An approach to integrated management of diabetes in tuberculosis patients: Availability and readiness of the health facilities of Bangladesh.

BACKGROUND: Comorbidity of diabetes mellitus and tuberculosis (TB) is a major public health concern in low- and middle-income countries including Bangladesh. An integrated approach is required for adequate management of diabetes mellitus and TB. The objective of the present study was to investigate the availability and readiness of the TB care centers of Bangladesh toward diabetic patients' management. METHODS: The present study was conducted based on existing data obtained from the Bangladesh Health Facility Survey (BHFS) 2017. Data collected from a total of 303 facilities providing TB services were retrieved. The outcome variables of the present study were availability and readiness of the TB health facilities for providing diabetes mellitus service. Readiness was measured for four domains: staff and guidelines, equipment, diagnostic facility and basic medicine. The independent variables were: facility level, management authority and location of the facility. Binary and multiple logistic regression models were constructed for both the outcome variables (availability and readiness) to find out their predictors. RESULTS: Services for diabetes mellitus were available in 68% of the TB facilities while high readiness was present in 36% of the facilities. For domain-specific readiness index, readiness for the domains of staff and guidelines, equipment, diagnostic facility and basic medicine was reported in 46%, 96%, 38% and 25% facilities respectively. In the logistic regression model, availability of diabetes mellitus services was better in primary level (aOR 2.62, 95% CI 1.78-4.77) and secondary level (aOR 3.26, 95% CI 1.82-9.05) facilities than community facilities. Similarly, readiness of diabetes mellitus care was also better in these facilities (aOR 2.55, 95% CI 1.05-4.71 for primary and aOR 2.75, 95% CI 1.80-4.32 for secondary facilities). Besides, private TB facilities had better availability (aOR 2.84, 95% CI 1.75-5.89) and readiness (aOR 2.52, 95% CI 1.32-4.29) for diabetes mellitus care. CONCLUSION: Availability and readiness for providing diabetes mellitus services in TB care providing facilities in Bangladesh is inadequate.

A rare variant of right sided pulmonary agenesis presenting in adulthood: 1st reported case from Bangladesh.

Pulmonary agenesis is a rare disorder, and the right-sided one is much rarer. Most of the cases are diagnosed during early life. Because of rarity, it can be misdiagnosed and even more challenging to diagnose when presented during adult life. However, we report a rare late manifestation of right-sided unilateral lung agenesis in a 22-year-old female patient who was treated for pneumonia several times, the first reported case from Bangladesh. We also highlighted the diagnostic approach of the case in low-resource settings.

Association Between Hair Diseases and COVID-19 Pandemic-Related Stress: A Cross-Sectional Study Analysis.

Introduction: Psychological stress from the ongoing coronavirus disease 2019 (COVID-19) pandemic can potentially aggravate the course of several stress-sensitive skin and hair diseases. This study aimed to determine the potential association of COVID-19 stress with hair diseases, such as telogen effluvium (TE), alopecia areata (AA), and seborrheic dermatitis (SD), among medical students in Bangladesh. Methods: This online-based cross-sectional study was conducted among 404 medical students of Bangladesh using a self-administered questionnaire, including sociodemographic information, status of hair diseases (i.e., TE, AA, and SD), COVID-19 fear scale, impact of event scale specific for COVID-19 (IES-COVID-19), and COVID-19 student stress questionnaire (CSSQ) scale, to determine pandemic-related stress. The logistic regression model was used to analyze the association. Results: Overall prevalence of TE, AA, and SD was 61.1, 24.7, and 57.7%, respectively, with female predominance in case of TE and male predominance in case of AA and SD. More than half of the participants had COVID-19-related fear and traumatic stress symptoms. In the multiple logistic regression model, smoking [adjusted odds ratio (aOR) 2.93, 95% CI 1.29-6.65 for AA and aOR 4.19, 95% CI 1.83-9.56 for TE], COVID-19-related fear (aOR 1.70, 95% CI 1.01-2.89 for AA and aOR 2.620, 95% CI 1.25-5.48 for TE), and COVID-19-related traumatic stress symptoms (aOR 1.84, 95% CI 1.08-3.13 for AA, aOR 2.61, 95% CI 1.19-5.68 for TE, and aOR 1.92, 95% CI 1.14-3.25 for SD) were the risk factors of hair fall disorders. Conclusion: Our study showed that a large number of medical students experienced TE, AA, and SD during the pandemic era. COVID-19-related stress and fear potentially have an association with these diseases.

Adherence to inhalers and associated factors among adult asthma patients: an outpatient-based study in a tertiary hospital of Rajshahi, Bangladesh.

BACKGROUND: Adherence to inhaler medication is an important contributor to optimum asthma control along with adequate pharmacotherapy. The objective of the present study was to assess self-reported adherence levels and to identify the potential factors associated with non-adherence to the inhalers among asthma patients. METHODS: This facility-based cross-sectional study was conducted in the medicine outpatient department of Rajshahi Medical College Hospital from November 2020 to January 2021. A total of 357 clinically confirmed adult asthma patients were interviewed. Inhaler adherence was measured using the 10-item Test of Adherence scale (TAI).. Both descriptive and inferential statistics were used to express the socio-demographic of the patients and predictors of poor adherence to inhaler. RESULTS: A substantial number of participants were non-adherent (86%) to inhaler medication. Patients non-adherent to inhaler medication are often younger (23.15, 95% CI 3.67-146.08), lived in the rural area (23.28, 95% CI 2.43-222.66), less year of schooling (5.69, 95% CI 1.27-25.44), and belonged to the middle income (aOR 9.74, 95% CI 2.11-44.9) than those adherent with the inhaler. The presence of comorbidities (12.91, 95% CI 1.41-117.61), prolonged duration of inhaler intake (5.69, 95% CI 1.22-26.49), consulting non-qualified practitioners (13.09, 95% CI 3.10-55.26) were the significant contributor of non-adherence. CONCLUSION: Despite ongoing motivation and treatment, non-adherence to inhalation anti-asthmatic is high and several factors have been found to contribute. Regular monitoring and a guided patient-centered self-management approach might be helpful to address them in long run.

A Case Report on Prepubertal Vaginal Bleeding due to Leech Bite: History Is Very Important.

Though prepubertal vaginal bleeding is rare, it can create a dilemma for both physicians and parents. Prepubertal vaginal bleeding due to leech bite is even rarer and very difficult to diagnose without proper history. We report a case of a six-year-old girl presenting with vaginal bleeding and ultimately diagnosed as a case of vaginal bleeding due to leech bite. We described how focused history helped us in diagnosis and management of such case in rural areas with limited healthcare resources. A detailed history with a high index of suspicion and a thorough examination is essential to diagnose leech bite in the vagina.