Tertiary Hospital In Bangladesh Research Articles

Correlation between antibiotic resistance and biofilm formation in Klebsiella spp.

Antibiotic resistance among various microbial species is becoming a global threat to human health. MDR, or multidrug resistance, is an organism’s ability to tolerate the effects of many antimicrobial treatments. Klebsiella spp. is the major bacteria that causes a variety of illnesses, including urinary tract infections. The primary goal of this study is to look into the relationship between antibiotic resistance and Klebsiella spp. biofilm production. This study included 26 clinical isolates of Klebsiella spp. (n=26) collected from a tertiary hospital in Bangladesh. Isolates were obtained from blood, wound swabs, urine, and other sources. Following isolation and identification, ampicillin resistance was found in all MDR Klebsiella spp. isolates, followed by Cefotaxime (84.61%), Polymyxin B (84.61%), Amoxicillin (80.76%), Trimethoprim (69.23%), Doripenem (57.69%), Ciprofloxacin (57.69%), Imipenem (50.0%), Meropenem (38.46%), and Oxytetracycline (34.61%). Out of 26 clinical isolates, about 26.92% (n=7) were positive for the bla-NDM-1 gene. However, 15.8% of Klebsiella spp. (n = 4) isolates tested positive for the blaOXA-1 gene. There were no bla-KPC gene positives. Plasmid profile analysis revealed that 24 of 26 Klebsiella spp. isolates included numerous plasmids ranging in size from less than 2kb to more than 10kb. Biofilm formation found that 31% of samples were extremely positive for biofilm formation, 69% were medium biofilm formation, and (n=4) isolates were positive for biofilm resistance gene out of a total of 26 isolates. This study provides an early report on the widespread presence of carbapenem-resistant Klebsiella spp., demonstrating the need for intensive surveillance systems and research initiatives in Bangladesh to reflect the influence of multidrug resistance features in clinical isolates and their risks.
 Bangladesh J Microbiol, Volume 40, Number 1, June 2023, pp 25-32

Parameters of PCOS in Tertiary Hospital in Bangladesh

Background: Polycystic ovarian syndrome (PCOS) represents a complex endocrinopathy with significant metabolic implications. The Rotterdam criteria establish the diagnosis based on the presence of two of three criteria: ultrasound-confirmed polycystic ovaries, hyperandrogenism, and persistent anovulation. Objective: Our objective was to investigate hormonal and anthropometric parameters in PCOS patients compared to controls, aiming to elucidate predictive markers and metabolic aberrations. Method: A case-control study comprising 50 PCOS subjects and 50 controls was conducted, focusing on females aged 18-40 attending an obstetrics and gynecology department, Tertiary hospital. Hormonal assays and anthropometric measurements were performed following strict inclusion and exclusion criteria. Results: Significant differences emerged between PCOS and control groups across various parameters. PCOS individuals displayed elevated levels of TSH, LH, FSH, and prolactin, coupled with increased BMI and altered waist-to-hip ratio, indicating early metabolic disruptions. Notably, the LH:FSH ratio was lower in PCOS subjects, suggesting hormonal imbalances. Conclusion: High levels of thyroid-stimulating hormone, LH, FSH, and prolactin, coupled with elevated body mass index and waist-to-hip ratio, served as indicators of PCOS and early metabolic irregularities.

Occupational Health Hazard Experiences of Doctors and Nurses at a Tertiary Hospital in Bangladesh

Objective: This study aimed to explore the workplace safety experiences of health workers (doctors and nurses) at a tertiary hospital in Bangladesh. Materials and Methods: This was a descriptive cross-sectional study among conveniently selected 305 registered physicians and nurses working in the designated tertiary hospital. After obtaining the written informed consent, data was collected using face-to-face interviews with a pre-tested, semistructured, interviewer-administered questionnaire from December 2021 to January 2022. Frequency and proportion described the variables. Result: The mean age of the participants was 28.8 years. Female individuals constituted the majority, accounting for 69.2% of the total. Approximately 69.8% of individuals reported experiencing occupational health hazards. Psychological hazards were the most frequently reported (56.1%), followed by workplace-acquired health hazards (15.7%) and physical hazards (13.8%) among all participants. While 79.0% of the participants were aware of workplace health and safety, only 7.9% received safety training, and only 7.5% reported any occupational hazard to the hospital management. Conclusion: Healthcare personnel adjust to several professional hazards in a complicated series of events, as the study shows. The complexity of the healthcare environment poses considerable psychological and health hazards. Although there is good preparedness and procedure awareness, the analysis shows some crucial resources and training still need to be improved. Therefore, some strategic actions are needed to improve healthcare professionals’ safety and well-being in the modern healthcare environment through crucial resources and training.

Health-Related Quality of Life (HRQoL) and Its Associated Factors Among Post-COVID-19 Patients at Three Months in a Tertiary Hospital of Bangladesh

COVID-19 is a burning issue brought on by the SARS-COV2 coronavirus. Many SARS-COV-2 survivors continue to experience a variety of symptoms, which negatively impact their standard of living. A total of 103 post-COVID patients participated in a prospective comparison study from July 2021 to December 2021 to assess the individual’s health-related quality of life (HRQoL) and the elements that contribute to it. A control group with age and gender that matched 110 seemingly healthy individuals was also included for comparison. At three months, the EuroQol 5-dimensional 3-levels (EQ-5D-3L) questionnaire, which encompasses a brief expressive system questionnaire and an EQ-VAS visual analogue scale, was collected in a predesigned datasheet. The EQ index score was used to reflect all HRQoL data, which was then contrasted to a set of matched controls for ages and sexes. At three months, the mean EQ-5D index and EQ-VAS scores were lower than those of age and gender that matched the control group, at 0.810±0.208 and 73.240±11.36, respectively. Regarding dimensions of the questionnaire, mobility, self-care, usual activities, pain/discomfort, and depression/anxiety were assessed at three months follow-up. The mobility and usual activity parameters showed a statistically evident difference (p-value = 0.001) compared to the control group.

Post-COVID Lung Function with Steroid and/or Antifibrotic in A Tertiary Hospital of Bangladesh

Background: Antifibrotic medication with or without steroid might be beneficial to prevent this postcovid fibrotic event; however, evidence could not establish it yet.Objective: To assess the effects of steroid and antifibrotics on the changes of SPO2 and 6MWD in COVID-19 patients whether antifibrotic has any beneficial effect combined with steroid to improve lung function.Methods: This quasi-experimental study was conducted on 76 moderate to severe COVID-19 patients admitted in Sher-e-Bangla Medical College Hospital, Barishal, Bangladesh, between June 2020 and June 2021. After recording the SPO2 and 6MWD, we gave steroid to 57 patients while the rest 19 patients received steroid and antifibrotic depending on severity. We followed the patients after 1 week, 6 weeks and 12 weeks of discharge to determine their SPO2 and 6MWD change as outcome variable.Results: We recorded nearly 83% improvement (n=63) of post Covid respiratory complains as evidenced by improved SPO2 of 76.9% from baseline to 96.7% in steroid group and from 74.6% to 95.6% in antifibrotic group (p<0.001). The 6MWD test also improved from 62 meter (p<0.001). Similarly, there was a significant improvement of 6MWD test from 53.1, 125.0 and 133.4 meter in 1st follow up, 2nd follow up and 3rd follow up respectively (p<0.001). On further analysis, we found that the antifibrotic treatment improved SPO2 and 6MWD test better than steroid only treatment group.Conclusion: Antifibrotic treatment with steroid improves pulmonary function better than steroid only in terms of SPO2 and 6MWD.International Journal of Human and Health Sciences Vol. 08 No. 01 Jan’24 Page: 38-43

Perinatal Outcome and Preventable Causes of Morbidity and Mortality in Eclampsia: A Cross-Sectional Observational Study in a Tertiary Hospital in Bangladesh

Background: Eclampsia poses a substantial threat to perinatal health in developing countries, with Bangladesh experiencing a notable impact on infant well-being. This cross-sectional observational study, conducted at Enam Medical College Hospital, Savar, Dhaka, aimed to investigate perinatal outcomes in eclampsia patients and identify preventable causes of perinatal mortality and morbidity associated with this condition. The study period spanned from June 2015 to July 2017, with a focus on understanding the specific factors contributing to adverse perinatal events in this population. Methods: A total of 155 eclampsia patients were enrolled in the study, resulting in the delivery of 161 babies, including six sets of twins. The study employed a comprehensive observational approach, assessing maternal and fetal conditions to analyze their correlation with perinatal outcomes. Data collection and analysis were conducted in the Department of Obstetrics and Gynaecology at the tertiary hospital, employing standard protocols and statistical methods to derive meaningful insights. Results: The study revealed a perinatal death rate of 27.32%, with stillbirth accounting for 15.52% and early neonatal death for 11.80%. In contrast, 84.47% of babies were born healthy. Among live-born neonates, 27.94% experienced jaundice, while 30.88% had no complications. Prematurity emerged as a significant contributor to perinatal loss in eclampsia cases. The findings underscore the critical role of early referral of eclampsia patients, the implementation of timely resuscitative measures, and improved neonatal care as potential avenues to enhance perinatal outcomes. Conclusion: In conclusion, this study highlights the importance of addressing stillbirth as a predominant component of perinatal death in eclampsia cases. Prematurity was identified as a key factor contributing to adverse perinatal outcomes. Early referral of eclampsia patients and the implementation of resuscitative measures, coupled with enhanced neonatal care, are crucial interventions that can potentially mitigate perinatal morbidity and mortality associated with eclampsia in the context of a tertiary hospital setting in Bangladesh. These findings provide valuable insights for healthcare practitioners and policymakers to guide strategies aimed at improving perinatal outcomes in similar healthcare settings.

Evaluation of Knee Radiograph and its Interrelation between Body Mass Index and Range of Motion in Osteoarthritic Knee

Abstract Context: Assessing knee osteoarthritis (OA) radiologically is a well-recognised investigation technique. Range of motion (ROM) measurement gives an idea about the functional status of the joint. Body mass index (BMI) increment is one of the risk factors of worsening knee OA. Aim: The aim of this study was to evaluate OA radiologically and to search the status of BMI, ROM and Kellgren–Lawrence (KL) score of osteoarthritic knee patients and find their interrelations. Settings: This study was conducted at the department of physical medicine and rehabilitation in a tertiary hospital of Bangladesh. Designs: This was a cross-sectional study. Methodology: Purposive selection of 66 primary OA knees was done. Compartmental distribution of osteoarthritic knee was determined. Radiographics were determined by KL score system. BMI was calculated conventionally. Maximum flexion, extension and total excursion were measured by a universal goniometer. Results: Fifty per cent of participants had tricompartmental OA. Patients with maximum KL score 2 had significantly more total excursion (127.44 ± 2.89) compared to maximum KL score 3 (121.51 ± 3.14) and 4 (110.00 ± 3.58). Subjects with normal BMI had significantly more total excursion (125.00 ± 4.21) compared to overweight (121.03 ± 6.84) and obese patients (122.54 ± 4.31) (P = 0.044). 60.9% of subjects with normal BMI had significantly more maximum KL score 2 compared to overweight (33.3%) and obese patients (7.7%). A positive correlation was present between BMI and maximal KL score (r = 0.345, P = 0.005). A significant strong negative correlation was found between maximal KL score and total excursion (r = −0.825, P < 0.001). Conclusion: Different percentages of unicompartmental, bicompartmental and tricompartmental knee OA were found. Osteoarthritic patients with higher BMI had lower ROM and increased KL radiographic scores.

Outcome of paraquat poisoning patients admitted in a tertiary hospital in Bangladesh

Background: Paraquat Poisoning is not unknown in clinical practice. However, the data from our country is scanty. Therefore, to find the outcome of paraquat poisoning in a tertiary level hospital was the objective of this study. Methods: The study was a longitudinal descriptive study and conducted at department of Medicine, Rajshahi Medical College Hospital. Patients of paraquat poisoning were approached for inclusion. Informed written consent was taken from the patients and/or attendants. Data were collected by face-to-face interview by the researcher with an aid of a semi-structured questionnaire. All available investigation reports, follow up notes, discharge papers and death certificates were scrutinized. A total 30 patients were included in this study. Results: Total 30 subjects were interviewed. Mean age was 25.33±8.86 (SD) years with female to male ratio-2:1.Majority were from rural area (90%). About 94% consumed with an intention of suicide. Most of the patients had renal impairment (53.3%) and hepatic impairment (50%) as complication. 63.3% patients reached to hospital >12 hours after ingestion of poison and 36.7% reached within 12 hours. Of all, 33.3% (n=10) patients survived. Possible cause of death were Multi organ failure (MOF) (40.0%), Acute renal failure (25.0%), ARDS (15.0%) and Hepatic failure (20.0%). However, overall outcome is not dependent with to time reaching hospital after poisoning but with amount of poison ingested (p<0.05). Conclusion: About 67% patients died following ingestion of the paraquat poisoning and it is not dependant with the time required to reach the hospital rather to the amount of poison ingested. TAJ 2023; 36: No-2: 35-46

Clinicoepidemiological Profile of Short Stature at A Tertiary Care Centre in Bangladesh

Background: Short stature (SS) is a common pediatric problem, which can cause psychosocial disturbances both in parents and children. The goal of the evaluation of a child with SS is to identify the subset of children with pathologic causes so that appropriate timely intervention can be made. Objective: The aim of the study was to study the clinical, epidemiological, and etiological profile of SS at a tertiary hospital of Bangladesh. Methods: This was a cross-sectional study and was conducted in the department of pediatric endocrinology, over a period of 1 year (January 2021-December 2021). A total of 100 children aged 3-14 years, with height <-2SD below the mean height for age and sex were studied. Clinical history, examination, and laboratory evaluations were done to assess the cause of SS and the data were analyzed using appropriate statistical methods. Results: About 55% were female and 45% were male. The causes of SS were found to be familial SS (36%), constitutional growth delay of growth and puberty (12%), hypothyroidism (11%), growth hormone deficiency (8%), malnutrition (10%), chronic diseases (9%), genetic syndromes and skeletal problem (8%). Conclusion: The majority of short stature in children had normal variation of growth. Along with endocrine causes, chronic systemic illnesses and malnutrition still form a major bulk in the etiological profile of SS in Bangladesh. DS (Child) H J 2022; 38(2): 79-83

Presentation and Outcome of Children with Kawasaki Disease: Experience in A Tertiary Care Hospital in Bangladesh

Background: Kawasaki disease (KD) is an acute difficult-to-diagnose febrile illness in children caused by self limiting vasculitis in medium and small sized arteries.
 Objetive: This study has been conducted to analyze its presenting symptoms, clinical course, laboratory findings, and therapeutic options in a tertiary hospital in Bangladesh to aid early diagnosis and optimum management.
 Methods: This is a retrospective study where the medical records of 31 children admitted and diagnosed with Kawasaki Disease (KD) in Evercare Hospital Dhaka between 2009 and 2020, were assessed. Through a structured form, the demographic information, clinical profile, laboratory results, and echocardiographic data were obtained from the hospital records and then entered into a Microsoft Excel sheet. Cleaned and verified data were transferred to SPSS program version 23 and analyzed to obtain descriptive statistics.
 Results: Out of total 31 patients with KD enrolled, 64.5% of the patients were between six months to five years of age with a median age of three years; 97% had an age below 6 months. Though 68% of patients met all the required criteria for KD, one-third (32%) were diagnosed as incomplete KD with fewer manifestations. Along with high fever in all cases, the most common clinical features were polymorphous rash (90%) and changes in extremities (90%) followed by changes in the lips and oral cavity (77.4%), cervical lymphadenopathy (68%) and conjunctival injection (61%). Common laboratory abnormalities found were anemia (90%), leukocytosis (65%), thrombocytosis especially in the second week (78%), high ESR (100%), and elevated CRP (84%). About 42% of patients had cardiac abnormalities at the onset. Seven children (63.6%) had coronary artery aneurysms (CAA) whereas 18% had coronary dilatations. In subsequent followups, coronary artery changes remained almost the same up to 6-8 weeks. After 3-6 months, 87.5 % of children recovered from cardiac abnormality.
 Conclusion: A high index of suspicion for KD and an active search for compatible findings in children with unexplained fever can help in early diagnosis. Timely initiation of IVIG treatment is needed to reduce the risk of cardiac complications. Young infants under six months of age need further careful early suspicion and evaluation because of their incomplete presentation and more vulnerability to developing cardiac complications.
 DS (Child) H J 2022; 38(2): 70-78

Depression among Patients with Chronic Hepatitis B: A Cross-sectional Study in a Tertiary Hospital of Bangladesh.

Patients with chronic hepatitis B suffer not only from physical illness. Rather, they often present with the mental health consequences of this chronic disease. The major objective was to assess the level of depression among patients having chronic hepatitis B. The Department of Hepatology of Bangabandhu Sheikh Mujib Medical University directed this study which was a comparative cross-sectional study during time duration from September 2021 to September 2022. Incidence and grading of depression between patients with chronic hepatitis B and HBsAg negative healthy volunteers were assessed and compared through this study. The association of different variables with depression among chronic hepatitis B (CHB) patients was also measured. Out of 90 patients having chronic hepatitis B, 52 (57.8%) were found to have some degree of depression; whereas among 90 HBsAg-negative healthy controls, 32 (35.6%) were found to have various degrees of depression. The dissimilarity between the two groups was significantly determined (p-value < 0.05). The majority of the depressed population from both groups had mild degrees of depression, however, the variance was not top the notch (p-value > 0.05). But the prevalence of moderate depression and moderately severe depression was statistically significant among CHB patients compared to their counterpart controls. Depression among CHB patients was found to be female-predominant. The study has shown a higher prevalence of depression among patients with chronic hepatitis B compared to HBsAg-negative healthy controls. Rahman M, Noor-E-Alam SM, Rahim MA, et al. Depression among Patients with Chronic Hepatitis B: A Cross-sectional Study in a Tertiary Hospital of Bangladesh. Euroasian J Hepato-Gastroenterol 2023;13(2):79-83.

Job Satisfaction and Burnout among Nurses Working at a Tertiary Level Hospital in Bangladesh

Background: Burnout is a state of physical, mental, and emotional exhaustion caused by chronic overwork, and nurses are particularly susceptible to experiencing burnout, which can have implications for both job satisfaction and patient well-being. This study aimed to investigate job satisfaction, burnout, and the relationship between these factors among nurses working in the pediatric ward of a tertiary hospital in Bangladesh. Methods: A descriptive cross-sectional study was conducted, involving 105 conveniently selected nurses from various pediatric wards at the Bangabandhu Sheikh Mujib Medical University Hospital. Face-to-face interviews were conducted using a structured questionnaire to collect data. Statistical Package for Social Science (SPSS) was used to analyze the data, with 101 participants' data being considered for analysis after excluding four participants. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used, along with inferential statistics including two-sample t-test, ANOVA, and correlation. Results: The participants' mean age was 28 years (SD±4.20). The average job satisfaction score was 2.50 (SD=.56), with approximately 16.3% of nurses reporting being very satisfied and 36.6% expressing satisfaction. Notably, nurses working in gastrology and neurology wards reported significantly higher job satisfaction (M=3.02; SD=.25) than those in other units (F=7.38; p=.000). Additionally, nurses who had participated in at least one training showed significantly higher job satisfaction (M=2.59; SD=.65) compared to those who had not received any training (M=2.40; SD=.55) (t=3.56; p&lt;.05). Regarding burnout, the mean score was 2.11 (SD=.69). Work place (F=3.03; p=.03) and length of service (F=2.55; p=.04) were found to be significantly associated with burnout. Job satisfaction was negatively correlated with burnout, though the correlation was weak (r=-.09; p=.32). Conclusion: The study concluded that nurses in Bangladesh generally experience a moderate level of job satisfaction and a low level of burnout.

Effectiveness of a Health Education Program for Patients Who Had a Stroke and Their Caregivers by Controlling Modifiable Risk Factors to Reduce Stroke Recurrence in a Tertiary Hospital in Bangladesh: Protocol for a Randomized Controlled Trial.

Stroke is a significant public health concern that causes severe and long-lasting disability. The recurrence of stroke is increasing due to lack of patients' knowledge and compliance with treatment to control modifiable risk factors and lifestyle changes. Health education can be an effective way to increase knowledge about behavioral changes in patients who had a stroke. The aim of this study is to evaluate the effectiveness of a health education program in Bangladesh for patients who had their first stroke and their family caregivers in order to reduce the recurrence of stroke by controlling modifiable risk factors. This is a parallel, open-label, prospective randomized controlled trial conducted at the National Institute of Neurosciences & Hospital in Dhaka, Bangladesh. We enrolled ≥18-year-old patients of both sexes who had a history of first stroke attack (transient ischemic attack, hemorrhagic stroke, lacunar stroke, atherothrombotic stroke, or cardioembolic stroke). We stratified patients into those aged <65 years and those aged ≥65 years and according to types of strokes for randomization. Our estimated sample size was 432. The intervention group receives face-to-face counseling on lifestyle modifications, blood pressure monitoring, and medication compliance-related health education during enrollment and monthly follow-ups. However, the control group receives only usual care from the hospital. The primary end point of this study is the reduction in the stroke recurrence rates at the end of the 12-month follow-up period. The secondary end points are to (1) assess the occurrence of all adverse events such as other cardiac events and all-cause mortality, (2) evaluate the status of the controlling modifiable risk factors such as blood pressure, glycated hemoglobin, and non-high-density lipoprotein cholesterol, (3) assess the knowledge related to stroke by using the investigator-developed questionnaire, (4) evaluate the lifestyle behavior related to stroke by using the investigator-developed questionnaire, (5) assess medication adherence, and (6) evaluate the quality of life of patients who had a stroke and their family caregivers. The evaluation points will be at baseline, 6 months, and 12 months for both groups. Patients' enrollment started on October 2022, and follow-up will be completed in March 2024. A total of 432 participants were included in both the intervention (n=216) and control groups (n=216). This study was approved by the institutional review board and the ethics review board of the National Institute of Neurosciences & Hospital (IRB/NINSH/2022/151) on August 30, 2022. Our health education program is expected to reduce the recurrence of stroke and improve the quality of life of patients who have had the first stroke. The results of this study will provide insights into the importance of health education for (self)-management and prevention of stroke. ClinicalTrials.gov NCT05520034; https://clinicaltrials.gov/ct2/show/NCT05520034. DERR1-10.2196/51178.

Assessment the Levels of Serum Ferritin and Some Biochemical Parameters in Type 2 Diabetic Subjects Attending A Tertiary Hospital in Bangladesh

Background: Type 2 diabetes (NIDDM) is the commonest form of diabetes constituting nearly 90% of the diabetic population in any country. Iron is an important mineral in normal physiological processes, and ferritin is a specialized iron storage protein, which reflects iron stores in the body. Iron overload is a risk factor for diabetes. The link between iron and diabetes was first recognized in pathologic conditions-hereditary hemochromatosis and thalassemia, but high levels of dietary iron also import diabetes risk. Iron plays a direct and causal role in diabetes pathogenesis mediated both by β-cell failure and insulin resistance. The objective of the study to evaluate serum ferritin level among type 2 diabetes patients. Method: A hospital based observational study a total of 240 subjects among them 60 male diabetes patients and 60 female diabetes patients were recruited. Serum ferritin level were checked in all participants. Results: The mean age of T2DM was 59  14 years and control group was 50  13 years. The BMI of each group was 27.52  2.6 and 24.80  2.4. Ferritin (ng/dL) level in T2 DM subjects was 231  36 and control subjects was 48  22. Serum ferritin level among the study subjects control vs T2 DM, t/p value (8.465/0.0001). Conclusion: From this study it was observed that ferritin level is significantly higher among type 2 diabetes patients.

Perceptions of antibiotic stewardship programmes and determinants of antibiotic prescribing patterns among physicians in tertiary hospitals in Bangladesh: implications for future policy and practice

The concerning growth of antimicrobial resistance (AMR) renders common infections life-threatening due to irrational antibiotic use and a lack of effective antimicrobial stewardship programmes (ASPs). To investigate the awareness, perceptions and practices of physicians regarding ASPs, AMR and antibiotic prescribing in tertiary care hospitals in Bangladesh. This hospital-based cross-sectional survey was conducted in 11 tertiary care hospitals across Bangladesh between September 2020 and January 2021. A semi-structured questionnaire was administered through face-to-face interviews for data collection. Descriptive and multi-variate analyses were performed using STATA Version 13. In total, 559 physicians were enrolled in this survey. Overall, 40.6% [95% confidence interval (CI) 36.5-44.8] of physicians reported being aware of ASPs, and this figure was higher in public hospitals compared with private hospitals (43.8% vs 27.1%). None of the study hospitals had any ASP initiatives. More than half (55.1%) of the participants were willing to receive feedback from an ASP on their antibiotic selection. Only 30.9% of respondents stated that they wait for the findings of microbiological tests before prescribing antibiotics, although challenges included empiric use of broad-spectrum antibiotics, delayed laboratory results and the existence of drug-resistant patients. In contrast, physicians aware of ASPs were 33% (adjusted odds ratio 0.67, 95% CI 0.45-0.98; P=0.033) less likely to wait for laboratory results before prescribing antibiotics. However, 42.5% of physicians considered patient affordability of purchasing antibiotics when prescribing. Physicians' fundamental knowledge of ASPs and rational antibiotic prescription were found to fall short of the standard. Context-specific and integrated ASP activities, availability and use of guidelines, and improved laboratory facilities are required to battle AMR in Bangladesh.

Status of lipid control in Bangladeshi subjects with type 2 diabetes mellitus on lipid-lowering drugs: a multicenter, facility-based, cross-sectional study

BackgroundAchievement of lipid targets is crucial in patients with type 2 diabetes mellitus (T2DM) to mitigate the risk of cardiovascular diseases (CVD). Data on lipid-control status among patients with T2DM in Bangladesh are scarce. This study was conducted to determine the lipid-control status among patients with T2DM who were on lipid-lowering drugs in the country.MethodsThis cross-sectional study was conducted in the diabetes outpatient departments of several tertiary hospitals in Bangladesh from January 2022 to December 2022. Adults of both sexes diagnosed with T2DM for at least one year and were on the lipid-lowering drug(s) for a minimum of 3 months were included in the study by consecutive sampling. Patients’ data were collected by face-to-face interviews, and blood samples were collected for fasting lipid profile. The lipid target was set at < 200 mg/dL for total cholesterol (TC), < 150 mg/dL for triglyceride (TG), < 100 mg/dL for low-density lipoprotein cholesterol (LDL-C), > 40 mg/dL for high-density lipoprotein cholesterol (HDL-C), and < 160 mg/dL for non-HDL cholesterol (non-HDL-C).ResultThree thousand sixty patients (age 44.7 ± 13.3 years, female 57%) with T2DM were evaluated. Overall, almost 81% of the study subjects achieved the LDL-C target. Besides, TC, TG, HDL-C, and non-HDL-C targets were achieved by 40.8, 21.6, 66.3, and 44.1% of patients, respectively. However, all the lipid parameters were under control in only 8.8% of patients. Almost 77.6% of the patients with ischemic heart disease, 81.5% of patients with stroke, and 65% of patients with CKD had LDL levels < 70 mg/dL. Only 10.03% achieved the HbA1c target of < 7%. 7.4% of patients achieved both HbA1c < 7% and LDL < 100 mg/dL and 5% achieved both HbA1c < 7% and LDL < 70 mg/dL. Advanced age (aOR 0.97, 95% CI 0.96, 0.98, p < 0.001), longstanding T2DM (aOR 0.53, 95% CI 0.39, 0.72, p < 0.001), and non-statin therapy (aOR 0.25, 95% CI 0.16, 0.37, p < 0.001) were negatively associated with lipid control (LDL < 100 mg/dL) while using oral hypoglycemic drugs or insulin (aOR 2.01, 95% CI 1.45, 2.77, p < 0.001) and having cardiovascular comorbidity (aOR 3.92, 95% CI 3.00, 5.12, p < 0.001) were positively associated with lipid control.ConclusionThough most patients with T2DM achieved their target LDL level, the prevalence of both glycemic and overall lipid control was low in our study despite lipid-lowering therapy.

COVID 19 - Dengue Co-Infection: Socio-Demographic, Clinical and Laboratory Characterestics in a Tertiary Hospital In Bangladesh

Background: Since starting of the SARS-COV 2 pandemic till date, in dengue endemic countries co-infection of COVID -19 and Dengue co-infection remains a healthcare concern and cases have been reported from some Asian countries. Bangladesh being a high endemic region for dengue infection bears risk of significant healthcare burden of such co-infection cases. During the surge of dengue cases during monsoon season in 2021, the possibility of COVID19 - Dengue co-infection cases also increased. Method: This study was carried out in the Department of Internal Medicine and Pulmonology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh from June 2021 to December 2021. Dengue and COVID 19 cases were confirmed as per Bangladesh National guidelines. Result: Total 12 cases including 8 males were diagnosed as dengue –COVID 19 co-infection during the study period. Mean age was 47.0 years. Majority of cases (10) were residing in Dhaka. Among risk factors, 5 cases were known diabetic and 4 cases were hypertensive while 1 case was congenital adrenal hyperplasia. Common presentations were fever (100%), headache (75%), bodyache (66.7%), dry cough (41.7%), nausea, vomiting, abdominal pain, and retro orbital pain were 25% while rash and shortness of breath occurred in 16.7%. Mean duration of fever was 5.8 days and mean recorded highest temperature was 102.5°F. Dengue manifestation was predominant in 8 cases (66.7%). Laboratory investigations revealed following mean values: baseline haematocrit (HCT) 39.9%, initial total white cell count 4.64x109/L, absolute neutrophil-lymphocyte ratio 2.4, lowest platelet count 100.4x109/L, C-Reactive Protein 143.8mg/L, serum ferritin 888.1 ng/ml, D dimer 2.0 µg/ml, LDH 668.1 U/L, serum Aspartate aminotransferase 88.1 U/ L, Alanine aminotransferase 73 U/L. Radiological findings were present in 7(58.3%) cases, among which pneumonitis was predominant (4 cases,57.1%). All cases were managed and followed up as per national guidelines till discharge and no one required critical care. Conclusion: Observation revealed that COVID -19 and Dengue co-infection may occur and if managed adequately fatal outcome can be avoided, even in high risk patients. Therefore, high degree of suspicion of co-infection should be considered in appropriate clinical scenario. J Bangladesh Coll Phys Surg 2023; 41: 44-50

Paediatric blunt abdominal trauma with organ injury: a comprehensive analysis of cases at a tertiary hospital in Bangladesh

Background: Pediatric blunt abdominal trauma with organ injuries is a critical issue in Bangladesh, lacking sufficient research. This study focuses on managing such cases in a tertiary hospital. Objectives were to assess clinical characteristics, injury patterns, and outcomes of pediatric patients with blunt abdominal trauma and organ injuries. It aims to identify causes, associated injuries, and hospital stay durations. Methods: A prospective study of 142 pediatric patients aged 1-12 was conducted at Rajshahi medical college hospital study period January 2020 to December 2021. In addition, this study aimed to identify and grade solid organ injuries according to the American association for the surgery of trauma organ injury scale. Results: Prevalence of hepatic injuries (76.8%), solid organ injuries (90.1%), road traffic accidents (71.8%), falls from height (25.4%). Most received conservative treatment, had short hospital stays, and a 7% mortality rate. Gender had no significant impact on organ injuries (p&gt;0.001). Among the causes, 84.5% had hepatic injuries, 15.5% had spleen injuries due to road traffic accidents, and 58.3% had injuries from falls from height, with a highly significant cause-organ injury relationship (p&lt;0.001). Conclusions: pediatric blunt abdominal injuries in Bangladesh affect various organs, primarily in males and school-aged children, primarily due to road accidents. Timely surgical intervention and preventive measures are crucial for improved outcomes.

Evaluation of feasibility phase of adaptive version of locally made bubble continuous positive airway pressure oxygen therapy for the treatment of COVID-19 positive and negative adults with severe pneumonia and hypoxaemia.

Bubble continuous positive airway pressure (bCPAP) oxygen therapy has been shown to be safe and effective in treating children with severe pneumonia and hypoxaemia in Bangladesh. Due to lack of adequate non-invasive ventilatory support during coronavirus disease 2019 (COVID-19) crisis, we aimed to evaluate whether bCPAP was safe and feasible when adapted for use in adults with similar indications. Adults (18-64 years) with severe pneumonia and moderate hypoxaemia (80 to <90% oxygen saturation (SpO2) in room air) were provided bCPAP via nasal cannula at a flow rate of 10 litres per minute (l/min) oxygen at 10 centimetres (cm) H2O pressure, in two tertiary hospitals in Dhaka, Bangladesh. Qualitative interviews and focus group discussions, using a descriptive phenomenological approach, were performed with patients and staff (n = 39) prior to and after the introduction (n = 12 and n = 27 respectively) to understand the operational challenges to the introduction of bCPAP. We enrolled 30 adults (median age 52, interquartile range (IQR) 40-60 years) with severe pneumonia and hypoxaemia and/or acute respiratory distress syndrome (ARDS) irrespective of coronavirus disease 2019 (COVID-19) test results to receive bCPAP. At baseline mean SpO2 on room air was 87% (±2) which increased to 98% (±2), after initiation of bCPAP. The mean duration of bCPAP oxygen therapy was 14.4 ± 24.8 hours. There were no adverse events of note, and no treatment failure or deaths. Operational challenges to the clinical introduction of bCPAP were lack of functioning pulse oximeters, difficult nasal interface fixation among those wearing nose pin, occasional auto bubbling or lack of bubbling in water-filled plastic bottle, lack of holder for water-filled plastic bottle, rapid turnover of trained clinicians at the hospitals, and limited routine care of patients by hospital clinicians particularly after official hours. If the tertiary hospitals in Bangladesh are supplied with well-functioning good quality pulse oximeters and enhanced training of the doctors and nurses on proper use of adapted version of bCPAP, in treating adults with severe pneumonia and hypoxaemia with or without ARDS, the bCPAP was found to be safe, well tolerated and not associated with treatment failure across all study participants. These observations increase the confidence level of the investigators to consider a future efficacy trial of adaptive bCPAP oxygen therapy compared to WHO standard low flow oxygen therapy in such patients. s Although bCPAP oxygen therapy was found to be safe and feasible in this pilot study, several challenges were identified that need to be taken into account when planning a definitive clinical trial.

Outcome of Adjuvant Chemo-Radiation in Operated Locally Advanced Rectal Cancer in a Tertiary Hospital in Bangladesh

Rectal cancer is the one the common cancer in Faridpur, Bangladesh. The clinical course of patient treated with surgery alone has been characterized by a high death rate and also by the pain and disability associate with pelvic recurrence of the tumor. Adjuvant chemotherapy combined with radiation has been studied for prevention of such reoccurrence. Most of the patients at our center are those who have already been in subjected to surgery in this hospital or other private hospital in this district or other district hospital. We studied role of Oxaliplatin and Capcitabine with Radiotherapy in AJCC stage IIB to IIIC locally advanced rectal cancer and toxicities in adjuvant settings. This study was done to assess the outcome of adjuvant chemoradiation in operated locally advanced treated cancer patients. A total of 30 patients were included in between June 2016 to June 2019 in non-randomized clinical trial. About 66.6% of the patient underwent low anterior resection and 33.3% had abdominoperineal resection. Patients were treated postoperatively with Oxaliplatin and capcitabine. Radiotherapy of 45 Gy in 20 fractions were delivered in concurrently with Capcitabine 825 mg/m2 from day 1 to day 5 of Radiotherapy at National Institute of Cancer Research and Hospital, Mohakhali, Dhaka, median follow-up was 3 years. At 3 years overall survival of operated patient was 66.3% with no disease relapse. Toxicities of this schedule were mostly Anemia and Gastrointestinal mucocitis but without treatment interruption. Combination of adjuvant chemotherapy and radiotherapy is effective modality in reducing local tumour recurrence and improves survival. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(2):101-105.