proper management can improve the outcome of these neonates. J Dhaka Med Coll. 2023; 32(1) : 43-50

The Risk Factors for Recurrence after Inguinal Hernia Surgery: A Prospective Study of a Tertiary Care Hospital in Bangladesh

The Risk Factors for Recurrence after Inguinal Hernia Surgery: A Prospective Study of a Tertiary Care Hospital in Bangladesh

Implementation of Postpartum Hemorrage Emergency Care Using Bundle Approach at a Tertiary Care Hospital in Bangladesh

Implementation of Postpartum Hemorrage Emergency Care Using Bundle Approach at a Tertiary Care Hospital in Bangladesh

Pattern Of Antibiotic Resistance In Urinary Tract Infections: Insights From A Tertiary Care Hospital In Bangladesh

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections, with increasing rates of antibiotic resistance complicating treatment. This study aimed to assess the prevalence and antibiotic resistance patterns of uropathogens in patients with UTIs at a tertiary care hospital in Bangladesh. Methods: A cross-sectional, retrospective study was conducted from June, 2023 to July, 2024 involving 60 UTI patients. Clinical and microbiological data, including urine cultures and antibiotic susceptibility tests, were collected. Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed using SPSS version 26.0. Results: Escherichia coli was the most frequently isolated pathogen (50.0%), followed by Klebsiella spp. (20.0%). Both pathogens exhibited high resistance to ciprofloxacin (66.7%) and amoxicillin (83.3%) (p < 0.05). Pseudomonas spp. showed 66.7% resistance to ceftriaxone, and Proteus spp. exhibited 75.0% resistance to nitrofurantoin. However, E. coli and Klebsiella spp. demonstrated higher susceptibility to nitrofurantoin and gentamicin, with 50.0% and 66.7% susceptibility, respectively. Conclusion: The findings indicate a high prevalence of antibiotic-resistant uropathogens, particularly E. coli and Klebsiella spp., in the study population. Nitrofurantoin and gentamicin remain effective treatment options. These results highlight the urgent need for updated empirical treatment protocols and regular monitoring of resistance patterns to guide UTI management in Bangladesh.

Recurrent Urinary Tract Infection- Etiology, Risk Factors and Outcome in a Tertiary Care Hospital of Bangladesh

Background: Urinary tract infections (UTIs) are one of the major causes of morbidity and comorbidities in patients with underlying conditions, and it accounts for the majority of the reasons for hospital visit globally. The high prevalence of recurrent UTIs represents a modifiable determinant for both societal and personal burdens, hence the importance of disease prophylaxis. Consultations for UTIs represent between 1% and 6% of all medical visits (~7 million visits and ~US$1.6 billion annually). They are associated with a significant burden of morbidity and mortality in the elderly, among whom UTIs are most prevalent. Methods: This cross-sectional descriptive type of observational study was conducted in the Department of Nephrology in Anwer Khan Modern Medical College Hospital, Dhaka, Bangladesh from January 2023, to December 2023. A total no of 93 patients were included in the study. Inpatients, age range 21-85 years, presenting or highly suspicious of having UTIs and the occurrence of ≥2 symptomatic episodes within 6 months or ≥3symptomatic episodes within 12 months were recruited in the study. Any patient who was terminally ill, who fails to give urine samples, with a history of antibiotic administration in the last two weeks and any female who was in their menstruation period were excluded from the study. Results: Among them 79 were female and 14 were male. Female to male ratio was 5.64:1. Mean age of the patients was 58.61±17.51 (Mean±SD). Most of the patients were of 61-70 years age group 23/93 (24.73%) and after that41-50 years 19/93 (20.43%). 92.47% (86/93) were married and 7.53% (7/93) were unmarried. Most of the patients were of Diabetes mellitus (DM) 57/93 (61.29%). After that Hypertension, Chronic Kidney Disease (CKD) and CKD + DM about 51/93 (54.84%), 39/93 (41.94%) and 36/93 (38.71%) respectively. 54/79 (68.35%) were of menopause and 24/79 (30.38%) women had regular menstrual cycle. 1/79 (1.27%) was pregnant.Escherichia coli(E coli) was the most prevalent uropathogens with 47/93 (50.54%) followed by Klebsiella pneumoniae 12/93 (12.90%), Pseudomonas aeruginosa 10/93 (10.75%), Streptococcus pyogenes 8/93 (8.60%), Staphylococcus aureus 6/43 (6.45%), Enterococcus faecalis 5/93 (5.38%) and others 5/93 (5.38%). 77.42% were of relapse and 22.52% were of reinfection. The Mean±SD of HbA1c was 7.83±2.15% and that of Serum creatinine and Hemoglobin were 2.17±1.18 mg/dl and 9.82±2.60gm%. On routine examination of urine, 39/93 (41.94%) patient had trace albumin present in urine and 57/93 (61.29%) had reducing sugar. 71/93 (76.34%) had1-2 pus cell in urine and 22/93 (23.66%) presented with plenty of pus cell with 19/93 (20.43%) had 0-4 RBC’s (Red blood cell). Factors associated with recurrent UTI were Age >50 years (56.99%), Female gender (84.95%), Married (92.47%), Menopause (58.06%), Diabetes mellitus (61.29%), Indwelling catheter >6 days (25.81%) and Genitourinary abnormalities (15.05%). Conclusion: This study has demonstrated that hospitalization, married individuals, duration of catheter, diabetes mellitus, genitourinary tract abnormalities, female gender and menopause are the most important factors associated with UTIs. Appropriate measures may help to reduce UTIs due to these associated factors. We recommend routine UTIs screening of patients of the following category: hospitalized, genitourinary tract abnormalities, indwelling catheter, diabetic, female gender, menopause and married individuals. If these routine checks are put in place, prevention of UTI can be realized at lower cost. Bangladesh J Medicine 2024; 35: 173-179

Prevalence of Hypothyroidism in Children with Transfusion Dependent Thalassemia Patient Attending in A Tertiary Care Hospital of Bangladesh

Background: Blood transfusions and iron chelation are standard treatments for β-thalassemia major and Hb E-Beta-Thalassemia. However, repeated transfusions raise body iron levels, leading to secondary hemosiderosis and complications in the heart, endocrine system, and liver. Thyroid dysfunction results from gland infiltration, chronic hypoxia, free radical damage, and iron overload. This study aimed to find out the prevalence of hypothyroidism in transfusion-dependent thalassemic children attending Bangladesh Shishu Hospital & Institute. Methods: A descriptive cross-sectional study was conducted at the Thalassemia Centre, Department of Hematology and Oncology, Bangladesh Shishu Hospital & Institute, from December 2019 to November 2020. The study included 140 children with thalassemia, aged 5 to 16 years, who were receiving blood transfusions. Data were collected using a structured questionnaire with participant consent. Statistical analysis was performed using SPSS version 23.0. Results: In this study, hypothyroidism was observed in 26.2% of patients, with 23.5% having subclinical and 2.9% overt hypothyroidism. In most of the patients (n=85), aged 11-16 years, 58.3% had normal thyroid function, 36.5% had subclinical, and 4.7% had overt hypothyroidism, which was statistically significant (p<0.05). Of the 91 patients with hemoglobin levels below 11.5 g/dL, 85.7% had normal thyroid function, 13.2% had subclinical hypothyroidism, and 1.1% had overt hypothyroidism, also significant (p<0.05). In the group with ferritin levels of 1200-2000 ng/mL, 78.1% had normal thyroid function, 18.8% had subclinical hypothyroidism, and 3.1% had overt hypothyroidism, which was not statistically significant (p>0.05). Conclusion: Subclinical hypothyroidism is commonly seen in thalassemia patients aged 5 to 16 years who undergo regular blood transfusions. Regular physical exams and thyroid function assessments are crucial to detect overt hypothyroidism early. Timely hormone replacement can

Exploring variations in dengue symptoms: a comparative study of 2013, 2019, and 2023 in a tertiary care hospital of Bangladesh

Background: Dengue fever remains a major public health issue in Bangladesh, with repeated outbreaks. This study compares dengue symptoms in a tertiary care hospital during 2013, 2019, and 2023. The purpose of this study is to evaluate the variations in dengue symptoms among Bangladeshi dengue patients from 2013 and 2019 to 2023. Methods: This was a cross-sectional study, conducted on 100 dengue positive patients, admitted between 1st January to 7th August 2023, to the Medicine Department, Holy Family Red Crescent Medical College and Hospital, Dhaka. Demographic data, sign and symptoms and laboratory investigation reports were collected. These data were compared with a previously published study from the same institute comparing dengue symptoms between 2013 and 2019 among admitted dengue patients. The study employed a convenience sampling method for participant selection, and data analysis was carried out using SPSS version 26. Results: Analysis of 100 sero-positive dengue cases reveals a predominant occurrence in the 20 to 40 age group (51%), with the mean age of patients being 34.5 years. Among these cases, a higher prevalence is observed in males (62%) compared to females (38%). Symptomatology exhibits variations over time, with fever being consistently present. Other symptoms such as headache (90%, 23% and 12%), retroorbital pain (45%, 3% and 16%), skin rash (16%, 4% and 1%) and constipation (32%, 1% and 5%) showing fluctuations, respectively in 2013, 2019 and 2023. Notably, a significant proportion of patients in 2023 exhibit normal ultrasound findings (53%). Conclusions: In conclusion, our study provides a comprehensive analysis of Dengue infection dynamics over a decade, highlighting significant variations in clinical manifestations, laboratory findings, and abdominal ultrasound results among Bangladeshi patients. The findings suggest that Dengue remains a considerable public health concern, with fluctuations observed in symptomatology, including fever and other associated symptoms, and changes in laboratory parameters over time. BIRDEM Med J 2024; 14(3): 131-136

Major cardiovascular and neurological events among diabetic patients with severe hypoglycaemia at a tertiary care hospital in Bangladesh

Background: Cardiovascular disease (CVD) is a major cause of death and disability among people with diabetes mellitus (DM). Hypoglycemia is a potential risk factor to augment life threatening CVD. This study intended to find out impact of severe hypoglycemia in adverse cardiovascular and neurological events among patients with DM. Methods: This cross-sectional study was conducted among diabetic patients with severe hypoglycemia (plasma glucose <70 mg/dl or 3.9 mmol/l) admitted in BIRDEM General Hospital from March 2014 to April 2015. Patients were categorized into two groups depending on blood glucose values (group A <2.8 and group B e”2.8) for analytical purpose. Major cardiac events including acute myocardial infarction (MI), non ST elevated MI or arrhythmia were observed along with neurological outcome including acute stroke, hypoglycemic encephalopathy and convulsion by both relevant clinical examinations and investigations as appropriate. Data were collected at discharge or death if any. Results: Among the 311 patients, 62% were in the age group of 51 to 60 years with mean age 49.02 years. Mean duration of DM was 8.5 (±5.4) years and in 85.5% cases HbA1c was e”7%. Majority was on insulin (79.41%); predominantly on premixed (33.5%) and self mixed (35.7%) regime. Meal related factors (p <0.001) e.g., delayed or missed meal, insulin related factors (p<0.001) e.g., miscalculation, overdosing were significant predisposing factors for developing hypoglycemia. Multivariate analysis revealed frequency of hypoglycemia was more in diabetic nephropathy (p<0.01), chronic liver disease (p=0.01), gastroparesis (p=0.01), cognitive impairment (p<0.001), established CVD (p=0.02) and adrenal insufficiency (p<0.01). Nocturnal hypoglycemia (33.80% ) and hypoglycemic unawareness (44.23%) was also observed among the participants. Cardiovascular events were found in 98 (31.55%) individuals which included any form of arrhythmia (p=0.02), non ST elevated MI (p=0.08) and ST elevated MI (p<0.008). Among the neurological events (n=67, 21.54%), hypoglycemic encephalopathy (p<0.02) and acute stroke (p=0.01) were significant. Seizure happened in 15 individuals (p=0.53). Nine patients died (death rate 2.89%). Predominant cause of death was acute MI (6, 66%) and hypoglycemic encephalopathy (3, 33.33%). Conclusion: The major finding of this study suggest that severe hypoglycemia is strongly associated with fatal cardiovascular and neurological events including MI, acute stroke and hypoglycemic encephalopathy in diabetic patients predominantly treated with insulin. Mortality was found in 2.89% participants. Co morbidities including renal disease, liver disease, gastroparesis, cognitive impairment increased the vulnerability of developing severe hypoglycemia. In most of the cases, lifestyle factors are the precipitating causes of hypoglycemia, which are readily recognizable and easily modifiable. Therefore, appropriate diabetic education and periodic reevaluation of patient’s knowledge, attitude and practice towards hypoglycemia is of utmost importance to prevent this common but life-threatening complication. BIRDEM Med J 2024; 14(3): 118-123

Anesthesia-related Complications in General Surgery: Strategies for Prevention and Management

Background: Anesthesia-related complications in general surgery remain a significant concern despite advances in anesthetic techniques. These complications can lead to increased morbidity and mortality if not effectively managed. This study aimed to evaluate the incidence, prevention, and management of anesthesia-related complications in a tertiary care hospital in Bangladesh. Methods: A prospective observational study was conducted on 60 patients who underwent general surgery at the Department of Anesthesia, Analgesia, and Intensive Care Medicine, BSMMU, Dhaka, from 2022 to 2023. Demographic data, anesthesia-related complications, preventive measures, and management strategies were recorded and analyzed. Results: Cardiovascular complications were the most common, with hypotension in 11.7% and arrhythmias in 6.7% of patients. Respiratory complications, including hypoxemia and bronchospasm, occurred in 13.3% and 5% of cases, respectively. Neurological complications, such as postoperative delirium, were observed in 10% of patients. Preventive strategies, including fluid preloading, bronchodilators, and antiemetic prophylaxis, were effective in reducing the incidence of complications. All cases of hypotension, hypoxemia, postoperative nausea and vomiting (PONV), and arrhythmias were successfully managed with standard interventions, achieving a 100% success rate. Conclusion: This study demonstrates that anesthesia-related complications can be effectively managed through vigilant perioperative care and established management protocols. Cardiovascular and respiratory complications were the most common, and prompt interventions such as fluid resuscitation, oxygen therapy, and pharmacological treatment ensured favorable outcomes. Future studies with larger sample sizes and multicenter settings are recommended to further validate these findings and optimize anesthesia practices in diverse healthcare environments.

Depression, Anxiety and Stress with Problematic Internet use Among Youth Attending; A Tertiary Care Hospital in Bangladesh

Background: Excessive and uncontrolled internet use can significantly impair daily functioning in various life domains. Despite the numerous benefits of the internet, its addictive use is a growing concern, particularly among youth, who are prone to anxiety, depression, and stress-related disorders. Understanding the current scenario is essential for devising effective interventions, yet no scientific data is available in Bangladesh. Objective: To assess between depression, anxiety, and stress among youth with problematic internet use (PIU) attending a tertiary care hospital. Methods: This cross-sectional and descriptive study was conducted at the Department of Psychiatry, Department of Bangabandhu Sheikh Mujib Medical University, from October 2020 to September 2022. Participants were interviewed using a structured socio-demographic questionnaire, the Bangla versions of the Internet Addiction Test (IAT), and the Depression Anxiety and Stress Scale-21 (DASS-21-BV). Data were analyzed using SPSS 26.0, with significance set at p<0.05. Results: Among the 90 participants (mean age: 21.33 years; 68% male, 32% female), 95% were students, and 87% were from nuclear families. Internet use exceeded one year for 83% of participants. PIU levels were minimal in 15%, moderate in 62%, and excessive in 22%. Severe depression was observed in 15% of participants, severe anxiety in 25%, and severe stress in 25%. Extremely severe levels of depression, anxiety, and stress were found in 14%, 5%, and 14% of participants, respectively. Significant risk factors for PIU included male gender (χ²=8.217; p=0.02) and over three hours of daily internet use (χ²=35.289; p=0.001). PIU was significantly associated with depression (χ²=20.380; p=0.001), anxiety (χ²=16.159; p=0.019), and stress (χ²=14.734; p=0.019). Conclusion: Depression, anxiety, and stress are significantly associated with PIU. Early risk assessment, proper internet use, and initial screening are essential for managing potential mental disorders linked to PIU.

Clinical and Angiographic Profile of Non-ST Elevation Myocardial Infarction Patients with Multivessel Disease: A Study in a Tertiary Care Hospital in Bangladesh

Background: Non-ST elevation myocardial infarction (NSTEMI) is a type of acute coronary syndrome without ST-segment elevation on electrocardiography. Many non-ST elevation myocardial infarction patients have multivessel disease, which leads to worse outcomes compared to single-vessel disease. Their clinical and angiographic profiles provide valuable insightf into the nature, severity, and treatment of this common cardiac condition. This study aimed to evaluate the clinical and angiographic profiles of non-ST elevation myocardial infarction patients with multivessel disease. Methods: This prospective study was conducted in the Department of Cardiology, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh from September 2022 to August 2023. The study enrolled 270 consecutive patients with NSTEMI. Coronary angiography and electrocardiogram were used in assessing the disease condition. The data were analyzed using SPSS version 23.0. Results: The mean age of total participants was 54.31 ±10.54 years and most of them were male (77.8%). Majority of the patients had hypertension (68.1%), diabetes mellitus (59.3%), and dyslipidemia (58.5%). In the clinical assessment, 89.6% of patients had femoral access, 31.1% had a bifurcation lesion, 8.1% showed calcification, and 22.6% had a left main lesion. Stents were used in 41.9% of cases, with a mean total stent length of 55.8 ±26.9 mm. The mean left ventricular ejection fraction was 49.10 ±7.3%. Among the major culprit vessel involvements identified, 6% involved the left main (LM) artery, 56% involved the left anterior descending (LAD) artery, 34% involved the left circumflex (LCX) artery, and 39% involved the right coronary artery (RCA). Regarding the final angiographic findings among the total participants, double vessel disease (DVD) was observed in 40% of cases, while triple vessel disease was observed in 60% of cases. Conclusion: The increased prevalence of triple vessel disease among non-ST elevation myocardial infarction patients underscores the importance of heightened vigilance among healthcare providers and policymakers. Understanding the clinical and angiographic profiles of these patients is essential for effective management strategies.

The relationship between lobar distribution and primary lung cancer histological types

Background: Lung cancer is the primary cause of cancer-related deaths globally. Accurate tumor location and subtype characterization are critical for optimizing treatment and predicting outcomes. This study aims to identify the relationship between lobar distribution and primary lung cancer histological types and describe the most recent patterns at the country-level origin. Methods: This cross-sectional study was conducted at a major tertiary care hospital in Bangladesh, including 165 patients recruited using purposive non-probability sampling. Data were collected using a semi-structured case record form and analyzed using SPSS version 28.0. Results: Tumors were most commonly found in the central area (58.2%). Squamous cell carcinoma was the most prevalent type (46.1%), followed by adenocarcinoma (38.8%), small cell carcinoma (13.9%), and large cell carcinoma (1.2%). The incidence of squamous cell carcinoma was significantly higher in the upper lobe of the right lung (55.9%) compared to other forms, particularly in the central region of the right lung (P < 0.001). Squamous cell carcinoma was more common in the lower part of the left lung (42.9%), while adenocarcinoma was exclusively observed in the lingular portion of the left lung (100%). The major bronchus of the left lung primarily exhibited squamous cell carcinoma (60%), but this finding was not statistically significant (p=0.899). Conclusion: The study highlights the significant association between lobar distribution and histological types of primary lung cancer, emphasizing the need for precise tumor characterization for better treatment strategies and prognostic evaluation.

Serum Magnesium and Glycemic Status in Newly Diagnosed T2DM Patients in Tertiary Care Hospital of Bangladesh

Background: Diabetes mellitus is a major global health issue. Trace elements play important role as co-factors for various events in this context. Recently, an inverse relationship between serum magnesium and glycemic control has been observed and magnesium is thought to be low in with type-2 diabetes mellitus (T2DM). Objective: This study aimed to see serum magnesium and HbA1c in newly diagnosed T2DM. Methodology: This cross-sectional study included 100 newly detected diabetes subjects (age: 40.65±11.65 years, mean ± SD; m/f: 35/65) diagnosed according to American Diabetic Association (ADA) 2016 diagnostic criteria for diabetes. 5 ml of blood was collected for serum magnesium and HbA1c measurement by utilizing atomic absorption Spectrometricanalysis and NGSP certified Bio-Rad D-10TM Hemoglobin A1c Program 220-0101 USA. All data were analyzed by SPSS (version 22.0). Results: Magnesium and HbA1c were 1.99±0.23 mg/dl and 8.65±2.18% (mean±SD). About 9% were hypomagnesemic and 91% eumagnesemic. Socioeconomically 50% were middle income group, family history was present in 48% and 11% had history of smoking. Magnesium (meanSD) was statistically similar between males and females (1.99±0.22 vs. 1.99±0.24 mg/dl, p=0.974), urban and rural subjects (1.98±0.24 vs. 1.99±0.22 mg/dl, p=0.754), subjects with or without family history of diabetes (1.95±0.22 vs. 2.02±0.23 mg/dl, p=0.117), in subjects with BMI <25 Kg/m2 and 25 Kg/m2 (2.01±0.25 vs. 1.98±0.22 mg/dl, p= 0.526) as well as among various HbA1c cut-off values (<6.5 vs. 6.5− 9 vs. >9%: 2.08 ±0.15 vs. 1.98±0.24 vs. 1.99±0.23; p=0.257). However, magnesium level was statistically and significantly different among the age groups (<25 yrs vs. 25-34 yrs vs. 35-44 yrs vs. 45-54 yrs vs. 55 yrs: 1.91±0.28 vs. 2.00±0.23 vs. 1.93±0.20 vs. 1.96±0.26 vs. 2.16±0.13 mg/dl, meanSD; p= 0.018). None of the variables showed any correlation with magnesium except age (r=0.220, p=0.028) nor any was significant independent predictor for hypomag