An Appraisal of Mortality in Intensive Care Unit of a Level III Military Hospital of Bangladesh.

BACKGROUND: Mortalities in Intensive Care Units (ICUs) are high and widely variable. The unpredictability of death rates is attributable to age, sex, nature and severity of illness, comorbidity, well-timed medical attention, quality of the attending staffs, iatrogenic events, total management facilities, and overall grade of the ICU in general. MATERIALS AND METHODS: A total of seventy patients who died in the ICU of a Level III Combined Military Hospital within a period of 2 years were studied in retrospect to review the mortality pattern. RESULTS: Overall mortality rate was 3.58%, among which 81.43% were male and 18.57% were female. The mortality rate in geriatric patients was 12.26% and 2.84% in the age group of 12-60 years and 2.56% in below 12 years. The major causes of death were ischemic heart disease (20%), cerebrovascular disease (14.28%), and chronic obstructive pulmonary disease (10%). Highest incidence of death occurred during 1-3 days of ICU stay (34.28%) and the lowest was at 4 days to 1 week (4.28%). CONCLUSION: Ischemic heart disease (IHD) is remaining as the most important cause of mortality in our community although many countries have succeeded in reducing the IHD mortality by a combination of lifestyle modification and improving the health-care delivery systems.

Synthesis of homo- and copolymer containing sulfonic acid via atom transfer radical polymerization.

Well-defined functional poly(p-phenyl styrenesulfonate) and poly(p-phenyl styrene-sulfonate-co-styrene) were successfully synthesized by the atom transfer radical polymerization (ATRP) using CuBr/bpy(PMDETA) catalyst and 1-phenylethyl bromide (1-PEBr) as an ATRP initiator in diphenyl ether (DPE) or dimethyl formamide (DMF). In both homo- and copolymers, the CuBr/PMDETA catalytic system in DPE or DME showed higher yield than CuBr/bpy and the polydispersity index (PDI) of polymer was low. Using PMDETA or bpy as a ligand in DMF, the high yield with high PDI was obtained than in DPE. We found that the CuBr/PMDETA catalyzed ATRP of p-phenyl styrenesulfonate and copolymerization with styrene comonomer in DPE proceeded in a controlled manner. The polymers containing sulfonic acid were obtained by the chemical deprotection of protecting group, followed by acidification. The molecular structure, molecular weights and thermal properties of the copolymers were determined by nuclear magnetic resonance (1H NMR) spectroscopy, Fourier transform infrared (FT-IR) spectroscopy, size exclusion chromatography (SEC), differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA), respectively.

Nutritional value, micronutrient and antioxidant capacity of some green leafy vegetables commonly used by southern coastal people of Bangladesh.

Southern coastal people of Bangladesh are highly vulnerable to food insecurity and malnutrition due to coastal flooding, deforestation and increased soil salinity. A number of green leafy vegetables are found in the southern coastal belt being traditionally eaten as daily basis by local people. But they are unaware of nutritional and medicinal use of these vegetables. To contribute to their wider utilization, five common vegetables namely Hibiscus sabdariffa, Trianthema portulacastrum, Diplazium esculentum, Heliotropium indicum L. and Hygrophila auriculata were selected for analysis of nutritional proximate, micronutrients and antioxidant potential. Nutritional properties were analyzed in terms of moisture, pH, protein, lipid, ash, fibre, minerals and carbohydrate. Total flavonoid, tannin and antioxidant capacity were evaluated using established protocols. The results demonstrated that collected plants are rich in carbohydrate, fibre, proteins, moisture and ash content but low in lipid content. The mineral elements were high with remarkable amount of Na (19.9-21.5 mg/gm), K (7.9-13.5 mg/gm) and P (1.0-1.8 mg/gm). All the samples were found to have considerable amount of flavonoid (90.6-144.5 mg QE/gm) and tannin content (26.8-57.2 mg GAE/gm). The IC50 value of DPPH and superoxide radical scavenging was the lowest for H. indicum (37.1 and 83.4 µg/ml, respectively) whereas T. portulacastrum possessed high reducing power (IC50 53.7 µg/ml). Among the five investigated species, T. portulacastrum and H. indicum were found to have good nutritional and antioxidant properties, thus can be promoted as a significant source of nutritional and antioxidant food supplements.

Role of very short-term intravenous hydrocortisone in reducing postdural puncture headache.

OBJECTIVE: Headache is not an uncommon complication of spinal anesthesia. The efficacy of intravenous (IV) hydrocortisone in treating the patients with postdural puncture headache was observed in this study. MATERIALS AND METHODS: Sixty patients with headache following spinal anesthesia were randomly allocated into two groups. Thirty patients received only conventional therapy (recumbent positioning, IV or oral hydration, analgesics with caffeine, stool softeners, and soft diet) plus 2 ml of normal saline IV (placebo) 8 hourly for 48 h. Thirty other patients received conventional therapy plus hydrocortisone IV (100 mg in 2 ml 8 hourly for 48 h). Headache intensity was measured using visual analogue scale. RESULTS: No significant difference was observed in baseline headache intensity between the two groups (P = 0.6642) before beginning of treatment. After 6 h, the mean headache intensity in patients treated conventionally was 6.02 ± 2.46, while it was 2.06 ± 1.98 in other patients who received additional hydrocortisone IV (P < 0.0001). After 24 h, headache intensity was 3.77 ± 1.85 in conventionally treated group versus 0.94 ± 2.67 in hydrocortisone group (P < 0.0001), while it was 1.95 ± 1.12 in conventionally treated group versus 0.69 ± 1.64 in hydrocortisone group (P = 0.001) after 48 h. CONCLUSIONS: Very short-term use of IV hydrocortisone was found effective in reducing headache following spinal anesthesia. However, its clear mechanism of action is yet to be determined. Large-scale studies are recommended to consider the steroid therapy as a standard treatment for postdural puncture headache.

The Role of Fluoroquinolones in the Treatment of Skin and Soft Tissue Infection.

Skin and soft tissue infections vary widely in their nature and severity, and their nomenclature is complex. Most are readily recognized and easily treated, but more severe infections may masquerade in forms similar to those of more innocent infections, causing delay in diagnosis and treatment that may result in loss of limb or life. Antimicrobial therapy is clearly beneficial for both recovery from these infections as well as preventing disease progression. The fluoroquinolones are potent broad-spectrum antimicrobial agents. The older fluoroquinolones mainly have excellent in vitro activity against gram-negative bacilli and borderline activity against clinically important gram-positive organisms, but newer fluoroquinolones were developed to have enhanced activity against both gram-positive and anaerobic organisms while retaining broad-spectrum anti-gram-negative activity. Several comparative trials using fluoroquinolones suggest that the efficacy of these agents is similar to that of b-lactam antimicrobial agents. Additional clinical trials are necessary to determine the overall role of newer fluoroquinolones as alternatives for skin and soft tissue infections.