Assessing acceptance and effects of child feeding counselling on nutritional status of children aged 6-23 months in a semi-urban community.

In Bangladesh, only 34 % of the children aged 18-23 months old are given minimum acceptable diets of complementary foods. Objective of the study was to find the effects of complementary feeding counselling on nutritional status among 6-23 months old children of poor families. This was a community-based randomised control trial. A total of 192 children in two groups were randomly selected. Nutrition education was given for a period of 4 months with post-intervention follow-up for 2 months. After 4 months of intervention, the difference in height for age Z score, weight for height Z score and weight for age Z score were significantly higher in the intervention group than in the control group (1·01 ± 0·31 v. 0·19 ± 0·01, P =< 0·001; 1·34 ± 0·15 v 0·72 ± 0·11, P =< 0·001; 1·5 ± 0·24 v. 0·62 ± 0·04, P =< 0·001). Mid-upper arm circumference Z score also improved in the intervention group than in the control group (0·95 ± 0·03 v. 0·57 ± 0·12, P =< 0·001). Morbidity of the children in the intervention group significantly reduced than in the control group (49 % v 80·20 %, P =< 0·001). Higher feeding frequency (3-4 times) (71·9 % v. 45·8 %) and energy intake increased in the intervention group than in the control group. Promotion of complementary feeding from the family foods can improve the nutritional status of 6-23 months old children of poor families within a short period.

Leukocytoclastic Vasculitis Masquerading as Chronic Idiopathic Thrombocytopenic Purpura.

Background: Idiopathic thrombocytopenic purpura and leukocytoclastic vasculitis can present in a similar fashion and can be very hard to differentiate clinically without a biopsy. This can cause diagnostic dilemma and delay in management. A thorough evaluation is recommended to determine etiology, although about half are idiopathic. Case Presentation: A patient aged 79 years with longstanding thrombocytopenia secondary to chronic idiopathic thrombocytopenic purpura presented with a rash. Although it was thought to be secondary to idiopathic thrombocytopenic purpura, a biopsy revealed presence of leukocytoclastic vasculitis. Conclusions: Although most leukocytoclastic vasculitis cases are mild and resolve without intervention, many go undiagnosed due to biopsy delays. Health care professionals should determine and treat the underlying cause.

Effectiveness of home-based "egg-suji" diet in management of severe acute malnutrition of Rohingya refugee children.

BACKGROUND: Prevalence of severe acute malnutrition (SAM) among Rohingya children aged 6-59 months who took shelter in refugee camp in Cox's Bazar District, Bangladesh, was found to be 7.5%. OBJECTIVE: To measure the effectiveness of homemade diet in the management of severe acute malnutrition of Rohingya refugee children. METHODS: In total, 645 SAM children (MUAC < 11.5 cm) aged 6-59 months were selected and fed the homemade diet for 3 months by their caregivers and followed up for next 2 months. Nutrition counseling, demonstration of food preparation and the ingredients of food (rice powder, egg, sugar and oil) were provided to the families for 3 months to cook "egg-suji" diet to feed the children. RESULTS: The study children were assessed for nutritional status. After intervention, energy intake from diet increased from 455.29 ± 120.9 kcal/day to 609.61 ± 29.5 kcal/day (P = 0.001) in 3 months. Frequency of daily food intake improved from 4.89 ± 1.02 to 5.94 ± 0.26 (P = 0.001). The body weight of children increased from 6.3 ± 1.04 kg to 9.93 ± 1.35 kg (P = 0.001), height increased from 67.93 ± 6.18 cm to 73.86 ± 0.35 (P = 0.001) cm, and MUAC improved from 11.14 ± 1.35 cm to 12.89 ± 0.37 cm (P = 0.001). HAZ improved from - 3.64 ± 1.35 to - 2.82 ± 1.40 (P = 0.001), WHZ improved from - 2.45 ± 1.23 to 1.03 ± 1.17 (P = 0.001), WAZ improved from - 3.8 ± 0.61 to - 0.69 ± 0.78, and MUACZ improved from - 3.32 ± 0.49 to 1.8 ± 0.54 (P = 0.001) from the beginning to the end of observation. Morbidity was found in 5.12% children in the first month which reduced to 0.15% at the end of follow-up. CONCLUSIONS: Nutritional counseling and supply of food ingredients at refugee camps resulted in complete recovery from severe malnutrition for all children which was sustainable.

A Case of Severe Acute Respiratory Distress Syndrome Secondary to Atypical Amniotic Fluid Embolism.

Acute respiratory distress syndrome (ARDS) is a noncardiogenic pulmonary edema that leads to acute respiratory distress. It remains one of the major diagnoses requiring ICU admission and mechanical ventilation. We present a case of a 25-year-old gravida 3 para 2 female who was admitted for uncomplicated 38-week pregnancy and delivered a healthy male infant but developed acute onset dyspnea six hours after vaginal delivery. She required mechanical ventilation four hours after the onset of respiratory distress and had to be transferred to a higher level facility for extracorporeal membrane oxygenation (ECMO) within 24 hours of the symptom onset. She was diagnosed with severe ARDS. Even though she missed the other typical feature of amniotic fluid embolism, atypical amniotic fluid embolism remained the most likely explanation for her symptoms after the other causes of ARDS were excluded.

IgG4 related pleural disease: Recurrent pleural effusion after COVID-19 vaccination.

IgG4-related disease is characterized by a systemic fibroinflammatory process associated with substantial infiltration by plasma cells with IgG4 in the organs. Our patient presented with pleural effusion, and was diagnosed with IgG4-related lung disease (IgG4-RLD) after he received two doses of the Pfizer COVID-19 vaccine. The patient developed dyspnea and hypoxia 2 weeks after receiving the second dose of the Pfizer COVID-19 vaccine. CT scan revealed left pleural effusion which was drained. However, the effusion recurred requiring thoracoscopic drainage, placement of an indwelling catheter, and decortication with biopsy. IgG4 serum level was 268 mg/dl and pathology revealed pleural fibrosis, lymphoplasmacytic infiltrates, and increased IgG4-positive plasma cells with no malignant cells leading to a diagnosis of IgG4-RLD. Although COVID vaccine-related IgG4-RLD is a novel finding, having a high degree of suspicion following vaccination is always important for early diagnosis and effective treatment.

Allergic Bronchopulmonary Aspergillosis (ABPA) Diagnosis Missed in the Context of Asthma Exacerbation Due to Medication Nonadherence.

Allergic bronchopulmonary aspergillosis (ABPA) results from a hypersensitivity reaction to Aspergillus fumigatus colonization of airways in patients with asthma or cystic fibrosis. Our patient is a 47-year-old female with a history of asthma and nonadherence to medications who presented with frequent asthma exacerbations. She required intubation three times within six months, labeled as asthma exacerbation due to nonadherence to medications until she was finally diagnosed with and successfully treated for ABPA. She was tested for ABPA very late as the medication nonadherence was thought to be the sole cause of repeated asthma exacerbations during previous hospitalizations. This case illustrates the importance of maintaining a high index of suspicion for ABPA in recurrent asthma exacerbation even in the setting of medical nonadherence.

Reversible Decerebrate Posture in Hepatic Encephalopathy: Case Report and Literature Review.

Decerebrate posturing is commonly associated with a global brain insult as in massive strokes, brain stem infarction, or hypoxic brain injury. The clinical presentation of hepatic encephalopathy is variable. ranging from an abnormal sleep pattern to somnolence and deep coma. Decerebrate or decorticate posturing is a rare manifestation of hepatic encephalopathy. We report a patient with liver cirrhosis who presented with a mild degree of hepatic encephalopathy that rapidly progressed to coma with decerebrate posturing. Although the pathophysiology of hepatic encephalopathy is unknown, it appears to be reversible as in our patient who completely recovered with the management of encephalopathy. Despite being uncommon, it should be considered in patients presenting with hepatic encephalopathy progressing to coma since it might save unnecessary workup.

Patient's Knowledge and Attitude towards Tuberculosis in an Urban Setting.

Tuberculosis is a public health problem in Bangladesh. This cross-sectional study was conducted to assess knowledge of TB patients about symptoms, ways of transmission and treatment of tuberculosis, and their perception of the illness. Between March and August 2008, 762 adult TB patients were interviewed at selected DOTS centre of Dhaka city. Male and female distribution was 55.6% and 44.4%, respectively. One quarter of them were illiterate, and more than half had extended family and live in a congested situation. Night fever was the most common symptom known (89.9%), and 56% were aware that it could spread through sneezing/coughing. Television was mentioned as a source of information about TB. The majority expressed a helping attitude towards other TB patients. Although most of them were positive about getting family support, 46.6% mentioned discrimination of separate utensils for food or drink. About 50.5% expressed increased sadness, 39.8% had fear of loss of job/wedges, and 21.4% felt socially neglected. Along with drug treatment the psychosocial reactions of TB patients should be addressed at DOTS centers for better control of the disease.

Access to skilled care at home during pregnancy and childbirth: Dhaka Bangladesh.

In Bangladesh the majority of childbirth takes place at home by unskilled persons. The objective of this study was to strengthen maternity care services through provision of skilled midwives and to explore people's perception of skilled birth attendants. As part of a quasi-experimental community trial conducted among selected urban area of Dhaka city, a group of skilled midwives were posted in selected urban centers between January to December 2002 to provide obstetric care services and some social mobilization activity in the community. Analysis of skilled midwives self-reported case records and monitory reports of the researchers was done on selected themes. The perception of the skilled midwife was not clear to people. They thought traditional birth attendants who conducts delivery over years were skilled midwives. Preparedness for obstetric emergency and birth planning was non-existent in the families. The skilled midwives were well accepted in the community but discouraged by center authority for home birth, apprehending that it will reduce their client flow and earning. Non-cooperation by other health care providers was common.

Talking about sexuality at secondary schools of periurban area of Dhaka city.

UNLABELLED: Adolescents constitute 23 percent of population in Bangladesh yet access to information and education on reproductive health is limited for them. OBJECTIVE: To determine the effect of introducing an education booklet on reproductive health knowledge among the adolescents and its acceptability to them. STUDY GROUP: Students of grade IX and X in eight secondary schools (both boys and girls schools) of periurban location of Dhaka city. METHOD: A quasi-experimental pre-post test design study was conducted during October 2004 to May 2005. The intervention was distribution of an education booklet and conduction of a health education session at the respective classes. RESULTS: Total number of respondents were 1,490 (862 during pre test and 628 during post test). About 4% of parents never attended school, whereas 10.7% of fathers and 3.2% of mothers were graduates. A greater proportion of adolescents could correctly narrate the physiological changes of adolescence, duration of menstrual cycle, fertile period, leucorrhoea, masturbation, and night emission in the post test. Almost all adolescents stated that health education was necessary and should be given in secondary schools. About 95% stated that the education booklet was necessary. They appreciated that the language was easy and fluent, the illustration was meaningful, and some suggested a few modifications. CONCLUSION: Providing reproductive health information to adolescents can be sustained through inclusion in school curriculum and has the potential to produce health benefits in future.

Twelve tips for better communication with patients during history-taking.

Eliciting proper history from a patient is of paramount importance to establish an accurate diagnosis and management in medical practice. Good communication skill is a prerequisite for an effective physician patient relationship. A systematic search of medical literature has been made to formulate a guideline for better communication during history taking. The guideline emphasizes on both physical environment and emotional encounter and the key points are expressed as tips on relevant issues.