Disaster Coping Strategy Practiced by the Affected People for their Livelihood Due to Climate Change

The purpose of the study were to (i) determine the disaster coping strategy practiced by the affected people (ii) assess the socio-economic profile of the respondents, (iii) ascertain the contribution of selected characteristics of the people and (iv) identify the constraints of disaster coping strategy practiced by the affected people. The study was conducted at Gangachara Upazila of Rangpur District. Data were collected from a sample of 302 respondents, randomly selected from disaster affected population. Age, education, family size, farm size, disaster affected land, annual income, training received, extension media contact, knowledge on disaster coping strategy, environmental awareness, household assets, credit facilities, IGAs, water and sanitation condition, risk orientation, awareness about SSNP, perception of Climate Change (CC), perception of disasters and scope of work in vulnerable situation constituted the independent variables, while disaster coping strategy practiced was the dependent variable. For measuring the disaster coping strategy practices, a 4-point rating scale was used against 50 items taking 10 items from each of five components of human needs e.g. 1) food preservation, collection and management, 2) agricultural products protection, 3) maintaining social network, 4) safeguard of health and sanitation, and 5) protection of housing and shelter. Numerical values and scales were used to measure the personal attributes. Regression and path analysis were employed to determine the contribution among the variables. For exploring relationship between the two variables Pearson’s Product Moment Correlation (r) was used. The majority (77.8 per cent) of the respondents had regular coping strategies compared to 22.2 per cent were found to have occasional coping strategies in the study area. Among 19 independent variables 16 were found significant relationship with the dependent variable. Stepwise multiple regression revealed that six variables namely education (23 per cent), participation in IGAs (3.6 percent), awareness of SSNPs (2.9 percent), disaster affected land (1.2 percent), farm size (1.9 percent) and perception of CC (1 percent) were the important contributing variables which combined explained 33.6 of the total variation of practice of coping strategy. Path analysis indicated that disaster affected land (0.589) had the highest positive direct effect while farm size (0.643) had the highest positive indirect effect to the disaster coping strategy practice. The major constraints for practicing disaster coping strategy in the study area were ‘Lack of knowledge and skills of affected people‘, ‘Lack of relief materials during disaster‘, ‘Lack of technologies‘, ‘Weak weather forecasting‘, ‘Less motivation’, ‘Low sanitation & health coverage’ and ‘Lack of communication during disasters’,. To cope up with the challenges of the disasters, the people used reduction of food intake per meal, putting goods above flood level, keeping women and children in safer places, using boiled and tube well water, providing health care support to the sick family members, transfer important documents to the safer places, increasing level of homestead with soil, taking relief, credit, religious fasting, using mosque/temple as campaigning center, borrowing principal food from neighbor, use savings, migration, livestock sell, and social interconnectedness as the major coping strategies to survive the situation and improve their livelihood.

Knowledge on Care of Autistic Child among the Mother’s Attending Protibondhi Foundation, Dhaka.

Objective: Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear. This descriptive type of cross sectional study was conducted to explore the knowledge on care of autistic children among the mother’s attending Protibondhi Foundation, Dhaka. Methods: A total of 385 samples were selected purposively, but due to time and budget constrict it was 150 finally. Data were collected by using an anonymous, pre-tested, semi structured and self-administered questionnaire. Results: The study revealed that more than 50% of the respondent’s were in the age group 16-30 years, majority of the respondent’s were Muslim. Almost 84% of the respondents were SSC-Graduate and majority of them (nearly 50%) were housewife .The monthly family income was ranged between Taka 25,001-50,000 and its percentage was 53.3%. The knowledge about type of autism is very low, the data showed that only two types of autism they knew and the respondent’s knowledge about the risk factor was also very low; only 24% of the respondents had knowledge about complications during pregnancy and delivery related risk factors. About 28% needed physiotherapy, 30% needed occupational therapy, 34% needed speech therapy & 44.7% needed psychotherapy. Here significant association was found between age, education and knowledge about autism (p<0.05). Conclusion: Overall knowledge on care of autistic child was not satisfactory among respondents.

Immunopathogenesis and Treatment of Rheumatoid Arthritis: Recent Developments.

Rheumatoid arthritis (RA) is a chronic inflammatory disease occurring three times more in females throughout the world affecting 1-2% of the adult population in all ethnic groups, usually in the age group of 25-60 years. Although the role of CD4 + T helper lymphocytes in the aetiopathogenesis has been studied for more than three decades, the focus on CD4 + T helper type 17 (Th17) lymphocytes and its associated cytokines is much more recent. The cytokines such as IL-17 and IFN-g induce secondary cytokines such as IL-1, TNF-a , etc which possibly cause inflammation in joints. This cytokine cascade, therefore, offers a number of points and opportunities for immunointervention in RA. The present review article highlights some of the major aspects of the immunopathogenesis that involve Th17 cells and their association relevant to recent developments in the treatment of RA.

Effects of Diet and Exercise in Middle Aged Subjects with Impaired Glucose Tolerance.

Patients with impaired glucose tolerance (IGT) are now considered as being pre-diabetic, which indicates their relatively high risk for developing diabetes mellitus associated with abnormal metabolic syndrome and cardiovascular diseases. However, dietary modification and physical exercise may play a critical role in this respect. To determine the influence of dietary modification and physical exercise in subjects with impaired glucose tolerance in Bangladesh, thirty three newly detected otherwise healthy subjects with IGT, aged 30-63 years, were randomly selected to participate in a 12 weeks diet and exercise program. Substantial improvement in glucose tolerance was observed at the end of 12 weeks particularly in middle aged subjects (41-50 years). Mean fasting blood glucose and 2 hr post load glucose value were reduced significantly. Glucose tolerance was reverted to normal in 66.7% of the participants, remained unchanged in 26.7% and deteriorated to diabetes in 6.7%. Significant reduction in serum total cholesterol, LDL cholesterol along with mild deterioration in HDL cholesterol and increase in triglyceride values were observed. It was found that the principles of 'prudent diet' in combination with physical exercise are highly effective in improving glucose tolerance, lowering total cholesterol and LDL cholesterol in IGT subjects.

Comparative Study between 12 and 15 Lead Electrocardiograms for Evaluation of Acute Posterior Myocardial Infarction.

Background: The ECG diagnosis of acute posterior infarction has traditionally been based on the presence of ST segment depression on the pericardial chest leads. However, such ST segment depression is neither specific nor sensitive for the diagnosis of a posterior infarction. Detection of ST segment elevation in V7- V9 in 15 lead ECG can help in early diagnosis of acute Posterior myocardial infarction. Method: Total of 100 patients Inferior myocardial infarction was evaluated by Electrocardiography in standard 12 lead and 15 lead. The patients were categorized into group I having posterior/ and or associated changes and group II having without posterior changes in ECG. Echocardiography and LVgraphy was done to evaluate the posterior wall movement. Result: For diagnosis of posterior myocardial infarction, 43.3% sensitivity and 95.1% specificity was found in 12 lead ECG, whereas in 15 lead ECG it was 80.0% sensitivity and 95.1% specificity. Conclusion: 15 Lead ECGs (including V7-V9) more sensitive than 12 lead ECGs in diagnosis of acute posterior myocardial infarction. Patient with inferior myocardial infarction or anterior ischemia developed more complications if associated with acute posterior myocardial infarction. 15 lead ECGs can routinely be used in patients with ischaemic type of chest pain.

Prediction of the Site of Coronary Artery Lesion in Acute Inferior Myocardial Infarction with Right Sided Precordial Lead (V4r).

Background: The patient with inferior wall AMI, site of culprit lesions is an important determinant of outcome. Patient with RV infarction have a poor prognosis whereas those with occlusion of LCX have a good prognosis. Early diagnosis and treatment substantially reduce cardiac events particularly in high-risk patients. V4R can be used as to locate the site of obstruction. Materials and methods: 81 patients with acute inferior myocardial infarction admitted to the coronary care unit (CCU) within 12 hours after the onset of chest pain who underwent coronary angiogram were included in the study. Standard 12-lead ECG with right precordial lead V4R was recorded. Patients were categorized into within 3 groups according to early changes of V4R-Group- I - ST-segment elevation > 1 mm and positive T- wave, Group-II- ST-segment iso-electric and positive T-wave, Group-III- ST-segment depression >1 mm and negative T -wave. Results: In group I patients, highest percentage of the patients had lesion in proximal RCA (97.2%); whereas in group II patients, highest percentage in the distal RCA (89.7%) followed by LCX (41.4%) and in group III patients, highest percentage also in LCX (100.0%) followed by LAD (56.3%). Based on analysis of sensitivity and specificity, it was revealed that in group I patients of ECG finding suggested 100.0% sensitivity, 97.8% specificity and 98.8% accuracy. In group II patients, 92.9% sensitivity, 94.3% specificity and 93.8% had accuracy. In case of group III patients, 93.8% sensitivity, 98.5% specificity and 97.5% accuracy. Conclusion: The configuration of the ST-T segment in lead V4R is a sensitive and specific tool to recognize the occluded vessel in acute inferior MI whether it is proximal RCA, distal RCA or LCX. Since it is an inexpensive method, it can be readily used to locate the site of occlusion in AMI - Inferior.

Pre-Procedural C-Reactive Protein Level Predicts In-Hospital Outcome in Percutaneous Coronary Intervention.

Background:To accurately stratify patients undergoing PCI, according to their risk of future adverse events, a quest for risk predictors is ongoing worldwide. But only a few powerful and independent predictors of early and late major adverse cardiovascular events have been found. These include traditional risk factors, such as acute coronary instability, diabetes mellitus, reference vessel diameter, and lesion and/or stent length. This study was undertaken to find out the relationship between pre-procedural CRP level with in-hospital (both procedural and before discharge) complications. Materials & methods: This prospective study was carried out in National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period of June,2006 to May,2007. After fulfilling the exclusion criteria, 100 consecutive patients were selected as sample those underwent percutaneous coronary intervention. C-Reactive protein (CRP) was measured in all patients before the procedure. Those having pre-procedural CRP level <.3 mg/dl was labeled as group-I and those with CRP level e”.3 mg/dl was labeled as group-II. In hospital outcomes were compared between two groups after percutaneous coronary intervention. Results: During the procedure, higher rate of complications (10.0% vs 26.0%) were noted in group- II, which was statistically significant. Among many complications abrupt occlusion, threatened (dissection and new thrombus) and residual stenosis were significantly high in group-II. Other complications like coronary spasm, arrhythmia, side branch occlusion, heart failure, shock and no reflow were also high in higher level of CRP level patients but statistically not significant. Inhospital complications were also significantly high (10.0% vs 28.0%) in patients with higher level of CRP ie. Group-II. Among other complications recurrence of ischemia and myocardial infarction developed at significantly higher rate in group-II. Post procedural CK-MB rose significantly (18.0% vs 36.0%) in patients with higher level of CRP (group-II) in comparison to normal level of CRP patients (group-I). When the in-hospital complications were distributed among three tertiles of CRP, it was observed that complications were proportionately high with increasing level of CRP. Conclusions: Many studies, conducted abroad, have suggested that factors like gender, extreme age, diabetes, multi-vessel disease and lesion characteristics adversely influence PCI outcome. But in this study, multivariate regression analysis has shown that elevated level of CRP is even stronger independent predictor of PCI outcome.

Urinary Bladder Tuberculosis – A Case Report.

Genito-urinary tuberculosis is an infrequent but not uncommon condition in countries with high incidence of tuberculosis like Bangladesh. A female patient of 25 years was admitted into Faridpur Medical college Hospital with acute retention of urine with history of haematuria, dysuria, fever and difficulty in urination for about three years. USG revealed few masses in the urinary bladder, later proved by histopathological examination as granulomatous lesion consistent with tuberculosis. Anti-TB treatment was given and the masses were removed surgically. With this treatment recovery of the patient is satisfactory and symptoms are disappearing. The aim of this study to make internist more efficient to diagnose the disease by strong clinical suspicion and relevant laboratory investigation, otherwise such uncommon disease and its complications may endanger life of such patient.

Anesthesia for emergency cesarean section.

Caesarean Section is one of the most common of all surgical procedures. Common indications for caesarean section may include foetal distress, Cephalopelvic disproportion and failure of labour to progress. Both regional and general anesthesia may be employed for caesarean section. Each is relatively safe and they have their own advantages and disadvantages. Actual decision to adopt one technique over another depends on maternal and foetal status and skill and ability of the anesthesiologist to tackle the situation with the aim of patient and baby safely. Among these, many of the cases come to the hospital as emergency basis. The Anesthesiologists have to face the challenge in providing anesthesia for emergency caesarean section, being the last member in the perinatal team. The challenge faces the risks in involvement of maternal changes in pregnancy, presence of foetal distress and various anesthetic complications arising in perioperative period. Still now anesthetic mishaps are considered as the sixth most frequent cause of maternal mortality. The use of regional Anesthesia reduced the number of deaths at about 80% but deaths involving general anesthesia has not decreased and the incidence is 17 times more than the regional anesthesia. Most of the deaths or complications are related to the airway management (also failed intubation). Better skill and knowledge in physiology, pharmacology and use of modern Anesthetic technique is essential to face the problems.

Epidemiological study of risk factors of stroke and its immediate consequence.

The study was a cross sectional study conducted among 48 stroke patients in Medicine & Neuromedicine department of Mymensingh Medical College & Hospital. The objective of the study was to reveal the risk factors and other relevant information & immediate outcome of stroke patients. The sample size was 48 who were selected purposively and study area was selected for easy access. Study period was from 15th May 2007 to 15th July 2007. Forty eight (48) respondents and their reliable attendants were interviewed by pre tested structured questionnaire. Among 48 stroke patients 60% were male& 40% were female. Occupations of the patients were 21% desk job, 15% laborious work, 37% housewife, 6% businessman &21% in other profession. Age group of respondents were 13% below 45 years of age, 25% were 45-55 years of age, 29% were 55-65 years of age & 33% were over 65 years of age. Among 48 stroke patients 62.5% had 1st attack & others had multiple attacks. Among all the stroke patients 37.5% performed physical exercise. Forty six percent (46%) patients have family history of Hypertension. 27% have no family history of Hypertension & 27% have no idea. Sixty six percent (66%) patients have suffering from Hypertension, 23% have no history of Hypertension & 10% have no idea. Sixty percent (60%) patients had habit of Smoking, 40% had no habit of Smoking. 21% patients have family history of Diabetes, 48% have no family history of Diabetes & 31% have no idea about family history of Diabetes. Complications among stroke patients are 51% have Hemiplegia, 10% have Paraplegia, 23% have Paresis, 10% have Aphasia & 6% have others complications.

Style of lecturing of medical teacher--an evaluation by medical students of Mymensingh Medical College.

It was a cross sectional descriptive type of study carried out among the 3rd year, 4th year and 5th year medical students of Mymensingh Medical College (MMC) with the objective of finding out the various lecture style followed by medical teachers of MMC and other relevant information regarding teaching tools used related to lecturing. The sample size was 134 who were selected purposively. The study was conducted in the month of June 2004. One thirty four (134) respondents were interviewed by pre tested questionnaire. From the study it was revealed that majority (66%) of these respondents were male and 34% were female and 57%, 28.5% and 14.5% were 3rd, 4th and 5th year students respectively. A good number of students (82.5%) expressed their opinion that lecture time was sufficient for their learning. Among the medical teachers the lecture methods followed were VIG (81%) OP (54%) EP (47.2%) EL (25.5%) AT (23%). Eighty Seven percent of the students gave their opinion that the best style of lecture was EP. Seventy and half percent students disliked the AT style followed by OP, which was 85.5%. Seventy two percent of the students were not satisfied with the teaching aids used by the teachers. OHP (90%) was the most commonly used teaching material. Most of the respondents (97.5%) expressed their opinion that SGT was the most suitable way for imparting information.

Contraceptive prevalence: experience from rural areas of Mymensingh.

Contraceptive prevalence although increased over the last decade but has not yet achieved the desired level. The present descriptive type of cross-sectional study aimed at exploring the status of Contraceptive prevalence rate (CPR) along with relevant issues in two rural areas in Mymensingh. A total 223 respondent was interviewed. Majority respondents were females and young aged 36 years or below. Around a half of the respondents were illiterate while more than half was earning less than 3000 taka a month. Majority women were married earlier than the legal age of marriage with 15.92 years. Around two third (63%) respondents were found using any contraceptives while female partners' shyness and male partners' disliking were reported as reasons for non-use. Increase in female literacy and involvement of family planning worker in motivational programme at individual level could help in improving the situation.

Pregnancy outcome in adolescent and adult - a case comparison study.

This study outlined the consequences of adolescent pregnancy with comparison to adults in Mymensingh Medical College Hospital, Mymensingh. It was a case-comparison study. The study population was the mothers who admitted and delivered at the Obstetrics and Gynaecology ward of hospital during April-June 2003. Sample size was 220 mothers, out of which 110 were primigravidae adolescent mothers and 110 were adults. The study finding showed that adolescents were 2.105 times and 3.679 times more at risk than adults to suffer from anaemia and UTI during pregnancy. Among adolescents 74(67.3%) and in adults 39(35.5%) had obstetric complications during pregnancy and the adolescents were 3.742 times more at risk than the adults. PET and Eclampsia were more common in adolescent than adult mothers. 86(78.2%) adolescents and 36(32.7%) adult mothers had complications before delivery. Pre term labour, Premature rupture of membrane (PROM) and Intra-uterine foetal death (IUD) were more common in adolescents than adult mothers. Stillbirths were more in adolescent mothers 23(20.9%) and adults 11(10.0%). There was more low birth weight (LBW) newborns in adolescents 42(38.2%) than adults 18(16.4%). As a result the adolescents were 3.157 times more likely to give birth to low birth weight babies .The newborns of the adolescent mothers were nearly 2 times more at risk to develop asphyxia neonatorum (p< 0.030, odds ratio=1.806).

Attitude of the parents seeking service from the paediatricians.

The overuse of antibiotics and other medicines have been standing a dangerous proposition and researchers are coming in fore front analyzing and assessing the aftermath of years of misperceptions and inappropriate usage of drugs prescribed by the pediatricians. Two hundred and two parents from the community as well as from the outpatient department of medical college hospitals were interviewed, to study their attitude while seeking for the health service for their children. Data were collected through a face-to-face interview using a structured questionnaire. One hundred and ninety nine (82.7%) of the parents interviewed were mothers and only 3 (1.5%) were fathers. One hundred and sixty-seven (82.7%) parents were from the urban population and the rest 35 (17.3%) were from rural areas. The mothers mean stay in the educational institution was 11.8 years and that of the father's was 13.1 years. About 34.7% parents had to seek for doctor's advice at least once or twice a month and around 43% had to visit doctor's clinic. Most (66.8%) of the parents were from the family earning tk.6000 to tk.20000 a month, 19.8% and 13.4 % were from the families earning below tk.6000 and above tk.20000 respectively. A vast majority of the parents expressed their preference for advice to medicines. Among the medicines they like antibiotics more than vitamins. Majority of the parents showed their interest to spend more time and to have less medicine. For anorexic children parents preferred advice to medicines. An overwhelming majority (98%) of the parents was interested to get advice and ORS for diarrhea. For ARI also a larger number (56.1%) of parents opted for advice only and no medicine at all but 37.1% kept their option for both. A large majority of the parents were preferring more frequent visit and having fewer medicines than the conditions of more medicines with less frequented visits.

A comparative study of body iron status and lipid profile in acute myocardial infarction patients.

This study was carried out to evaluate the relationship between body iron status and lipid profile in hospital admitted clinically diagnosed AMI patients considering the concept that there is a potential association between body iron status and coronary heart disease (CHD). Total 80 subjects were selected, of which 40 were healthy adults and 40 were AMI patients. Fasting blood samples were collected from healthy adults. Blood samples of AMI patients were collected within 24 hours of the attack of myocardial infarction. Body iron status was measured in term of 3 variables serum total iron concentration, TIBC and transferrin saturation. Lipid profile variables measure were total cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol. No correlation was found between serum iron and the variables of lipid profile. TIBC was found to maintain negative correlation with total cholesterol, triglyceride and LDL-cholesterol but positive correlation with HDL-cholesterol. Transferrin saturation was found to maintain strongly positive correlation with total cholesterol, triglyceride and LDL-cholesterol but strongly negative correlation with HDL-cholesterol. This correlation of TIBC and transferrin saturation with lipid profile supports the hypothesis that there is a potential association between body iron status and coronary heart disease.

Solitary thyroid nodule: a study of 100 cases.

One hundred cases of solitary thyroid nodules attending the thyroid clinic, Institute of Postgraduate Medicine & Research, Dhaka (IPGMR) and the Institute of Nuclear Medicine (INM) were included in a prospective study. Thyroid ultrasonography (USG), scintiscanning, radioactive iodine (I131) uptake (RAIU), estimation of serum total T3, T4 & TSH and Fine Needle Aspiration Cytology (FNAC) were performed in all cases. Surgical resection with histopathologic study was performed in selected cases. Extra-nodular part of the thyroid gland was normal in 68 and diffusely enlarged in 32, RAIU was normal in 62, high in 36 and very low in two subjects. Nodules were solid at USG in 67 subjects, cystic in 16 subjects and of mixed consistency in 17 subjects. Goitrous subjects had significantly lower T4 (p < 0.001) and higher T3 (p < 0.01) and TSH (p < 0.001) than non-goitrous ones. Colloid nodule was the commonest pathology occurring in 41 cases, followed by thyroid cysts (26), follicular adenoma (23), adenoma with cystic change (7), subacute thyroiditis (2) and papillary carcinoma (1). Colloid nodules were more common in goitrous subjects which could hint at iodine deficiency as the major cause of such nodules. Hyperfunctioning follicular adenomas occurred exclusively in non-goitrous subjects. Carcinoma appeared to be uncommon in patients with solitary nodules. It gives an opportunity to our physicians to be more conservative in selecting patients with solitary thyroid nodules for surgical treatment.