Risk factors associated with morbidity and mortality outcomes of COVID-19 patients on the 28th day of the disease course: a retrospective cohort study in Bangladesh.

Diverse risk factors intercede the outcomes of coronavirus disease 2019 (COVID-19). We conducted this retrospective cohort study with a cohort of 1016 COVID-19 patients diagnosed in May 2020 to identify the risk factors associated with morbidity and mortality outcomes. Data were collected by telephone-interview and reviewing records using a questionnaire and checklist. The study identified morbidity and mortality risk factors on the 28th day of the disease course. The majority of the patients were male (64.1%) and belonged to the age group 25-39 years (39.4%). Urban patients were higher in proportion than rural (69.3% vs. 30.7%). Major comorbidities included 35.0% diabetes mellitus (DM), 28.4% hypertension (HTN), 16.6% chronic obstructive pulmonary disease (COPD), and 7.8% coronary heart disease (CHD). The morbidity rate (not-cured) was 6.0%, and the mortality rate (non-survivor) was 2.5%. Morbidity risk factors included elderly (AOR = 2.56, 95% CI = 1.31-4.99), having comorbidity (AOR = 1.43, 95% CI = 0.83-2.47), and smokeless tobacco use (AOR = 2.17, 95% CI = 0.84-5.61). The morbidity risk was higher with COPD (RR = 2.68), chronic kidney disease (CKD) (RR = 3.33) and chronic liver disease (CLD) (RR = 3.99). Mortality risk factors included elderly (AOR = 7.56, 95% CI = 3.19-17.92), having comorbidity (AOR = 5.27, 95% CI = 1.88-14.79) and SLT use (AOR = 1.93, 95% CI = 0.50-7.46). The mortality risk was higher with COPD (RR = 7.30), DM (RR = 2.63), CHD (RR = 4.65), HTN (RR = 3.38), CKD (RR = 9.03), CLD (RR = 10.52) and malignant diseases (RR = 9.73). We must espouse programme interventions considering the morbidity and mortality risk factors to condense the aggressive outcomes of COVID-19.

Risk factors of hemorrhagic and ischemic stroke among hospitalized patients in Bangladesh--A case control study.

The risk factor profiles, management and outcome have significant difference between stroke subsets. Aim of this study was to investigate the risk for the two most common subtypes of stroke in Bangladeshi population. Seventy cases of hemorrhagic stroke (HS) and 105 cases of confirmed ischemic stroke (IS) were recruited from the Shaheed Suhrawardy Medical College Hospital (ShSMCH) and Dhaka Medical College Hospital between January-June 2011. Total 171 age, sex matched controls were selected from the hospitalized patients with history of no stroke ever. Average hemorrhagic stroke patients (60.4 ± 12.3 years) were younger than both ischemic strokes (63.5 ± 13 years). Family history of premature cardiovascular death was found more in HS patients (p = 0.001). Multivariate logistic regression showed, in IS model 'less fruit consumption (OR 4.6), table salt intake (OR 8.15), psychosocial stress (OR 3.5), abnormal ECG (OR 3.6) and Increased WHR (OR 6.9) appeared as significant predictors adjusted for all potential candidate confounders. In HS model less fruit consumption (OR 5.0), table salt intake (OR 9.9), Stress (OR 4.1), family history of cardiovascular disease (CVD) death (OR 11.3), hypertension (OR 43), aspirin intake (OR 4.5) and increased WHR (OR 3.7) remained as significant predictors.

Evaluation of Triage System in a Dedicated Covid-19 Hospital.

The global health system faces a substantial burden from the Covid-19 pandemic. To prevent Covid-19 transmission an effective triage system is useful in resource-limited countries like Bangladesh. The purpose of the study was to determine the status of the triage system in a dedicated Covid-19 Hospital. This cross-sectional study was conducted among conveniently selected 150 respondents including 63 doctors, 72 nurses and 15 administrative staff. Data were collected through face-to-face interviews using a pretested semi-structured questionnaire and observation checklist. The collected data were processed and analyzed with the help of SPSS (Version 26.0) and Xcel 2019. The study was conducted at Kurmitola General Hospital, Bangladesh from January 2020 to December 2020. Among study participants, 54.0% of the respondents belonged to the (31-40) age group and 74.0% were female. Half 50.7% of the respondents working duration was (0-4) years. Two-thirds 67.0% of the respondents had training on the triage system. All of the respondents mentioned the presence of a triage system in this hospital but there was no tele-triage. Regarding infrastructure facilities like triage room, sitting facilities with 1-meter distance in waiting area, one-way entrance, and exit, separated ticket counter and washroom, proper hand wash facilities, all were present in this hospital. All of the respondents mentioned the presence of available logistic support for the triage system in this dedicated Covid-19 hospital including a sufficient supply of PPE, thermometer, and pulse oximeter. All doctors and nurses wore PPE. Almost four-fifths 87.30% of the respondents mention that there was no training on donning and doffing procedure of PPE. There was a statistically significant association between training on triage with age group and occupation of the respondents (p<0.05). The ideal working time of healthcare providers was not maintained. There had no facilities of isolated accommodation and health checkups for staff. But RT-PCR for Covid-19 test was done for all staff when he/she returns to normal life after duty. Based on study findings it has been concluded that the infrastructure facilities and logistic supports are sufficient. But staff management has to be improved and the authority should pay special attention to an effective triage system.

Anterior cervical discectomy and fusion without instrumentation for cervical spondylosis.

This prospective study included 50 patients receiving anterior cervical discectomy and fusion (ACDF) was conducted at Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The study period was 1st July 2006 to 30th June 2010. This study was done to see the functional outcome of surgery in relation to duration of symptoms and age of the patient. The clinical information and relevant imaging of 50 consecutive patients, 41 male and 9 female, was reviewed at 1 year after surgery. All surgery was performed at no more than 2 contiguous levels, by one surgeon. After anterior discectomy alone, or combined with posterior vertebral body margin osteophytectomy, anterior bone grafting was performed at each level using a tricortical autogenous iliac crest bone block inserted under compression. All surgery was completed without internal fixation. A postoperative semirigid cervical collar was prescribed for 2 months. In 50 patients, there were 4 pseudarthroses (8%). Only 4% of the 50 patients had pain related to the donor site. The functional outcome was excellent to good (87.5%) when duration of symptoms less than 1 year and outcome was excellent to good (85.29%) when the age less than 50 years. These results tend to confirm published reports of most expected outcome related to young age and short duration of symptoms. Patients with technically successful fusions were less likely to have postoperative neck pain. Donor site pain was not a significant postoperative complication. ACDF is a safe, cheap and effective procedure for cervical spondylosis. In this series no major operative complications have occurred. No extra expenditure for plate and screw in this procedure.

Large calcified subdural empyema.

Subdural empyema is a known disease entity; however, calcified subdural empyema is uncommon. The authors present a case of an 11-year-old boy in whom there was diagnosed a chronic calcified subdural empyema 10 years after an attack of meningitis. The patient had suffered from generalized tonic clonic seizures occurring 2-6 times in a month. A large fronto-temporo-parietal craniotomy was carried out and the subdural empyema filled with numerous uncharacteristic tissue fragments with thick pus together with the partially calcified and ossified capsule was removed. The empyema mass was found to be sterile for bacteria. After the operation, no epileptic seizure occurred and the boy is on sodium valporate. We must emphasize the unusual occurrence of the chronic subdural empyema presenting with calcification-ossification and large size as observed in our case.

Maternal over weight and obesity: its effect on pregnancy outcome.

Obesity in pregnancy remains a significant health problem that result in physiological, emotional, social and economic consequences on woman, their families and society. Obesity is considered one of the nutritional problems complicating pregnancy in our country. This study was conducted in antenatal clinic at out patient department of Obstetrics & Gynecology, BIRDEM Hospital, one of the countries largest tertiary level hospitals, during January 2007 to December 2008. During the study period of two years, a total no. of 100 cases were enrolled in two groups. Out of this 50 were control and 50 were over weight and obese. In this study, Mean of height, weight and BMI of the over weight and obese group were 5.21±0.21, 79.35±13.66, 32.36±4.76 respectively. The Mean of birth weight, APGAR score after 1 min and after 5 min of the over weight and obese group were 3.07±0.75, 7.10±1.11, 9.92±0.98 respectively and in normal weight group were 2.74±0.55, 7.40±1.56, 9.92±1.83 respectively. There was significant difference in birth weight, APGAR score after 1 min between the groups (p<0.05) but there was no significant difference in APGAR score after 5 min between groups (p>0.05). Regarding the fetal outcome in this study, 20% of the over weight and obese group delivered macrosomic baby in comparison to only 4% in the normal weight group. On the other hand 46% of the case group had to refer their babies to the neonatal unit in comparison to only 12% in the control group. Gestational Diabetes Mellitus (GDM) (46%) and Preeclampsia (44%) developed more in obese group. Eighty eight (88%) of obese and overweight mother experienced in caesarean delivery. Asphyxia, Respiratory Distress Syndrome (RDS), congenital anomaly and prenatal death were more in the over weight and obese group than normal weight group. Thus, overweight and obesity has got significant deleterious effect on maternal and perinatal outcomes of pregnancy.

A primary intracranial ependymal cyst.

A case of a giant ependymal cyst in the fronto-parieto-temporal region in a 9 months old male baby, who presented with recent onset epilepsy, drowsiness and loss of vision. Neurosurgical intervention of this cystic lesion was curative. Interesting clinical and neuroimaging features are presented. This ependymal and primary intracranial cystic lesion which is rare. These are congenital, benign ependyma lined, commonly intraparenchymal and uncommonly extraparenchymal cysts in leptomeningeal location of variable size. Surgical intervention is warranted in cysts, which produce a mass effect and raised intracranial pressure.

Molecular characterization of chikungunya virus causing the 2017 outbreak in Dhaka, Bangladesh.

Chikungunya viruses from the 2017 outbreak in Dhaka, Bangladesh, were analysed phylogenetically. E1 sequences from 21 strains belonged to the Indian Ocean clade of the East/Central/South African (ECSA) genotype, forming a novel cluster with latest South Asian strains. They lacked the A226V substitution.