Tertiary Care Hospital In Bangladesh Research Articles

Cardiac ischemic symptoms among diabetic patients with their exercise tolerance test findings at a tertiary care hospital of Bangladesh

Background: Cardiovascular disease is the leading cause of death among diabetic patients. Diabetics who experience chest pain should get a full cardiac evaluation. Exercise tolerance test (ETT) is a noninvasive, less costly and relatively accurate test for evaluation of ischemic heart diseases. This study aimed to describe cardiac ischemic symptoms among diabetic patients and their ETT findings. Methods: This cross-sectional study was carried out among 82 diabetic patients with ischemic symptoms, in the Department of Cardiology, BIRDEM General Hospital, Dhaka from July to December 2018. Results: The mean±SD age was 60.91±11.68 years with male predominance (67%). The respondents had diabetes for an average of 8.34±4.92 years. Two-thirds of research participants were on insulin. The majority of the resting ECG results were ST-T changes (86.58%); mostly in anterior leads (54.9%) and ‘T’ inversion was predominant feature (64.2%) among all ST-T changes. The ETT result was positive in 69.72% of the individuals. During the ETT test, 57.31% of the individuals reached their goal heart rate. Test was terminated owing to tiredness in the majority of the individuals (86.58%). Chest pain and shortness of breath were significantly higher (p 0.042 and 0.011 respectively) in ETT positive participants. Aside from diabetes, the ETT positive participants had risk factors such as dyslipidaemia, hypertension, a family history of IHD and smoking (18.3%, 8.53%, 14.63% and 13.42% respectively). Conclusion: Over two-thirds of the diabetic patients with suspected IHD had positive ETT findings in this study. BIRDEM Med J 2023; 13(2): 67-75

Antimicrobials Resistance Trend Of Bacterial Uropathogens in Patients Attending in Tertiary Care Hospitals In Bangladesh

Background: Urinary tract infection (UTI) has now become the most common infectious disease, mostly in developing regions, indicating healthcare and economic constraints. Antimicrobial resistance (AMR) is a condition in which microorganisms use varied resistance mechanisms, including horizontal gene transfer (for example, plasmids and bacteriophages), genetic recombination, and mutations. Methods: This study is a retrospective cross-sectional study that was conducted at Mitford Hospital and Dhaka Medical College Hospital. The study was conducted from January 2021 to January 2022. The total sample size for this study was 500. Result: The proportion of uropathogenic species of isolates (from total UTI patients; 250) showed E. coli 94(37.6%) and followed by K. pneumoniae 28(11.2%), CONS 11(4.4%), S.aureus 23(9.2%), Proteus spp. 4(1.6%), Citrobacter Spp. 18(7.2%), Salmonella Spp. 1(0.4%), GNR 27(10.8%), Enterobacter Spp. 9(3.6%), Streptococcus spp. 6(2.4%), Klebsiella Spp. 8(3.2%), Pseudomonas Spp. 1(0.4%), Providencia spp. 1(0.4%), K.ozaenae 10(4%), Shigella Spp. 2(0.8%), Enterococcus Spp. 5(2%), Serratia spp. 1(0.4%) and M.morgani 1(0.4%). Gram-positive isolates presented a high resistance to tetracycline 14(93.3%) and penicillin 13(86.7%). Antimicrobial agents most effective against Gram-positive uropathogens were vancomycin and nitrofurantoin. Staphylococcus aureus was the most common isolate of Gram-positive isolates. It was highly resistant to tetracycline 32(100%) and trimethoprim-sulfamethoxazole 26(81.3%). In addition, 9(28.1%) of S. aureus were resistant to cefoxitin. Conclusion: UTI is the most spreading bacterial infection globally. The increase in antimicrobial resistance is associated with UTI, which is a serious threat and has become a global health emergency. J Dhaka Med Coll. 2022; 31(1) : 23-28

Mean Platelet Volume in Patients With Subclinical Hypothyroidism Attending at A Tertiary Care Hospital of Bangladesh

Background: Subclinical hypothyroidism (SCH) is a common endocrine disorder affecting about 3-8% of the general population. On the other hand, mean platelet volume (MPV) is an indicator of platelet activity, and elevated MPV is associated with adverse cardio-metabolic complications. This study was conducted to observe MPV in SCH and to correlate it with thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels. Materials and Methods: This cross-sectional observational study was conducted in Medicine and Endocrinology OPD of US- Bangla Medical College & Hospital over twelve (12) months from September 2020 to August 2021. This study included forty (40) cases of newly detected SCH and twenty (20) age & body mass index (BMI) matched euthyroid control subjects as per inclusion and exclusion criteria. Results: SCH group had higher TSH and MPV than controls (P value <0.001 and <0.05 respectively) where age, BMI, and FT4 level were comparable (P value>0.05). MPV shows a positive correlation with BMI in SCH & controls (P values <0.05). MPV shows a significant positive correlation with TSH and a negative correlation with FT4 only in SCH (P<0.05) but not in controls (P value>0.05). Conclusion: Patients with SCH have elevated MPV, so they are at increased risk of developing an adverse cardiovascular outcome. J Dhaka Med Coll. 2022; 31(1) : 61-65

Change of lipid profile in children with acute lymphoblastic leukemia due to induction chemotherapy in a tertiary care hospital of Bangladesh

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. In the Department of Paediatric Haematology and Oncology of Bangabandhu Sheikh Mujib Medical University (BSMMU), 58% of ALL cases were recorded among 455 newly diagnosed malignancy patients in a single year. Studies found that remarkable hypertriglyceridemia occurs with L-asparaginase therapy and steroid. This study was done to evaluate the changes of serum total cholesterol, triglycerides (TG), high density lipoprotein (HDL), and low-density lipoprotein (LDL) during and after induction chemotherapy in children with ALL. Methods: This prospective observational study was performed in the Department of Pediatric Hematology and Oncology of BSMMU from March-November 2013. Newly diagnosed acute lymphoblastic leukemia patients aged 3-15 years were included in this study after having written consent from the parents of the participants to participate in the study and enrolled for the treatment of ALL (according to modified UKALL 2003 protocol). Results: Total cholesterol, TG, HDL, and LDL changed significantly due to induction therapy. Serum total cholesterol and LDL decreased after completion of L-asparaginse in comparison to before induction, increased significantly after completion of induction in comparison to after completion of L-asparaginase (P=0.001), and increased significantly after induction in relation to before induction therapy (P=0.003). TG decreased significantly (P=0.033) after completion of L-asparaginase than before induction but increased after completion of induction. HDL increased after completion of L-asparaginase and after induction significantly (P=0.001). LDL decreased after completion of L asparaginase which was significant (P=0.005). Conclusion: After induction chemotherapy, total cholesterol, HDL and LDL level increased and TG level decreased among ALL patients. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 35-40

Correlation of Body Mass Index with Vitamin D and Parathormone (PTH) in Obese and Overweight Children, Study from a Tertiary Care Hospital of Bangladesh

Introduction with aim and objectives: Childhood obesity and vitamin D deficiency both are emerging health issues. Vitamin D is essential for normal growth and development and frequently found low in obese and overweight children. The aim of this study was to assess serum vitamin D level, calcium, inorganic phosphate, alkaline phosphatase and parathormone (PTH) in obese and overweight children and to see the correlation between BMI, vitamin D and parathormone. Materials and Methods: This study was conducted at Pediatric Endocrinology clinic of department of Paediatrics of Bangabandhu Sheikh Mujib Medical University from the period of November 2016 to October 2018. We assessed 50 obese and overweight children for serum vitamin D, calcium, inorganic phosphate, alkaline phosphatase, and parathormone and we also tried to find out the correlations among the parameters in this cross sectional study. Results: Endocrine society clinical practice guideline was used to define vitamin D status. Result found that all of the obese/overweight children had low vitamin D (82% had deficiency and 18% had insufficiency). There was a statistically significant negative correlation between BMI and serum vitamin D level and positive correlation between BMI and the parathormone level (p value < 0.05). In this study significant negative association was found between vitamin D level and the PTH level p value <0.05. Conclusion: All the studied obese and overweight had vitamin D deficiency or insufficiency. There was negative correlation between BMI and serum vitamin D level and positive correlation between BMI and the parathormone level (PTH). Medicine Today 2023 Vol.35(1): 52-55

Histopathological Study of Appendectomy Specimens in a Rural Tertiary Care Hospital in Bangladesh

Background: Appendicitis is one of the most common causes of the acute abdomen that demands emergency surgical intervention. It is a clinical condition that is frequently encountered as a diagnostic challenge. Sometimes grossly normal-appearing appendix, removed from patients with suspected acute appendicitis, on histopathological examination may reveal a more serious underlying pathology. Hence, histopathological studies form the gold standard for the diagnosis of appendicitis. Aim: To study the histopathological patterns of appendicitis in patients who underwent appendectomy. Methods: This study was carried out in the department of Pathology, Jahurul Islam Medical College, Bajitpur, Kishoreganj from January 2020 to December 2020. All the appendectomy specimens were received in 10% formalin as fixative. Sections obtained were studied to determine various histopathological patterns in appendectomy specimens. Results: A total of 252 specimens were undertaken for histopathological examination. There were 154 (61.1%) males and 98 (38.1%) females with male to female ratio of 1.6:1. The most common lesion observed was acute appendicitis (51.98%) followed by recurrent appendicitis (28.17%), acute suppurative appendicitis (07.15%), gangrenous appendicitis (06.36%), eosinophilic appendicitis (02.38%), follicular lymphoid hyperplasia (02.38%), mucinous adenoma (0.40%) and mucinous adenocarcinoma (02.38%). Conclusion: Most of the cases in this study were diagnosed with the usual features of appendicitis, though a few of them were incidental diagnoses that were missed clinically. These important incidental diagnoses undisputedly support the notion that every appendectomy specimen must be sent routinely for histopathological examination. Mediscope 2023;10(1): 17-21

Prevalence and Phenotypic Detection of Carbapenem-Resistant Enterobacter Species from the Clinical Specimens of a Tertiary Care Hospital in Bangladesh

Background: Carbapenem-resistant Enterobacter (CRE) is an emerging threat spread rapidly around the world in the past few years, posing substantial hazards to human health. Objective: The study was conducted to evaluate the prevalence of carbapenem resistance and to detect carbapenemase producers phenotypically from patients of a major tertiary care hospital, in Bangladesh. Methods: Prospective cross-sectional study was conducted from July 2018 to June 2019, at the Dhaka Medical College hospital. Patients admitted to different wards, and intensive care units, visited the outpatient department, and samples received in the microbiology department were included in this study. A total of 350 clinical samples were collected, inoculated, and incubated in accordance to the standard protocol. Identification was done using the standard biochemical method. Antimicrobial susceptibility testing of commonly used antibiotics including imipenem was done using Kirby Bauer disk diffusion method. All the clinical isolates of Enterobacter were screened for carbapenem resistance as per CLSI guidelines. Such strains were then subjected to phenotypic confirmation of carbapenemase production by the Modified Hodge test. All isolates that gave a positive screening test were further evaluated for Metallo-β lactamase (MBL) production. MBL was further detected by Combined Disc Test (CD) using a combination of Imipenem and Imipenem-EDTA and double disc synergy (DDS) test. Result: A total of 350 clinical specimens were analyzed, of which 224 (65.14%) isolates yielded growth. Among them, 28 (12.28%) Enterobacter were isolated of which 12 (42.86%) were found to be Imipenem resistant (14.25%) and were labeled 'Carbapenem-resistant Enterobacter" or CRE. Minimum inhibitory concentration (MIC) was determined among the carbapenem-resistant clinical isolates. Modified Hodge test (MHT) performed on the 12 carbapenem-resistant isolates showed 9 (75%) isolates to be carbapenemase enzyme producers. Nine out of twelve carbapenem-resistant isolates are Metallo-beta-lactamase producers detected by combined disc test (CDT) and eight (66.67%) MBL producers detected by DDS test. Conclusion: The finding from this study revealed a high prevalence of carbapenem resistance among isolated Enterobacter species in hospital settings as well as community levels. As there are limited treatment regimens, therefore, the timely and accurate detection of carbapenem-resistant Enterobacter species is essential for the clinical treatment and prevention of infections. Simple phenotypic methods like MHT can be used for the rapid detection of carbapenemases, and these are expected to be used routinely in clinical microbiology laboratories. Update Dent. Coll. j: 2023; 13(1): 17-22

Outcome of Management of Tetralogy of Fallot in a Cardiac Center of a Tertiary Care Hospital in Bangladesh

Background: Congenital heart diseases (CHD) represent one of the major groups of birth defects and make up approximately 1% of human malformations. Incidence of congenital heart disease is 8-10/1000 live births. The incidence is higher in premature infants. In Bangladesh incidence of congenital heart diseases was found up to 25/1000 live birth in a one year study conducted in CMH Dhaka. Congenital cyanotic heart disease accounts for less than 25% of total congenital cardiac defects. In TOF the lungs are under-perfused as blood shunts from right to left bypassing the lungs. TOF constitutes 5-7% of congenital heart disease. It is the commonest congenital cyanotic heart disease in Bangladesh. Objective: The aim of this study was to assess outcome of management of Tetralogy of Fallot in a cardiac center of a tertiary care hospital in Bangladesh. Methodology: It was a retrospective observational study and was conducted in the department of Pediatric Cardiology of Combined Military Hospital (CMH), Dhaka, Bangladesh from January 2015 to December 2016. We included 50 patients with TOF taking treatment from our department. All the patients were divided into three groups according to treatment type. Medical management group, palliative surgery group and total intra cardiac repair group and their outcome were assessed. Results: In our study we found 6 (12%) patients were in medical management group, 8 (16%) were in palliative surgery group and 36 (72%) were in total intra cardiac repair group. Among them 33 (66%) were male and 17 (34%) were female. Majority patients 30 (60%) were in less than 3 years of age. In medical management group all the patients had oxygen saturation <80%, 4 (66.68%) patients reduced frequency of hyper-cyanotic spell, 1 (16.67%) patient had cerebral abscess. In palliative surgery group 6 (75%) patients had >90% oxygen saturation, 2 (25%) had <90% oxygen saturation, tet spell reduced in all the cases. After total intra cardiac repair no patient had .....

Factors Associated with Neonatal Survival in a Special Care Newborn Unit in a Tertiary Care Hospital in Bangladesh.

The 2020 neonatal mortality rate in Bangladesh was 17 deaths per 1,000 live births, higher than the 2030 Sustainable Development Goal target (12 deaths per 1,000 live births). Over the past decade, Bangladesh has established special care newborn units (SCANUs) in medical facilities countrywide to improve neonatal survival. We conducted a retrospective cohort study in the SCANU of a tertiary-level healthcare facility in Bangladesh to study neonatal survival and associated risk factors using descriptive statistics and logistic regression models. Of 674 neonates admitted to the unit between January and November 2018, 263 (39%) died in hospital, 309 (46%) were discharged against medical advice, 90 (13%) were discharged healthy, and 12 (2%) had other discharge statuses. The median duration of time spent in hospital was 3 days, and 60% were admitted at birth. Neonates delivered via Cesarean section (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.2-5.6) had an increased odds of recovering and being discharged, whereas those diagnosed with prematurity and/or low birth weight at admission (aOR: 0.2; 95% CI: 0.1-0.4) had a decreased odds of doing so. The high mortality rate and large number of neonates discharged against medical advice suggest a need to investigate the etiology of death and the factors leading to children leaving hospital prior to recovery. Medical records lacked information on gestational age that could provide key insights about mortality risk and age of viability in this setting. Addressing these knowledge gaps in SCANUs may enable better support for the improvement of child survival.

New-born with Hypoglycaemia and their Neurodevelopmental Outcome: A Prospective Study in a Tertiary Care Hospital in Bangladesh

Background: Brain mainly utilizes glucose to maintain its basic function as well as higher order executive functions. Among metabolic problem, hypoglycaemia in the most common in new-born nursery as well as Neonatal Intensive Care Unit (NICU). Hypoglycaemia may adversely affect developing brain and cause neurological impairment. Objectives: The aim of this study was to assess the neurodevelopmental outcome of new-borns with hypoglycaemia admitted in NICU. Methods: This prospective observational study was conducted in the department of Neonatology and Institute of Paediatric Neuro-disorder and Autism (IPNA), Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from March 2020 to August 2021. The inclusion criteria were babies admitted in NICU with hypoglycaemia or developed hypoglycaemia. Consent was taken from the parents/guardians whose baby develop hypoglycaemia (blood glucose <2.6 mmol/L). Hypoglycaemia was detected by capillary blood glucose estimation by heel prick tests and confirmed by corresponding blood sugar (RBS). Hypoglycaemia was treated by ensuring feeding or glucose infusion as per standard departmental treatment protocol. New-borns were followed up at 6 and 12 months of age and their neurodevelopmental assessment was done by Bayley Scales of Infant and toddler Development III (BSID III). Data were analysed using the SPSS 22.0 version software. Result: Among 66 admitted hypoglycaemic neonates 62 babies neurodevelopmental assessment was done at 6 and 12 months by BSID III method. Among them 48.5% were males while 51.5 % were females, 24.24% were gestational age <34 weeks, 36.36% were between gestational age 34 – < 37 weeks and 39.39% were ≥37 weeks of gestation. 60 (90.9%) babies were inborn whereas 6 (9.1%) were out born. Among hypoglycaemic neonates, normal birth weight (≥2500 g) were 27.27%, low birth weight (1500 – <2500 g) were 39.39% and rest of the babies (33.33%) were < 1500 g. IDM was 42.4% and IUGR was 33.3%. Most patient developed hypoglycaemia within 24 hrs of age (48.55%), among them 13.6% were symptomatic and 46% required glucose infusion. At 1st follow up overall adverse outcome (composite score < 70 in BSID III) were 19.4% and at 2nd follow up overall adverse outcome were 12.9%. Hypoglycaemia with very low birth weight, hypothermia and symptomatic babies were significantly associated with adverse neurodevelopmental outcome. Conclusion: Among hypoglycaemic new-borns those were symptomatic, very low birth weight and hypothermic were more prone to develop adverse neurodevelopmental outcome.

COVID-19 Related Multi System Inflammatory Syndrome in Children: Scenario from a Tertiary Care Hospital in Bangladesh

Background: An association of multisystem inflammatory syndrome in children (MIS-C) with SARS-CoV-2 infection is now a well-established serious phenomenon and been increasingly reported from different countries. Objectives: The present study documents the presentation, management and immediate outcome of MIS-C patients from Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. Study design: This was a retrospective study. Methods: This retrospective study was conducted in the department of pediatrics, BSMMU, Dhaka, Bangladesh. It included all the eligible MIS-C patients diagnosed during the study period (August 2020 to February 2022). Sixty cases fulfilled the diagnostic criteria and they had been included in the study. Data were collected using a predesigned and pre-tested questionnare from hospital records and also by interviewing the patients/parents over telephone when required. Results: Mean age of the children was 6.8year with F: M ratio of 1.2:1. All the sixty cases presented with fever associated with gastro-intestinal complications in 68% followed by other symptoms. Fifty two cases (87%) had known contacts. Laboratory evidence ofSARS-CoV-2 infection was present in 55% cases having positive serology or RT-PCR. Twelve patients (20%) had pre-existing co- morbidities. Majority of patients (48%) presented with Kawasaki Disease (KD) like illness. Mean neutrophil count, ESR, CRP, ferritin, LDH and D-dimer were higher and mean platelet and lymphocyte count were lower in this series. Interleukin-6 (IL-6) level was raised in all theseventeen (28%) patients, who were tested. Sixteen patients (27%) had chest X-ray abnormalities and ten of them had HRCT involvement. Fifteen (25%) patients had abnormalities in abdominal ultrasonogram. Coronary artery dilatation and ventricular dysfunction was present in seventeen (28%) and thirteen (22%) of MIS-C cases. IVIG and intravenous steroid was used in forty one (68%) and thirty nine (65%) children. Aspirin was given to twenty eight (47%) cases. Inotropic support was needed in 17% cases. Antibiotics were prescribed to all the patients. Fifty seven percent and 37% children were discharged without and with complications respectively. Mechanical ventilation was required in 6.6 % children who had pre-existing co-morbidities and all of them expired. Conclusion: Forty eight percent of MIS-C cases presented with KD like illness. Mortality was 6.6% and all the cases had preexisting comorbidities. MIS-C is a pediatric emergency and is of a great concern especially in children with pre-existing co-morbidities. Early diagnosis and referral to tertiary center for optimum management is essential. Bangladesh Medical Res Counc Bull 2023; 49(1): 22-31

Clinical and Biochemical Profile of Children with Chronic Kidney Disease in a Tertiary Care Hospital of Bangladesh

Background: Chronic kidney disease (CKD) is an insidious and irreversible condition that eventually progresses to end stage renal failure and important cause of morbidity and mortality in children worldwide. However, the care of these patients represents a challenge for health care providers, which must pay attention not only to renal disease, but also to the various extra renal manifestations that affect growth and development. Evaluation of clinical and biochemical profile of children with chronic kidney disease can help to meet up this challenge. Methods: This cross-sectional observational cohort study evaluated clinical, anthropometric and biochemical variables of children with chronic kidney disease aged 2 to 16 years in the department of Pediatric Nephrology, Dhaka Shishu (Children) Hospital, Bangladesh, during July’ 2018 to December’ 2018. A total of thirty-six children with chronic kidney disease with creatinine clearance <60ml/min/1.73 m2 and on supportive treatment and haemodialysis were included. In control group, equal number of age and sex matched healthy children without any preexisting chronic diseases were included. Both study group and control group were assessed for sociodemographic data, nutritional status, clinical and biochemical parameters. Results: The mean age was 9.09±3.01 years in case group and 7.85±3.69 years in control group. In case group, 22 patients (61.1%) were male and 14 (38.9%) were female and the ratio was 1.5:1. In this study we found that a statistically significant decrease in Z-score for (Weight, Height and Body Mass Index) in the CKD patients’ group than control. In terms of blood pressure, 66.7% of patients in the cases group were hypertensive (P = 0.001). There was no significant difference of hypertension among CKD stages in this study. CKD Patients were found anemic with significant decrease in hemoglobin level. Anemia found in 35 patients (97.2%) in the case group than control (P=0.001). CKD stage 5 children had significantly lower hemoglobin level. Serum phosphate and potassium were significantly higher while serum calcium was significantly lower and parathyroid level was higher in case group than control. Conclusion: The present study stated that CKD patients had significantly lower BMI and hemoglobin but hypertensive in comparison to case group. Serum potassium, phosphate and parathyroid higher but serum calcium level was lower in case group. J Bangladesh Coll Phys Surg 2023; 41: 120-125

Major Symptoms and Outcome of Covid-19 Positive Patients: A Study in a Tertiary Care Hospital in Bangladesh

Background: An outbreak of Covid-19 caused by the SARS-Cov-2 initially emerged in China in December 2019 and the first Covid-19 patient was detected on 8 March 2020 in Bangladesh. The preconception about the major symptoms and outcomes of Covid-19-positive patients may be helpful for healthcare professionals in the management of Covid-19 patients. This study aimed to evaluate the major symptoms and outcomes of covid-19 positive patients.
 Methods: This prospective observational study was conducted in the Department of Medicine, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from January 2021 to December 2021. In total 67 confirmed Covid-19 cases by RT-PCR tests who attended the mentioned hospital were enrolled in this study as the study population. For data collection, a pre-designed questionnaire was used. Along with demographic and clinical features data regarding in-hospital mortality, intensive care unit (ICU) admission, use of invasive mechanical ventilation, total hospital length of stay, complications, and treatment patterns were recorded. Collected data were processed, analyzed and disseminated by using the MS Excel program.
 Results: The highest number of patients were with a cough which was found among 49% of cases. Besides this, shortness of breath, hypoxemia/oxygen use, lower limb swelling and bleeding were found among 39%, 27%, 12% and the rest 7% of patients respectively. The highest number of patients were with hypertension (HTN) as comorbidity which was found in 15% of cases. Besides this, diabetes mellitus (DM), chronic kidney diseases (CKD), chronic respiratory diseases (CRD), cancer/immunodeficiency and cardiac diseases were found among 12, 10%, 7%, 4% and the rest 1% of patients, respectively. As the outcomes, the cure rate was found up to 97% and death occurred in only 3% (n=2) cases. We observed that 10% of patients did not stay at the hospital even for a single day. For only 7% of patients, ventilation facilities were in needed and the average ventilation time was 13.5 days.
 Conclusion: Cough and shortness of breath are two major symptoms for Covid-19 patients. Proper ventilation and ICU facilities can decrease the suffering, mortality as well as morbidity of Covid-19 patients.

Clinical Profile Analysis of Tuberculosis Patients Attended in a Tertiary Care Hospital in Bangladesh

Background: Despite noteworthy socio-economic development and advances in medical science, tuberculosis (TB) remains a major public health problem. Although it is a curable disease, still millions of people suffer and a large number of patients die from this infectious disease. Now a day, the prevalence and nature of tuberculosis are not in a consistent stage. So we need more current information regarding this issue. Aim of the study: The aim of this study was to assess the clinical profile of tuberculosis patients attended in a tertiary care hospital in Bangladesh. Methods: This was a prospective, observational study which was conducted in the department of Medicine, North Bengal Medical College, Sirajgonj, Bangladesh during the period from January 2020 to June 2022. In total 87 diagnosed patients with tuberculosis, treated in the mentioned hospital were selected as the study subjects. Before data collection, proper written consents were taken from all the participants. For data collection a predesigned questionnaire was used in data collection. Collected data were processed, analyzed and disseminated by using MS Excel and SPSS version 23.0 program as per necessity. Results: In this study, the male-female ratio of the participants was 1.7:1. The highest number of participants were from the 41-50 years’ age group which was 27.59%. BMI (Kg/m2) was found ≥18.5 in 61% and < 18.5 was found in 39% of patients. Majority (56%) of the cases were ‘non- smoker’. As the types of TB, pulmonary Koch’s, CNS tuberculosis, abdominal Koch’s, and TB lymphadenitis were found in 43% 21%, 14%, and 13% of participants respectively which was noticeable. In this study, among all the participants, cough and fever were found as two most frequent symptoms which were found in 93% and 84% of patients respectively. Conclusion: Fever and cough are the two most frequent symptoms in tuberculosis patients. Although the death rate among TB patients is not alarming, the treatment success rate of the first treatment attempt is not satisfactory among tuberculosis patients.

Risk Stratification of Chronic Myeloid Leukaemia Patients with ELTS Risk Score at a Tertiary Care Hospital in Bangladesh

Introduction: Chronic Myeloid Leukaemia (CML) is a myeloproliferative neoplasm characterised by uncontrolled proliferation of white blood cells and its precursors. At diagnosis, various risk scoring systems have been formulated for risk stratification. In 2016, European Treatment Outcome Study (EUTOS) Long Term Survival (ELTS) score has been formulated most recently. This score was recommended by European LeukaemiaNet in 2020. Objective: The objective of the study was to estimate the frequency of high-risk patients among Chronic Myeloid Leukaemia patients in chronic phase using ELTS scoring system. Materials and Methods: This observational study was conducted among patients at Bangabandhu Sheikh Mujib Medical University (BSMMU) between September 2020 and October 2021. A total of fifty chronic myeloid leukaemia patients were enrolled using purposive sampling technique. Clinical information and haematological parameters were recorded. Bone marrow study was conducted to confirm phase of the disease. ELTS risk score was calculated, and risk stratification was done. Chi-square test was done to find out statistical association between variables. Results: Among study participants, 14% were identified as high-risk cases using ELTS score. 40% of patients were intermediate-risk and 46% were low-risk disease. Presence of hepatomegaly or splenomegaly were significantly more common among high-risk patients. Significantly increased eosinophil and blast percentages and significantly lower haemoglobin level were found in high-risk patients. Conclusion: A fair proportion of the CML patients were identified as high-risk patients. Hepatomegaly, splenomegaly, lower haemoglobin, higher eosinophil and higher blast percentages were identified to be independently associated with higher risk stratification of patients.

Assessment of Joint Health Status of Haemophilia Patients in a Tertiary Care Hospital of Bangladesh

Background: Haemophilia is a sex-linked bleeding disorder. Affected patients suffer spontaneous or post-traumatic bleeding into various sites of the body, mainly into joints, depending on the level of coagulation factor deficiency. Recurrent joint bleeds lead to progressive disability. Susceptibility to joint haemorrhage in persons with haemophilia suggests that the routine assessment of joint health is an important aspect of clinical management and outcome studies assessing the efficacy of treatment. Aim: The aim of the study was to assess of joint health status in haemophilia patients attending in a tertiary care hospital, Bangladesh. Methodology: A descriptive observational study was carried out in the department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. A total number of 45 patients who were attended in OPD and IPD, meeting inclusion and exclusion criteria of enrolled haemophilia patients, were included in the study. Joint assessment or any kind of joint impairment was assessed by the Haemophilia Joint Health Score (HJHS) score 2.1 version (an eight-item scoring tool for assessing joint impairments of the six index joints in boys with haemophilia aged 4–18 years. Clinical and laboratory information was recorded with a semi structured questionnaire. Result: Among 45 haemophilia patients, the mean age was 12.9±3.4 years while males were predominant (91.1%). Majority (80.0%) of the patients (36) were diagnosed as haemophilia A. This study observed that, 48.9% of the patients had moderate and 28.9% had severe haemophilia. Knee joint was the predominant target joint. Left knee joint involved in 80% cases and right knee joint were involved in 55.6% of patients. The mean global gait score was found 1.49±0.66 and mean HJHS score was 15.8±4.4. There was no significant correlation between HJHS score and severity of haemophilia (r= -0.081; p=0.596) while significant correlation between the ages of patient with HJHS score (r=0.536; p=0.001) was observed. Conclusion: Haemophilia is a debilitating and life-threatening disease that affects mostly knee, ankle and elbow joints. The joint evaluation system is of paramount importance in clinical practice which is capable to prevent major haemarthrosis and chronic haemophilic synovitis. Haemophilia Joint Health Score (HJHS) is an effective and reliable tool to detect early and subtle changes in joint health and function. This study finding will help in future to assess early the joint conditions and complications, which will assist to modify the treatment approach on demand and start prophylaxis.

The Impact of COVID-19 Pandemic on the Mental Health of Working Nurses at a Tertiary Care Hospital in Bangladesh

The psychological consequences of corona virus disease (COVID- 19) pandemic on health care professionals specially working nurses were serious due to their higher exposure. The aim of this study was to assess the impact of covid-19 pandemic on the mental health among working nurses. This institutional based cross sectional study was conducted at Bangabandhu Sheik Mujib Medical University (BSMMU) Hospital, Dhaka, Bangladesh, from July 2020 to June 2021. A total of 120 nurses, working in different units of BSMMU Hospital were included. Data were collected by face-to-face interview. The depression, anxiety and stress scale- 21 (DASS- 21) was used to assess the psychological impact of COVID- 19 on nurses. The prevalence of depression, anxiety and stress among working nurses was 25.8%, 44.2% and 64.1% respectively. Nurses working in the day shift duties, having no infection prevention training, lack of family support and excess work load were the factors significantly associated with depression (p<0.05). While contact with confirmed cases and unavailability of infection prevention training were the factors that significantly increase the risk of developing anxiety (p<0.05). On the other hand; lack of infection prevention training, excess work load and worries about bringing the virus at home were the factors significantly associated with developing stress among the nurses (p<0.05). This study concluded that the prevalence of depression, anxiety and stress among nurses working in COVID-19 pandemic was high. Severity of stress was higher than anxiety and depression. Different risk factors were significantly associated with developing these mental disorders.

Evaluation of platelet indices in dengue fever in a tertiary care hospital in Bangladesh

Background: Dengue fever is the most rapidly spreading mosquito-borne viral diseases in the world. Some evidence suggests that platelet indices may have diagnostic and prognostic value in Dengue fever. The aim of the study is to evaluate platelet indices and to find their correlation between platelet count in Dengue fever. Methods: This retrospective cross-sectional study was conducted through the use of stored data in Bangabandhu Sheikh Mujib Medical University (BSMMU) dengue cell from July 2019 to September 2019 at department of laboratory medicine and department of internal medicine, BSMMU, Dhaka. Among them, clinical records of 260 cases are preserved in a structured clinical record form (CRF). After ethical clearance from institutional review board (IRB), form clinical records of 260 cases which were preserved in a structured CRF patients who fulfilled the inclusion and exclusion criteria was selected as study population. Results: Platelet indices (MPV and PDW) were statistically significant difference among different platelet counts (p<0.05). There was significant negative correlation between platelet count and PDW (r=-0.228, p≤0.001). There was also negative correlation between platelet count and MPV (r=-0.106) which was not statistically significant (p=0.088). Conclusions: Platelet indices are useful parameters in dengue infection. Other than platelet count, PDW and MPV are useful to monitor dengue fever.

Phenotypic and Genotypic Characterization of Salmonella Typhi isolated from Human Blood with Distribution of Virulence Genes and Sequencing

A cross-sectional study was conducted in the Department of Microbiology at tertiary care hospital in Bangladesh from July 2019 to June 2020, to see the phenotypic and genotypic characterization of Salmonella Typhi isolated from human blood with distribution of virulence genes and sequencing. Clinically suspected enteric fever patients irrespective of age and gender who attended either the Department of Microbiology or Medicine out-patient department (MOPD) in a tertiary level hospital in Bangladesh for blood culture and sensitivity test were included in this study. The positive growth S. Typhi was identified by gram straining, colony morphology and biochemical test. Then Salmonella Typhi was identified by using Salmonella specific antisera. Final identification was done by using 16s Rrna by PCR. Virulence factors like hemolysin and siderophore was detected by siderophores production assay. PCR and sequencing of virulence genes were done. A total number of 50 isolated organisms were identified as Salmonella species of which Salmonella Typhi was detected in 40 (48.2%) isolates. Among 40 isolated Salmonella Typhi, no Salmonella Typhi produced hemolysin and 30 (75.0%) isolates have ability to produce siderophore. Among the isolated Salmonella Typhi all isolates 40 (100%) were positive for viaB and staA gene, 21 (52.5%) were positive for iroB. Sequencing of viaB and iroB were done for further validation. In conclusion all isolated Salmonella Typhi carried viaB and staA, iroB genes were responsible for S. Typhi pathogenicity.
 CBMJ 2023 January: Vol. 12 No. 01 P: 41-47

Clinical spectrum of dengue fever in patients admitted to a tertiary care hospital in Bangladesh

Background: Dengue fever is a viral infection transmitted by mosquitoes and is a significant public health problem in many tropical and subtropical countries, including Bangladesh. The clinical spectrum of dengue fever can vary widely, ranging from asymptomatic infection to severe and potentially life-threatening illness. In this study, we aimed to describe the clinical spectrum of dengue fever in patients admitted to a tertiary care hospital in Bangladesh. The aim of the study was to observe the clinical spectrum of dengue fever patients. Methods: This prospective observational study was conducted at the department of medicine, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh. The study duration was 7 months, from June 2022 to December 2022. During this period, a total of 65 cases of dengue fever cases admitted to the hospital for treatment were included in the study, who had a hospital stay of at least 3 days. Results: The mean age of the participants was 30.78 years, and the male: female ratio was 1:1.95. 86.15% of the participants had no comorbidities, while diabetes and hypertension were observed in 6.15% of patients each. Patients' mean temperature had been high at the first check-up and dropped slowly to normal levels throughout the following check-ups, but the mean platelet count had significantly dropped from the first check-up throughout the following check-ups, improving only at the 6th check-up. ≤20,000 platelet count was observed in 6.15% at the first check-up, 9.23% at the 2nd check-up, 15.38% at the 3rd, 5.41% at the 4th, 15% at the 5th, and 0% at the 6th check-up. The most common warning signs were a positive tourniquet test (21.54%), vomiting (16.92%), and abdominal pain (15.38%). Hospital stay duration was <1 week for 95.38% of participants, and during discharge, only 3 patients had minor complications, with 3.08% mortality. Conclusions: The study observed a higher prevalence of dengue among younger age groups, and females had a higher prevalence in the study. The regular-interval check-ups revealed that dengue severity progressed slowly, and did not become worse immediately after the infection, rather continued to progress adversely slowly throughout the check-ups. Hospital stay was <1 week for the majority of the participants, and minor mortality was observed in the study.