Tertiary Level Hospital In Bangladesh Research Articles

Tolerance of Gastro-Intestinal Endoscopy without Sedation: An Experience in a Tertiary Level Hospital in Bangladesh

Background: Upper and lower GI endoscopy are the most exigent procedure to diagnose various diseases in gastroenterology. Acceptability and tolerability of Endoscopy are variable due to its way of approach to the individuals. Negative attitude towards these procedures can be overcome by proper motivation of patients regarding importance of the tests and also by explaining the additional sideeffects of sedatives, cost and time to spend for tests.Objective: The aim of this study was undertaken to see the attitude, response during procedure, easiness of finding lesions and completeness of these procedures without sedation.Methodology: This was a cross-section study. Samples were collected purposively of whom age were between 13 and 65 of either sex and who underwent Upper and Lower GI procedures in the department of Gastroenterology, Shaheed Suhrawardy Medical Hospital from January 2016 to October 2016. This study was approved by the Ethical review board of Shaheed Suhrawardy Medical College.Results: Among 1205 patients, 724 (Upper GI 663 and lower GI 61) patients were male and 481 (Upper GI 433 and lower GI 48) were female. 58.26% patients showed positive attitude towards GI procedures through both upper and lower route. 57.61% male and 46.19% female well tolerated upper GI endoscopy, whereas 37.70% male and 43.75% female tolerated lower GI endoscopy. Procedures were successfully completed in 97.89 % male and 97.22% female patients of UGI and 96.72 male and 85.42% female patients of LGI endoscopy without sedation.Conclusion: Endoscopy of both upper and lower gastrointestinal tract can safely and effectively be done without sedation.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 141-144

Effect of Chlorhexidine Cleansing of Umbilical Cord for Prevention of Infection

Background: Chlorhexidine cleansing of the cord can reduce neonatal mortality among newborns.Objective: The aim of study was to determine the effect of cord cleansing with chlorhexidine in reduction of umbilical infection among newborns in hospital settings.Methodology: This randomized controlled trial was carried out between April 2013 to July 2014 and 510 newborns were randomly assigned within a tertiary level hospital in Bangladesh to receive 1 of 3 cord care regimens single cord cleansing with 4% chlorhexidine(Group-1), multiple cord cleansing with 4% chlorhexidine (Group-2) and clean and dry cord care (Group-3 : control).Results: The risk of umbilical cord infection (omphalitis) was significantly reduced in both the single (Relative risk [RR] 0.15 [95% CI] 0.008-0.93) and multiple chlorhexidine cleansing group (RR 0.37 [95% CI] 0.04- 0.99) compared to the dry cord care group. The risk of omphalitis was not significantly different between multiple and single chlorhexidine cleansing group (RR 3.14 [0.13-76.54]). Conclusion: Chlorhexidine significantly reduce the risk of umbilical infection in both single and multiple cord cleansing neonates.Bangladesh Journal of Infectious Diseases 2017;4(2):35-39

Mortality in Coronary Care Unit of a Tertiary Level Hospital of Bangladesh

Background and objectives: Cardiovascular disease is the most common cause of death worldwide and Coronary Care Unit (CCU) plays a central role in reducing this mortality. Currently the data on mortality in CCU is very limited in our country. Our purpose of this study to provide data on mortality so that we can focus and improve the factors determining deaths in CCU. Methodology: The data of all death cases admitted in the CCU of a tertiary level hospital between 1 January 2016 and 31 December 2017 were included for assessing the data on demography, diagnosis, and comorbidities at the time of death.Results: Among 802 cases admitted in CCU in two years, 40 patients died (5%). Male was 55% and female was 45%. Most of the death occurred in their 6th decade of life, due to Non-ST-Elevation Myocardial Infarction (NSTEMI) and sepsis, within 24-hour of CCU admission.Common associated co-morbidities were DM (75%), hypertension (42.5%), CKD (27.5%), and hypokalemia (12.5%).Conclusions: The death rate is much lower in our CCU in comparison to global rate. The common cause of death is still NSTEMI. The common co-morbidities we found are DM, hypertension and CKD. Most of the deathsoccurred within 24-hour of admission.Bangladesh Heart Journal 2018; 33(1) : 28-31

16. Study on recurrence of HCV infection after recommended treatment in a tertiary level hospital in Bangladesh

Background and Aims: The world is now in HCV-RNA treatment revolution after introducing oral drugs. But it is shown that there are some recurrences of HCV infection after optimum treatment. This Study was done to see the rate of recurrence. Methods: It was a cross sectional descriptive study done in Rajshahi Medical College hospital, Bangladesh from June-2016 to December-2017. Total number of patients 83. Male 73 & Female 10. Age 18–65 Years. All patients have HCV RNA (PCR) > 20000 IU/ml. Genotype 3a & 3b are in 75 and 1a, 1b are in 8 patients. Patients are divided into two groups. Group ‘A’ & Group ‘B’. Group A- 41 patients, Group B- 42 patients. According to the anti-viral drugs schedule. Group ‘A’ took Sofosbuvir & Velpatasvir and Group ‘B’ took Sofosbuvir, Velpatasvir & Ribavirin with standard dose and duration. Comorbidities (DM & CKD) were in 10 patients. There were no Cirrhotic patients. Results: After completed of treatment HCV-RNA (PCR) were done and undetected in 36 (87.80%) patients & detected in 05 (12.19%) patients in Group A and In Groups B 39 (92.85%) patients were undetected & 03 (7.14%) were detected. After 1 year, HCV RNA (PCR) tests were done again in previously undetected all patients. HCV- RNA (PCR) were detectable in 05 (13.88%) patients in group A and 3 (7.69%) patients in group B. Conclusions: Some certain number of patients got recurrence of HCV infections after standard recommended treatment and create burden in health system in our country. Further studies should be done to solve the problems. The authors have none to declare.

Chlorhexidine Cleansing of the Umbilical Cord for Prevention of Umbilical Infection: A Hospital based Study in Bangladesh

Background: The umbilical cord is an important site for bacterial colonization. A possible consequence of bacterial colonization is cord stump infection, a factor that can greatly increase morbidity and mortality for infants in developing countries. Chlorhexidine cleansing of the cord can reduce neonatal mortality among newborns infants in low-resource settings with high risk of infection. This objective of this study was to determine the effect of cord cleansing with chlorhexidine in reduction of umbilical infection among newborns in hospital settings.Methodology: Between April 2013 to July 2014, 510 newborns were randomly assigned within a tertiary level hospital in Bangladesh to receive 1 of 3 cord care regimens: single cord cleansing with 4% chlorhexidine(Group-1), multiple cord cleansing with 4% chlorhexidine (Group-2) and clean and dry cord care (Group-3 : control).Results: The risk of umbilical cord infection (omphalitis) was significantly reduced in both the single (Relative risk [RR] 0.15 [95% CI] 0.008-0.93) and multiple chlorhexidine cleansing group (RR 0.37 [95% CI] 0.04- 0.99) compared to the dry cord care group. The risk of omphalitis was not significantly different between multiple and single chlorhexidine cleansing group (RR 3.14 [0.13-76.54]).Conclusion: 4% chlorhexidine significantly reduce the risk of umbilical infection in both single and multiple cord cleansing groups as compared to clean and dry cord care group.Bangladesh J Child Health 2018; VOL 42 (1) :4-8

Risk factors and causes associated with maternal mortality in a rural tertiary level hospital in Bangladesh

The aim of the study was to find out the risk factors and causes of maternal mortality in rural hospitals of Bangladesh. The retrospective study was conducted at the Department of Obstetrics and Gynaecology, Jahurul Islam Medical College Hospital with duration of 3 years from May 2009 to April 2012. Total number of maternal deaths was 21 yielding the rate of maternal death as 7.0 per 1000 live births during the study period. The risk factors were age ranging from 21 to 25 years, primigravida, low socioeconomic condition, and less antenatal checkup. Eclampsia was the leading cause of death followed by obstetric hemorrhage, unsafe abortion, obstructed labour.Mediscope Vol. 5, No. 1: Jan 2018, Page 28-32

Laparoscopic Appendicectomy in Common Surgical Practice and Our Experience in a Tertiary Level Hospital in Bangladesh

Laparoscopic Appendicectomy in Common Surgical Practice and Our Experience in a Tertiary Level Hospital in Bangladesh

Childhood Stroke: A Cross-sectional Study in a Tertiary Level Hospital of Bangladesh

Background & objective:The present study was undertaken to find the prevalence and pattern of childhood stroke and to see its clinical presentation and sub-types.
 Materials & Methods:The present cross sectional study was conducted in the Department of Pediatrics, BSMMU, Dhaka over a period of 6 months. A total of 30 children suffering from childhood stroke, provisionally diagnosed on the basis of clinical criteria and confirmed by neuroimaging were the study population.The demographic variables were age, sex, age at onset and age at case taking. The signs and symptoms at presentation, causes, investigations, neuro-imaging findings and final diagnosis were recorded.
 Result: Over half (53.4%) of the patients were in the range of 13 – 36 months with mean age of the patients being 39.1 ± 8.2 months. The mean age at onset was 36.2 ± 8.3 months. About 47% of patients were male and 53% female. Paresis of limb was invariably present, unconsciousness at onset (50%), convulsion (33.3%), aphasia (26.7%), raised blood pressure (23.3%), vomiting (13.3%), visual defect (8.7%) and headache (6.7%). Arterial occlusion was the main cause of childhood stroke (36.7%) followed by hypertensive encephalopathy (10%), migraine, hematoligical disease, cardiomyopathies (each 6.7%). Investigations revealed that over one-third (36.7%) of the patients had leucocytosis and 13.3% abnormal echocardiography. All the children either exhibited ischemia or infarction or hemorrhage on Computed Tomography (CT) and 86.7% on Magnetic Resonance Imaging (MRI). Seventy percent and 36.7% of patients had MRA and MRV abnormality respectively. About 47% of the patients had acute ischemic stroke, 13.3% AIS with left-sided haemiparesis with facial palsey and another 13.3% AIS with right-sided haemiparesia. Acute haemorragic stroke (AHS), acute stroke with Hb beta-thalassaemia, acute stroke with right-sided haemiparesis with cardiomyopathy and recurrent haemorragic stroke were rare.
 Conclusion: The study concluded that childhood stroke occurs most frequently between one to three years of age and equally affects male and female. Paresis of limb and unconsciousness at the onset were the main presenting features and arterial hypertension and hypertensive encephalopathy were the common cause of childhood stroke. Nearly three-quarters of the children present with ischemic stroke and the rest with haemorrhagic stroke.
 Ibrahim Card Med J 2016; 6 (1&2): 20-24

Undernutrition and Morbidity Profile of Exclusively Breastfeeding Children: A Cross-sectional Study.

Background:Undernutrition is common and has been recognized as a public health problem in Bangladesh. It has devastating effects on any population as it increases morbidity children and reduces the quality of life of all affected. The study was done with the objective to assess the undernutrition and morbidity profile in children who have completed exclusive breastfeeding.Methods:This was a descriptive cross-sectional study, which was carried out among children aged 6–12 completed months attending a tertiary level hospital in Bangladesh. A total of 251 children were selected through convenient sampling from January to December 2015. Nutritional assessment was done in terms of underweight, stunting, and wasting.Results:One hundred and forty-three (57.0%) were boys while 108 (43.0%) were girls. The prevalence of undernutrition (Z-score ≤−2) was observed in 11.2%, 16.3%, and 12.0% based on stunting, underweight, and wasting. Among 251 children, 16.7% were not suffering any diseases, whereas majorities (69.7%) were suffering from single disease and 13.5% were suffering from multiple diseases. Cough and fever (55.0%), pneumonia (18.3%), measles (9.9%), and diarrhea (8.3%) were the most common cause of infectious morbidity observed in children.Conclusions:The prevalence of undernutrition was high in the study population, and it continues to be a public health burden because of its major effect on morbidity and impairment of intellectual and physical development in long-term. Increasing the practice of exclusive breastfeeding, the introduction of timely complementary feeding, and standard case management of morbidities would be beneficial to combat the problem of undernutrition.

The Burden of Severe Hypoglycemia on Quality of Life among Diabetes Mellitus Patients in a Tertiary Level Hospital of Bangladesh.

Objective:This study aimed to determine the impact of hypoglycemia on health-related quality of life from a patient perspective.Materials and Methods:A cross-sectional study was conducted in 164 type 2 diabetes patients admitted due to severe hypoglycemia from August 2015 to October 2016 at Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, in Dhaka. Impact of severe hypoglycemia on health-related quality of life in diabetic patients was evaluated using the disease-specific questionnaire audit of diabetes-dependent quality of life-19 (ADDQOL-19).Results:The median ADDQOL score was calculated at −3.31. Totally, 88 (53.7%) patients reported an ADDQOL score of − 3.31 or more, and 76 (46.3%) patients had an ADDQOL score of less than −3.31 (lower quality of life [QoL]). After considering weighting, “Freedom to eat” (mean Weighted Impact Score-6.32 ± 1.94) was the most and “Holidays” (mean Weighted Impact Score-0.96 ± 0.19) was the least affected QoL domains, respectively. In multivariate logistic regression analysis, severe hypoglycemia impact on ADDQOL was related with age (odds ratio [OR] 0.932, 95% confidence intervals [CIs] 0.897–0.969, P < 0.001), sex (OR 0.088, 95% CIs 0.023–0.338, P < 0.001), glycated hemoglobin (%) (OR 0.613, 95% CIs 0.422–0.890, P = 0.010), and marital status (OR 9.264, 95% CIs 2.467–34.790, P = 0.001).Conclusions:The results of this analysis suggest hypoglycemia impacts heavily on the well-being and quality of life of people with diabetes, and every effort should be made to minimize hypoglycemia while aiming for good glycemic control.

Tracheostomy at a tertiary level hospital in Bangladesh: any change in pattern?

Objective: This study was conducted on tracheostomy to find out the different indications and complications occured at the tertiary level hospital in Bangladesh. Study design: Cross-sectional observational study.Place and Duration: This study was conducted at the department of Otolaryngology &amp; Head Neck surgery and department of ICU, Sir Salimullah Medical College Mitford Hospital, Dhaka &amp; DMCH over one year from January 2014 to December 2014.Methodology: 55 tracheostomy operation were performed in both genders and all age groups either in emergency situations or within an elective environment. All the patients were registered with a definite protocol by filling a pre designed proforma equipped with demographic data, details of present illness mirroring the indication for the procedure, relevant physical examination &amp; investigations, details of the surgical procedure of tracheostomy and postoperative follow up with note of any attendant complications described as immediate, early and late postoperative.Results: Mean age of this study was 40.09 years and male female ratio iwas 3.2: 1. 30(54.54%) patients underwent emergency tracheostomy and 25(45.46%) underwent tracheostomy electively. The commonest indications were laryngeal &amp; hypopharyngeal malignancies which affected 28(50.9%) patients. The overall rate of complications was 25.45%. These were 4(28.57%) immediate post operative, 8(57.14%) early post operative and 2(3.63%) late post operative. Out of overall 14 complications, 11(36.66%) complications occurred in 40 patients who underwent tracheostomy in emergency and 3(12%) complications occurred in 25 patients who underwent tracheostomy electively.Conclusion: Upper airway obstruction due to laryngeal and hypopharyngal carcinoma still remains the most common indication for tracheostomy in our centre but prolonged intubation as an indication for tracheostomy is evolving based on recent improvement in the facilities available at our ICU.J Dhaka Medical College, Vol. 25, No.1, April, 2016, Page 67-71

Perinatal Characteristics and Outcome of Neonates at NICU of a Tertiary Level Hospital in Bangladesh

Background: One of the Millennium Development Goals (MDG-4) is to reduce child mortality up to two-thirds by 2015. In most developing countries, a higher proportion of neonatal deaths are observed. It has been recognized that without a substantial reduction in neonatal deaths, MDG-4 will not be met.Objective: To assess the perinatal characteristics, pattern of admissions and outcome of neonates in a tertiary care centre in Bangladesh.Methods: A retrospective review of consecutive neonatal admissions to Bangabandhu Sheikh Mujib Medical University, between January and December 2013, was conducted. Data were collected from the neonatal admission, discharge and death registers. Standard definitions of the conditions were used to diagnose the clinical conditions.Results: Total 683 neonates were admitted to the NICU. Among them 56.1% were inborn and males were 56.8%. Total 61.3% neonates were low birth weight and 60.3 % were preterm. The overall cesarean section rate was 61.9%. Total 35.3% neonates had sepsis and perinatal asphyxia was present in 16.8% neonates. Congenital anomaly was present in 17.6% neonates. The mean duration of hospital stay was 11.1 days and overall mortality rate was 14.9%.Conclusion: Prematurity, neonatal infections, birth asphyxia and congenital anomalies were the main causes of neonatal hospital admission and neonatal deaths in this study.Bangladesh J Child Health 2017; VOL 41 (1) :34-39

Association of Serum Calcium with Acute Myocardial Infarction

Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide. The incidence of AMI is dependent on certain traditional predisposing risk factors. In addition to the traditional risk factors, raised serum calcium level is also being considered as an associated factor for AMI. The aim of the study is to evaluate the association of serum calcium level with acute myocardial infarction in a tertiary level hospital in Bangladesh. This case control study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from January 2013 to December 2013. In this study, 50 diagnosed cases of AMI and 50 age and sex matched apparently healthy subjects were selected from DMCH purposively according to the selection criteria. Blood pressure, height and weight were measured and BMI was calculated. Biochemical parameters- serum calcium and fasting blood glucose in two groups were estimated in mmol/l. Then serum calcium was compared between two groups to observe the association with AMI. Results were analyzed statistically in SPSS version 17.0. Unpaired student's 't'-test and Spearman correlation analysis was done. All the results were expressed as mean ±SD and p value &lt;0.05 was accepted as level of significance. Present study showed that serum calcium level was significantly higher(p=.001) in cases (2.61±.15 mmol/l) when compared with that of controls (2.13±.15mmol/l). Serum calcium also showed a significant positive correlation with AMI (rho=0.858, p=0.001).Findings of study concludes that increased serum calcium is associated with AMI.Bangladesh J Med Biochem 2015; 8(1): 16-20

Association of Cerebrospinal Fluid Tau Protein in Patients with Alzheimer’s and Non Alzheimer’s Dementias in a Tertiary Level Hospital in Bangladesh

Background: Alzheimer’s disease is one of the common causes of dementia in our country. The growth of the elderly population, together with the rising incidence of dementia requires immediate attention. There is very limited data regarding how CSF Tau protein correlates with this group of people’s cognitive function. Objectives: To evaluate association of CSF Tau protein in different types of dementia patients (AD and non-AD) and to find out the correlation of CSF Tau with severity of dementia and duration of disease. Methods: This cross sectional analytical study was conducted in dementia clinic (OPD) and inpatient department of Neurology, BSMMU from March’2013 to September’2015. 48 both male and female adult subjects were included in this study. Then they were divided into 3 groups: Alzheimer’s disease (AD) group (n=15), non-AD other dementias (OD) group (n=18) and subjects having neither AD and/or OD were included as control (n=15). CSF Tau protein was measured and compared between 3 groups. Results: Mean age of dementia in AD group was 68.2±9.33 years and in OD group was 67.72±12.74 years. Mean MMSE score in AD group was 13.47± 4.72, in OD group 15.83±3.31 and in control group 28.60±1.12. This study showed that CSF Tau protein was highly elevated in AD group (315.30±279.68 pg/ml) than in OD (57.08±27.41pg/ml) and control (39.23±12.21) groups. Conclusion: The study found that CSF Tau levels are elevated in AD patients in comparison to non AD other dementias. So, CSF Tau protein can be an early biomarker of Alzheimer’s disease.

Clinical Profile of Acute Pancreatitis in Children in a Tertiary Level Hospital of Bangladesh

Background: Acute pancreatitis is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. The incidence of acute pancreatitis in children has increased significantly in the past two decades. It can be associated with severe morbidity and mortality. It should be considered in every child with unexplained acute abdominal pain.Objectives: To observe the clinical, biochemical and imaging profiles of acute pancreatitis in children.Methods: It was a cross-sectional study conducted at the Department of Pediatric Gastroenterology &amp; Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2014 through June 2015. A total of 50 cases of acute pancreatitis were included in this study. The diagnosis of acute pancreatitis was based on diagnostic criteria of acute pancreatitis made by INSPPIRE group (If a child had any 2 of the 3 criteria: the abdominal pain compatible with acute pancreatitis, elevated serum amylase and /or lipase level more than three times of upper limit of normal, imaging findings compatible with acute pancreatitis). Clinical characteristics, laboratory and imaging profile of the cases, complications were studied.Results: Among 50 cases, male were 46% and male female ratio was 0.8:1. Mean age at presentation was 10.2 ± 3.2 years. Forty eight (96%) patients had abdominal pain which was severe agonizing in 81.3% cases. The common location of pain was in epigastric region (77%). Pain radiating to back in 22.9% patients. Mean duration of pain was 6.6 ± 4.4 days before hospital admission. Vomiting was present in 72% patients followed by fever (30%). Two (4%) patients had jaundice. Ascites was noted in 12% patients and abdominal mass in 6% patients. Out of 50 cases of AP, biliary sludge was associated in 6% patients, biliary ascariasis in 4%, choledochal cyst in 2% and gallbladder stone in 2% patients. But in this study, 4% patients had Wilson disease. Laboratory tests showed leukocytosis in 28% patients, high serum amylase and lipase level in 56% and 58% patients respectively. Postive findings in ultrasonogram were present in 66% patients. In the present study, hypocalcemia was found in 38% patients, pseudocyst in 6% and pancreatic necrosis in 2% patients.Conclusion: Although acute pancreatitis may present with varieties of clinical feature, the most common one is abdominal pain and common location of pain is in epigastric region. For confirmation of clinically diagnosed pancreatitis, both serum amylase and lipase level and abdominal ultrasound are useful tools.Bangladesh J Child Health 2016; VOL 40 (3) :160-165

Intramuscular Loading dose versus Combined Intravenous &amp; Intramuscular Loading dose of Magnesium Sulphate in the Management of Eclampsia in a Tertiary Level Hospital of Bangladesh

Background:Intramuscular loading dose of Magnesium Sulphate could be a suitable alternative for community intervention of the management of severe Pre- Eclampsia and Eclampsia.Objective: To compare the efficacy of the loading total IM regime of injection Magnesium Sulphate (MgSO4) with the standard loading combined IV and IM regime for termination &amp; prevention of recurrent convulsions in the treatment of Eclampsia.Methods: Total 200 patients were studied at Dhaka Medical College Hospital, Bangladesh from October 2012 to May 2013 where 100 patients were treated with loading IM regime (Case group) and 100 patients received standard loading combined IV &amp; IM regime (Control Group). The efficacy of both regimes was measured by the rate of recurrent convulsions.Results: No significant differences was observed in both groups in terms of age (23.03±3.90 vs 23.34±4.63 years), parity (64% vs 63% primi), gestational age (36.39±3.64 vs 36.13±3.95 weeks),no of convulsions (5.28±3.21 vs 5.35±3.31 times), mean diastolic blood pressure (98.74±17.22 vs 104.25±15.43 mmHg) and Glasgow Coma Scale (e”8, 96% vs&lt;8, 92%). No significant differences observed between the two groups in mean convulsion to treatment interval (5.16±3.71 vs 4.95±3.12 hr) and convulsion to delivery interval (13.26±8.8 vs 13.95±8.46 hr). The recurrent convulsion rate was almost same in both groups (3% vs 5%, ð2 = 0.521, P&gt; 0.05ns). Case fatality was 2% in case group and 3% in control group (P &gt; 0.05ns).Conclusions: Loading total IM regime of MgSO4 is found as effective as the loading combined IV and IM regime in terms of control of convulsions and prevention of recurrent fits in Eclampsia. So it could be used by the field level workers before referral.J Bangladesh Coll Phys Surg 2016; 34(2): 85-91

Outcomes of Feeding Training to Mothers Having Child with Cerebral Palsy Admitted at A Tertiary Level Hospital in Bangladesh

Background: The majority of children with Cerebral Palsy have feeding difficulties. It has a great impact on growth and development in children with cerebral palsy. Feeding difficulties may leads to chronic respiratory disease, malnutrition and reduce quality of life of both children and caregiver. Feeding difficulties cause stressful meal time for caregivers and fear of food for children. In well resource country many hi-tech equipments for the management of feeding difficulties are available but which is not available in low resource country like Bangladesh. Though some of low tech approaches have started a little but the effectiveness or outcomes of these technologies are not evaluated. This study is aimed to evaluate the effect of feeding training on feeding difficulties in children with cerebral palsy.Methods: This is a quasi experimental study. Twenty children with cerebral palsy aged 2 – 9 years having feeding difficulties enrolled as study subjects. Initially degree of feeding difficulties were assessed by evaluating body posture and frequency of aspiration during feeding which is scored according to the response of the child. After giving feeding training to the mother feeding difficulties were reevaluated. Mean score of feeding difficulties before and after intervention were compared by paired 't' test. Results were analyzed by SPSS.Results: Among the study subject 14(70%) were male and 6(30%) were female. Most of them were found to have hemiplegic CP 7(35%). The mean score in terms of positioning and frequency of aspiration were significantly changed after intervention (14.15 vs. 15.85 p = &lt;0.0005), (11.6 vs 15.5 p = &lt; 0.0005).Conclusion: Low-tech strategies and therapies are helpful for the management of feeding difficulties in children with cerebral palsy. Foods and drinks modifications should need to get extra attention for the nutritional improvements of those children. Government and international and national health NGOs should studied more about these low tech strategies to improve the condition of the children with cerebral palsy and to reduce the stress and sufferings of the parents.Chatt Maa Shi Hosp Med Coll J; Vol.15 (2); Jul 2016; Page 25-29

Immunohistochemical Staining of Estrogen Receptor and Human Epidermal Growth Factor Receptor 2 in Carcinoma Breast in Bangladeshi Women

Introduction: Breast cancer is the most common cause of cancer death among women. Estrogen Receptor (ER), Progesterone Receptor (PR) and human epidermal growth factor receptor 2 (Her-2/ neu) status are used as an important prognostic marker for breast cancer.Objectives: The aim of this study was to evaluate ER and Her-2 in breast carcinoma among Bangladeshi women and to co-relate with other prognostic parameters.Materials and Methods: The study was carried out in a tertiary level hospital in Bangladesh during the period of January 2010 to December 2011. Total 100 histologically proved breast carcinoma cases were included in the study. Immunostaining for ER and Her-2/neu were carried out. Quick scoring of ER and expression of Her-2/neu were correlated with histomorphological parameters.Results: Among 100 cases 93 were ductal carcinoma and 07 were non ductal. Among all, 38% show ER positive (score- 3-8) while 62% are ER negative (score 0-2). Her-2/neu was over expressed in 30%, 22% were borderline and 48% were negative. There were inverse relationship between ER positivity and Her-2/neu overexpression. ER positivity was related with lower histological grade, while Her-2/neu overexpression was related with higher histological grade.Conclusions: ER positivity in Breast carcinoma patients in Bangladesh is lower in comparison to western literature while Her-2/neu overexpression rate is quite high like other Asian countries.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 7-13

P280 Pediatric Palliative Care in a Tertiary Level Hospital in Bangladesh

P280 Pediatric Palliative Care in a Tertiary Level Hospital in Bangladesh

Factors related to Quality of Work Life among Nurses, Tertiary Level Hospitals, People's Republic of Bangladesh

Background: Quality of work life is important for hospital employees including nurses as it affects safety and quality care for patients as well as organizational factors. Objective: To examine the level of quality of work life and examine the relationship between personal factors, organizational factors and quality of work life among nurses in tertiary level hospitals, People's Republic of Bangladesh Methods: Descriptive correlational study design was conducted with 288 nurses, randomly selected from six tertiary level hospitals in Bangladesh. The research instruments consist of Quality of Nursing Work Life Survey, Expanded Nursing Stress Scale, Questionnaire of Organizational Commitment, and Practice Environment Scale of the Nursing Work Index which were translated into Bengali using back translation process. The content validity of each instruments were confirmed by the developers and reliability of Quality of Nursing Work Life Survey, Expanded Nursing Stress Scale, Questionnaire of Organizational Commitment, and Practice Environment Scale of the Nursing Work Index were 0.94, 0.95, 0.84, and 0.90 respectively. Data were analyzed by Pearson Product Moment statistics. Results: The result found that nurses working in tertiary level hospital, People's Republic of Bangladesh perceived their quality of work life at moderate level. Personal factors include years of experience, years of education, and monthly income were statistically significant positively related to quality of work life (r = 0.50, 39, and 0.17 respectively). Organizational factors include organizational commitment and nursing practice environment were statistically significant positively related to quality of work life (r = 0.66 and 0.74) and job stress was found statistically significant negatively related quality of work life (r = −0.46). Conclusion: Nurse administrators can use the findings of the study to develop policies and strategies to manage the quality of work life among nurses working in tertiary level hospitals. Priority of intervention for improving quality of work life among nurses will be designed based on the personal and organizational factors that are related to quality of work life among Bangladeshi nurses.