Reasons of relapse and pattern of drug use among the substance users in Bangladesh: A nationwide study.

This study aimed at investigating the reasons of relapse and patterns of drug use among the substance users in Bangladesh. We have conducted a descriptive type of cross-sectional study among the relapse cases of substances users in the whole of Bangladesh. Concerning the reasons for relapse after taking treatment; family unrest (29.5%), peer pressure (27.4%), to reduce depression (24.8%) and craving for drugs (24.3%) were the most frequent. Amphetamine was reported to be the most used drug (76.1%, n = 693), followed by cannabis (75%, n = 683) and alcohol (54.3%, n= 495). Further extensive studies are also needed to explore the association.

Legal and social consequences of substance use: Results from a nationwide study in Bangladesh.

Substance use is a major public health concern and its consequences can destroy someone's life. This study aimed to explore the legal and social consequences of substance use in Bangladesh. We conducted a nationwide descriptive cross-sectional study among relapse cases of substance use from January to December 2018. We visited 138 drug rehabilitation centers countrywide and were able to recruit 939 relapse cases, from where 28 cases were excluded due to incomplete data. Finally, data from 911 cases were analyzed. The majority (89.3%) of the study participants were 19-45 years old. Most commonly used drugs were amphetamine (76.1%), cannabis (75.0%), alcohol (54.3%), cough sirup (54.2%), heroin (47.0%) and sleeping pills (21.6%). Almost half (49.5%) of the substance users were arrested for drug use and among arrested cases, 52.1% were sent to jail. About 75% of the substance users experienced a lack of family interaction, 70% experienced destroyed family relationships, and 71.4% faced social stigma. Our study also found 60% of the participants were bullied, 50% were deprived or unwilling to have social interactions. Moreover, 13.8% of the participants left home, while 8% got divorced. Our data represented the significant impact of substance use on the legal aspect and social life of individuals. However, with a multi-dimensional treatment, rehabilitation, and social intervention approach, it is not impossible to overcome. Therefore, we believe it is imperative to focus on social awareness and to create a robust platform for health promotion and improve quality of life.

Quality of life in renal transplant recipient and donor.

OBJECTIVES: Quality of life (QoL) assessment in renal transplant patients has become an important tool in evaluating outcomes. In this work the QoL of the renal transplant donor and recipient are compared to healthy, age- and BMI-matched individuals. MATERIALS AND METHODS: The donors were all living related. The immunosuppression protocol was prednisolone, cyclosporine/tacrolimus, and mycophenolate mofetil/azathioprine. Renal function was stable. Quality of life was assessed by KDQOL-SF-36. It includes 36 items divided into 8 scales. RESULTS: Comparison among healthy subjects (n = 20), kidney donor (n = 20), vs recipients (n = 40) for age was 35 ± 8, 40 ± 11, vs 37 ± 10 years (P = NS), and BMI was 23 ± 5, 21 ± 4, vs 21 ± 4 kg/m(2) (P = NS). The mean duration of transplantation of donor and recipients was 22 ± 11 vs 28 ± 25 months (P = NS). Items in SF-36 among 3 groups, respectively, showed general health scores of 48 ± 23, 60 ± 20, vs 59 ± 20; physical functioning 61 ± 28, 84 ± 23, vs 76 ± 265; role physical 31 ± 38, 70 ± 44, vs 636 ± 53; pain 79 ± 36, 73 ± 23, vs 69 ± 25; emotional well-being 63 ± 17, 74 ± 14, vs 73 ± 34; social function 83 ± 20, 95 ± 8, vs 91 ± 15, and energy/fatigue 57 ± 17, 62 ± 16, vs 58 ± 15; (P = NS) was similar in all groups. Correlation studies showed strong positive association of all the items with each other. CONCLUSIONS: This study finding is in accordance with the expected outcome that QoL improves significantly to near normal in renal transplant recipients. At the same time donors' QoL also is not compromised. Both donor and recipient have similar high quality scores to those of a healthy person.

Factors associated with relapse into drug use among male and female attendees of a three-month drug detoxification-rehabilitation programme in Dhaka, Bangladesh: a prospective cohort study.

BACKGROUND: To determine relapse rates and associated factors among people who use drugs (PWUDs) attending abstinence-oriented drug treatment clinics in Dhaka, Bangladesh. METHODS: A cohort of male and female PWUDs admitted to the 3-month drug detoxification-rehabilitation treatment programmes of three non-governmental organisation-run drug treatment clinics in Dhaka, Bangladesh were interviewed on admission and over the following 5 months, which included the first 2 months after discharge. The study subjects comprised 150 male and 110 female PWUDs who had been taking opiates/opioids, cannabis or other drugs (including sedatives) before admission, had provided informed consent and were aged ≥16 years. Interviews were conducted using semi-structured questionnaires at four time points; on admission, at discharge and at 1 and 2 months after discharge. Relapse rates were assessed by the Kaplan-Meier method. Factors associated with relapse on enrolment and after discharge were determined using the Cox proportional hazards regression model. RESULTS: A greater proportion of female than male subjects relapsed over the study period (71.9% versus 54.5%, p < 0.01). For men, baseline factors associated with relapse were living with other PWUDs (relative hazard ratio [RHR] = 2.27), living alone (RHR = 2.35) and not having sex with non-commercial partners (RHR = 2.27); whereas for women these were previous history of drug treatment (RHR = 1.94), unstable housing (RHR = 2.44), higher earnings (RHR = 1.89), preferring to smoke heroin (RHR = 3.62) and injecting buprenorphine/pethidine (RHR = 3.00). After discharge, relapse for men was associated with unstable housing (RHR = 2.78), living alone (RHR = 3.69), higher earnings (RHR = 2.48) and buying sex from sex workers (RHR = 2.29). Women' relapses were associated with not having children to support (RHR = 3.24) and selling sex (RHR = 2.56). CONCLUSIONS: The relapse rate was higher for female PWUDs. For both male and female subjects the findings highlight the importance of stable living conditions. Additionally, female PWUDs need gender-sensitive services and active efforts to refer them for opioid substitution therapy, which should not be restricted only to people who inject drugs.

Celiac disease and celiac crisis in children.

OBJECTIVE: To determine the frequency of clinical features of Celiac disease (CD) and Celiac crisis in children. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Paediatrics Unit, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, from September 2009 to September 2010. METHODOLOGY: Forty children aged between 4 to 13 years of either gender, presenting with complaints of recurrent diarrhea, abdominal distention, severe emaciation and dehydration were included. The information about breast feeding, weaning diets, age of introduction of wheat diets, onset of diarrhea, characteristics and frequency of stools, growth, vaccination status, symptoms in 1st degree relatives, restriction of Gluten diet in the past and anthropometric measures were recorded. Serological tests against anti-Tissue Transglultaminase (anti-tTG) antibodies were obtained in all cases. Upper gastrointestinal endoscopies were performed and multiple biopsies were taken from distal parts of duodenum. RESULTS: Among the forty children, twenty four (60%) were females and 16 were males (40%). The mean age was 6.35 ± 2.83 years. Thirty five (87.5%) parents were cousins. Breast feeding was not exclusively given and the Gluten containing weaning diets were given as early as 3.5 months of age. Thirty (75%) children presented with typical sign and symptoms of CD. Celiac crisis presented with profuse diarrhea, severe dehydration; abdominal distention; pedal edema, carpopedal spasm due to tetany; wasted muscles; head drop and inability to stand. The serum TtG antibodies in thirty-eight cases (95%) were above the cut off level of 7 u/ml ranging from 35-99 u/ml. The histopathology of specimens from distal duodenum revealed lesions of M3 type in thirteen (32.5%) and M2 type in eighteen cases (45%). All cases recovered and improved on follow-up after strict adherence to gluten-free diet (GFD). CONCLUSION: Majority of children with Celiac disease presented with typical symptom, while Celiac crisis was characterized by severe dehydration, weakness and calcium deficiency signs. Most were the product of consanguineous marriages and were given Gluten-containing weaning foods as early as the 4th month of life.