Measuring the effectiveness of an integrated intervention package to improve the level of infection prevention and control: a multi-centre study in Bangladesh.

BACKGROUND: Infection prevention and control (IPC) is a critical component of delivering safe, effective and high-quality healthcare services, and eliminating avoidable healthcare-associated infections (HAIs) in health facilities, predominantly in population-dense settings such as Bangladesh. AIM: Our study aimed to assess the effect of an integrated intervention package in improving the IPC level of the health facilities in Bangladesh. METHODS: We conducted a pre-post intervention study in six district hospitals (DHs) and 13 Upazila Health Complexes (UHCs) in the six districts of Bangladesh. Baseline and endline assessments were conducted between March and December 2021 using the adapted World Health Organization Infection Prevention and Control Assessment Framework (WHO-IPCAF) tool. The IPCAF score, ranging from 0-800, was calculated by adding the scores of eight components, and the IPC promotion and practice level was categorized as Inadequate (0-200), Basic (201-400), Intermediate (401-600) and Advanced (601-800). The integrated intervention package including IPC committee formation, healthcare provider training, logistics provision, necessary guidelines distribution, triage/flu corners establishment, and infrastructure development was implemented in all facilities. RESULTS: The average IPCAF score across all the facilities showed a significant increase from 16% (95% CI: 11.5-20.65%) to 54% (95% CI: 51.4-57.1%). Overall, the IPCAF score increased by 34 percentage points (P<0.001) in DHs and 40 percentage points (P<0.001) in UHCs. Following the intervention, 12 (three DHs, nine UHCs) of 19 facilities progressed from inadequate to intermediate, and another three DHs upgraded from basic to intermediate in terms of IPC level. CONCLUSION: The integrated intervention package improved IPCAF score in all facilities.

Hypoalbuminaemia as a Marker of Severity of Patients of Community Acquired Pneumonia.

Community-acquired pneumonia (CAP) is a common presentation with an acute infection of the pulmonary parenchyma occurring in the community level. Despite the availability of potent antibiotics, it remains as a serious illness with significant morbidity and mortality in both developed and developing countries. This study was undertaken to determine the relation between serum Albumin and severity of CAP. This was a cross sectional descriptive study which was carried out in the Department of Medicine of Mymensingh Medical College Hospital (MMCH), Bangladesh from July 2019 to December 2019. The sample size was 67. Purposive sampling technique was employed. Patients of community acquired pneumonia (CAP), aged ≥14 years of both sex with recently developed radiological pulmonary shadowing with compatible clinical symptoms and signs were included. Patients who were chronically immunosuppressed, with chronic starvation, advanced liver disease or chronic kidney disease with or without receiving haemodialysis were excluded. Data analysis was done by SPSS software for Windows (version 23.0). The mean age 65.7±15.3 years, majority 13(19.4%) patients had chronic lung disease, 12(17.9%) had diabetes mellitus, 9(13.4%) had heart failure, 6(9.0%) had cerebrovascular disease, 6(9.0%) had neoplastic disease and 5(7.5%) had chronic renal failure. Majority 22(32.8%) patients had CURB-65 score 3, out of which 12(54.5%) had albumin level <20g/l, 9(40.9%) had albumin level 20.0-24.9g/l and 1(4.5%) had albumin level 25-29g/l. 17(25.4%) had score 4-5 out of which 10(58.8%) had albumin level <20g/l and 7(41.2%) had albumin level 20.0-24.9g/l, 15(22.4%) had score 2 and 13(19.4%) had score 0-1. Negative significant correction (r=-0.782; p=0.001) was found between CURB-65 score and albumin level. Significant number of patients with severe CAP show low serum albumin level at admission which is statistically significant when compared with CURB-65 score. Thus hypoalbuminaemia may be a good marker of severity of patients with CAP.

Complete Heparin Reversal by Protamine during Off-Pump Coronary Artery Bypass Surgery (OPCAB): A Necessity or Myth?

In our country majority of the coronary artery bypass surgery (CABG) are done off-pump and was reported having excellent clinical outcome along with cost efficiency by various investigators. Heparin is commonly used as most effective anticoagulant, and protamine sulfate is now generally used to reverse the anticoagulant action of heparin. While under dosing of protamine may result in incomplete heparin reversal and prolonged anticoagulation, protamine overdosing is associated with impaired clot formation exerted by the intrinsic anti-coagulation properties of protamine itself, moreover protamine administration is associated with mild to severe cardiovascular and pulmonary complications. Apart from traditional full neutralization of heparin now-a-days, half dose protamine was also introduced showing good outcome regarding lower activated clotting time (ACT), overall, less surgical bleeding with less transfusion. This comparative study was designed to detect differences between traditional and decreased protamine dosing in Off-Pump Coronary Artery Bypass (OPCAB) surgery. Four hundred (400) patients who underwent Off-Pump Coronary Artery Bypass Surgery (OPCAB) surgery at our institution over a period of 12 months were analyzed and were divided into two groups. Group A- received 0.5mg of protamine per 100 unit of heparin; Group B-received 1.0mg of protamine per 100 unit of heparin. ACT, blood loss, hemoglobin and platelet count units of blood and blood product transfusion requirements, clinical outcome and hospital stay were assessed in each patient. This study showed that 0.5mg of protamine per 100 unit of heparin was always able to reverse the anticoagulant effect of heparin with no significant difference in hemodynamic parameters, amount of blood loss and requirements of blood transfusion in between the groups. A standard protamine dosing formula (protamine-heparin at ratio of 1:1) adequate for on-pump cardiac surgical procedures significantly overestimates protamine requirements for OPCAB. Patients treated with decreased protamine do not appear to have adverse outcomes in terms of post-operative bleeding.

Correlation among the structural, electric and magnetic properties of Al3+ substituted Ni-Zn-Co ferrites.

This study explored the structural, electrical, and magnetic properties of diamagnetic aluminium (Al3+) substituted nickel-zinc-cobalt (Ni-Zn-Co) mixed spinel ferrites, though the research on this area is in the infancy stage. Single-phase cubic spinel structures with the Fd3̄m space group of the synthesized Ni0.4Zn0.35Co0.25Fe(2-x)Al x O4 (0 ≤ x ≤ 0.12) ferrite samples were confirmed by X-ray diffraction (XRD) analysis. The average particle size ranged from 0.67 to 0.39 µm. Selected area electron diffraction (SAED) patterns were indexed according to the space group Fd3m, representing the particle's crystallinity. The optical band gaps ranged from 4.784 eV to 4.766 eV. Frequency-dependent dielectric constants and ac conductivity measurement suggested that the prepared ferrites were highly resistive. Relaxation times were reduced to a low value from 45.45 µs to 1.54 µs with the composition x. The Curie temperatures (T c) were 615-623 K for all samples. Real part permeabilities (µ /) were relatively stable up to an extended frequency range of 106 Hz with relative quality factors (RQF) of around 103. Tuning of the properties indicates that the fabricated ferrites may be promising for high-frequency electronic devices.

Study on Body Mass Index and Serum Calcium Level in Postmenopausal Women.

Menopause is one of the natural parts of women's life when menstrual cycle stops due to lack of estrogen, which occurs in middle age. Various health problems occur in this period which hampers quality of life. This study was done to evaluate the changes of body mass index and serum calcium level in post-menopausal women in comparison to reproductive women. This cross-sectional analytical type of study was done in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2021 to December 2021. A total number of 140 female subjects age ranged from 25-65 years were included in this study. Among them 70 (seventy) postmenopausal woman (45-65 years) were taken as study group (Group II) and 70 (seventy) reproductive women (25-45 years) were taken as control group (Group I). Body mass index was measured by Anthropometric measurements such as height and weight taken in meter and kilogram respectively and Serum calcium level was measured by colorimetric method with O-Cresolftalein-complexone (OCC). Data were expressed as mean (±SD) and statistical significance of difference among the group was calculated by unpaired Student's 't' test. The mean±SD of BMI of Group I and Group II were 23.05±4.43 kg/m² and 29.01±3.12 kg/m² respectively. The mean±SD of body mass index is significantly higher in study group in comparison with control group. Serum calcium of Group I and Group II were 10.95±0.77 mg/dl and 7.99±0.55 mg/dl respectively. The mean±SD of serum calcium level was significantly lower in study group in comparison with control group. Post-menopausal women with low serum calcium level have a chance of development of osteoporosis. So, assessment of this parameter is important for early detection and prevention of complication related to low serum calcium level for leading a sound life.

Outcome of Danis-Weber Type-B ankle fracture treated by Pre-contoured Distal Fibular Locking Plate.

Danis-Weber type-B ankle fracture is one of the most common injuries in young and active individual. This fracture offers a considerable challenge to orthopedic surgeon. Though there are several options for treating such type of fracture, ORIF by Pre-contoured Distal Fibular Locking Plate is the preferred option in the recent years. This descriptive type of observational study was performed from July 2017 to June 2019 in NITOR. Thirty (30) patients, 22 male and 8 female with an average age of 39 years with Danis-Weber type-B ankle fracture underwent ORIF by Pre-contoured Distal Fibular Locking Plate for fractured fibula and ORIF by 4.0mm cannulated cancellous screw for fractured medial malleolus. All the patients were initially managed by analgesic and short leg posterior slab. Average follow up was 24 weeks. Final outcome was assessed by AOFAS score. The main cause of injury was RTA (56.67%). Mean operation time was 1.2 hours. Mean duration of Hospital stay was 16.43±1.73 days. Superficial infection was in 3.33% and skin necrosis in 3.33% patient. Mean duration of radiological healing was 12.73±0.39 weeks. At final follow up, mean dorsi flexion was 10.93°±0.357° and plantar flexion was 50.93°±0.357°. Ninety percent (90%) patient had no difficulties in walking on any surface; 96.67% patient had stable ankle hind foot; 86.67% patient had good. Ten percent (10%) had fair and 3.33% patient had poor alignment of foot. The mean score in this study was 88.67±2.31. Satisfactory outcome was observed in 86.67% patients and 13.33% had unsatisfactory results. On the basis of results in the present study, it can be concluded that treatment of Danis-Weber type-B ankle fracture by Pre-contoured Distal Fibular Locking Plate is an effective and reliable method.

Study on Precipitating Factor of Chronic Hepatic Encephalopathy.

Hepatic encephalopathy (HE) is a neuro-psychiatric manifestation of chronic liver disease causing significant morbidity and mortality worldwide. Though the exact mechanism is unknown but it is well accepted that various precipitating factors are involved in hepatic encephalopathy. Aim of the study was explore the precipitating factors of chronic hepatic encephalopathy. This cross sectional descriptive study was conducted in the Department of Medicine and Department of Hepatology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during the period from April 2016 to October 2016. One hundred patients with hepatic encephalopathy fulfilling the inclusion and exclusion criteria were enrolled. Inclusion criteria were designed for all diagnosed cases of hepatic encephalopathy associated with cirrhosis of liver aged 18 years or above irrespective of sex. Patients with acute fulminant hepatitis and non-cirrhotic hepatic encephalopathy were excluded. The result of the study was mean age of hepatic encephalopathy was 52.81±8.15 years and 94.0% patients were above 40 years. Male (66.0%) were predominant over female (34.0%). HBsAg and Anti HCV were positive in 49.0% and 11.0% patients respectively. Stage of hepatic encephalopathy was stage-I in 8.0%, stage-II in 37.0%, stage-III in 39.0% and stage-IV in 16.0% patients. Changes of biochemical parameters were low haemoglobin level (70.0%), raised total count of leukocyte (25.0%), low platelet count (68.0%), low serum albumin (98.0%) raised prothrombin time (60.0%), low serum sodium (34.0%) and low serum potassium (63.0%). The recoded precipitating factors were gastrointestinal bleeding (14.0%), constipation (37.0%), hyponatremia (34.0%), hypokalemia (28.0%) infections (20.0%), use of diruretics (8.0%), use of sedatives (4.0%) and excess intake of protein (6.0%). While precipitating factor was absent in 11.0% of cases. In conclusion there are different factors which play a key role in precipitating hepatic encephalopathy but electrolytes imbalance, constipation, infections, Upper GI bleed, diuretics are the most common precipitating factors.

Ultrasensitive detection of pathogenic viruses with electrochemical biosensor: State of the art.

Last few decades, viruses are a real menace to human safety. Therefore, the rapid identification of viruses should be one of the best ways to prevent an outbreak and important implications for medical healthcare. The recent outbreak of coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus which belongs to the single-stranded, positive-strand RNA viruses. The pandemic dimension spread of COVID-19 poses a severe threat to the health and lives of seven billion people worldwide. There is a growing urgency worldwide to establish a point-of-care device for the rapid detection of COVID-19 to prevent subsequent secondary spread. Therefore, the need for sensitive, selective, and rapid diagnostic devices plays a vital role in selecting appropriate treatments and to prevent the epidemics. During the last decade, electrochemical biosensors have emerged as reliable analytical devices and represent a new promising tool for the detection of different pathogenic viruses. This review summarizes the state of the art of different virus detection with currently available electrochemical detection methods. Moreover, this review discusses different fabrication techniques, detection principles, and applications of various virus biosensors. Future research also looks at the use of electrochemical biosensors regarding a potential detection kit for the rapid identification of the COVID-19.

Clinical Study on Rupture Uterus in Mymensingh Medical College Hospital.

Uterine rupture is a devastating situation, has claimed innumerable lives of both the mother and the fetus. Even today, it is one of the common obstetric complications and a significant cause of maternal and fetal death. Several factors are responsible for this including-inadequate antenatal and intra partum care, poor communications and inadequate logistic support, above all, illiteracy and lack of knowledge of the people. To evaluate the patients with rupture uterus A cross sectional descriptive study was carried out in the department of Obstetrics & Gynaecology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2012 to June 2013. Total 100 cases of rupture uterus were included in this study within this period. Data were processed and analyzed by Computer software SPSS-16 version (Statistical Package for Social Science) & cases were selected purposively. Incidence of rupture uterus was 1.43%, common age group was 20-30 years, majority (67%) came from rural areas, multi-gravid patients were mainly affected (98%). Most of the patients (68%) had no antenatal check-up and 46% were handled by untrained Dai at home during labour pain and 56% exposed to oxytocic drugs. Unscarred uterus was more common (61%) & common clinical presentation was hypo-volumic shock (64%). Subtotal hysterectomy (51%) had done as surgical procedure in 51% patients and average duration of hospital stay was 11±4 days. The common post operative complications were sepsis (20%), wound infection (13%), shock (10%) and urinary fistula (8%). Incidence of peri-natal mortality was 89% and maternal mortality 14%.This study suggests maternal and perinatal morbidity and mortality is high due to rupture uterus. So prevention and proper management is necessary to overcome this problem. This study will hopefully give us some guide to take the strategies in improving the care of rupture uterus.

Complications Following General Anaesthesia in Paediatric Patients.

Complications in paediatric anaesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with smell patient samples. Major morbidity is rare. It is best assessed by very large clinical studies and by review of cases malpractice claims. Both minor & major complication occurs most commonly in infants and children under three especially those with severe co-morbidities. Knowledge of risk profiles in paediatric anaesthesia is a starting point for the reduction of risk complication.

Distribution of Heavy Metals in Surface Sediments of the Bay of Bengal Coast.

The concentrations of major (Si, Al, Ca, Fe, and K) and minor (Cd, Mn, Ni, Pb, U, Zn, Co, Cr, As, Cu, Rb, Sr, and Zr,) elements in the surficial sediments were studied in an attempt to establish their concentration in the Bengal coast. It was revealed that the majority of the trace elements have been introduced into the Bengal marine from the riverine inflows that are also affected by the impact of industrial, ship breaking yard, gas production plant, and urban wastes. The concentration of heavy metals was measured using Atomic Absorption Spectroscopy and Energy Dispersive X-ray fluorescence instruments. The highest concentrations for several trace elements were thus recorded which generally decrease with distance from the coast. It was observed that the heavy metal concentrations in the sediments generally met the criteria of international marine sediment quality. However, both the contamination factor and pollution load index values suggested the elevation of some metals' concentrations in the region. Constant monitoring of the Bengal coast water quality needs to be recorded with a view to minimizing the risk of health of the population and the detrimental impacts on the aquatic ecosystem.

Pyrolytic Waste Plastic Oil and Its Diesel Blend: Fuel Characterization.

The authors introduced waste plastic pyrolysis oil (WPPO) as an alternative fuel characterized in detail and compared with conventional diesel. High density polyethylene, HDPE, was pyrolyzed in a self-designed stainless steel laboratory reactor to produce useful fuel products. HDPE waste was completely pyrolyzed at 330-490°C for 2-3 hours to obtain solid residue, liquid fuel oil, and flammable gaseous hydrocarbon products. Comparison of the fuel properties to the petrodiesel fuel standards ASTM D 975 and EN 590 revealed that the synthetic product was within all specifications. Notably, the fuel properties included a kinematic viscosity (40°C) of 1.98 cSt, density of 0.75 gm/cc, sulphur content of 0.25 (wt%), and carbon residue of 0.5 (wt%), and high calorific value represented significant enhancements over those of conventional petroleum diesel fuel.

Growth performance and nutrient composition of juvenile Nile tilapia (Oreochromis niloticus) fed Spirulina flakes, rice bran and mustard oil cake.

INTRODUCTION: Tilapia (Oreochromis niloticus) is an important cultured fish that is widely distributed in Bangladesh. This study was conducted to improve the growth performance and nutrient contents of the fish using five different types of feeds. METHODS: Tilapia fingerlings were fed two types of commercial fish feeds (Feed-1 and Feed-2), Spirulina flakes (Feed-3), Feed-2 mixed with Spirulina flakes (Feed-4) and manually mixed feed made from a mixture of mustard oil cake and rice bran (Feed-5). After 4 weeks of being fed with the diets, growth parameters and meat nutrient composition of the tilapia fingerlings were recorded. RESULTS: Significant growth in length and weight was observed in juvenile tilapia fish fed with commercial Feed-1 only, while growth performance varied significantly among fingerlings fed other types of feeds. Body tissue calcium (92.8 mg/100 g), iron (1.29 mg/100 g) was higher in fishes fed with dry Spirulina flakes (Feed 3), while the highest amount of zinc (2.09 mg/100 g) was recorded in fishes fed Feed-5. Protein (13.32%) content was highest in fish fed Feed-2 mixed with Spirulina flakes (Feed-4). CONCLUSION: Meat nutritional quality of tilapia can be improved by combining commercial feeds with Spirulina flakes, compared with feeding commercial feeds in isolation.

Caudal anesthesia in pediatric surgical practice.

Prospective study was carried out on 100 patients since May 2005 in my private practice and in the department of pediatric surgery of MMCH. Under caudal anesthesia along with or without ketaminie induction and gas inhalation all the patients underwent different surgical procedure namely anorectal surgery (eg. anoplasty, rectal polyp), urogenital surgery (Circumcision, hypospadias, meatotomy), groin surgery (hernia, hydrocele) and foot & leg surgery. Calculated dose schedule of drugs used in anesthesia and volume were maintained. Time of giving anesthesia and time of starting analgesia were recorded. Per-operative and postoperative analgesia were evaluated. Every parent was explained regarding the merit of caudal anesthesia calculated and compared with that of general anesthesia. Application of caudal anesthesia with or without ketamine & diazepam induction can be used safely and cost effectively and may be put into protocol in many of the pediatric surgical practice both in institute and also in private practice.

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).

Repair of cleft lip on relatively older children with anthropometrical surgical outcome.

A prospective study was done on 54 patients aged over 6 months with cleft lip with or without cleft palate admitted in the department of pediatric surgery of Mymensingh Medical College Hospital during the period from Oct 2002 to Dec 2004. The anthropometrical surgical outcome was evaluated by measuring the length, diameter and thickness of hemilip and diameter of nostril both pre and postoperatively (according to schedule). Patients were categorized into three groups according to their age. Mean Corrective rate was evaluated and it was shown 95% in the 1(st) age group, 93% in 2(nd) age group and 95.55% in the 3(rd) group. Complication was evaluated in only 16.66% of patients. Regarding the out come scar, cupid's bow, notching, labial and nasal symmetry were taken in consideration. Beside these this study might play a comparative role with the results of correction of cleft lip in early age.