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1.
J Infect Dev Ctries ; 14(10): 1098-1105, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33175702

RESUMO

The novel coronavirus has become a global risk because of its massive transmission and high rates of mutation. Efficient clinical management remains a challenge in combatting the severe acute respiratory syndrome caused by this virulent strain. This contagious disease is new to the people of Bangladesh. The country is at high risk of spreading the coronavirus infection particularly because of its high population density. Significant morbidity and mortality have been observed for the quick transmission of this virus since March 8, 2020. The basic objective of this article is to analyze the preparedness of Bangladesh, given its constraints and limitations, to cope with the rapid spread of COVID-19 infection. In doing so, it summarizes the origin of coronavirus, epidemiology, mode of transmission, diagnosis, treatment, prevention and control of the disease. Although many steps have been taken by the Government and the private sector of Bangladesh to create awareness about measures needed to prevent the deadly infections, many people are unaware of and reluctant to accept the prescribed rules. Inadequacy of diagnostic facilities and limitations of clinical care and health care services were major constraints faced in treating COVID-19 infected people in Bangladesh. Greater compliance by the people in following the suggested measures may help reduce the rapid spread of the disease and overcome the challenges faced by this pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Bangladesh/epidemiologia , Betacoronavirus , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Guias como Assunto , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Fatores de Risco
2.
Mar Pollut Bull ; 160: 111649, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33181930

RESUMO

This study reports the mass fractions of Al, Cr, Mn, Fe, Co, Zn, As, Ni, Cu, Cd, Hg, and Pb in water and sediments of the Halda river, Bangladesh, and studies the distribution, contamination, and potential ecological risks of the metals and metalloid. The average mass fractions of As, Cd, and Pb are relatively higher in sediments compared to those in background values, whereas Al, Fe, Mn, and Pb concentration fractions in water are higher than the international guideline values. The results of the different contamination indices indicate that Halda river sediments are minorly contaminated by As and Pb and moderately to considerably contaminated by Cd. The ecological risk assessments indicate considerable to high ecological risk due to Cd. Multivariate statistical analysis reveals the origin of the contaminants in the river, and indicate that Cr, Zn, Pb, and Cd are from anthropogenic activities while the other metals originate from natural lithogenic actions.


Assuntos
Metais Pesados , Poluentes Químicos da Água , Bangladesh , Cruzamento , China , Monitoramento Ambiental , Sedimentos Geológicos , Metais Pesados/análise , Medição de Risco , Rios , Água , Poluentes Químicos da Água/análise
3.
Trials ; 21(1): 883, 2020 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-33106167

RESUMO

OBJECTIVES: General: To assess the safety, efficacy and dose response of convalescent plasma (CP) transfusion in severe COVID-19 patients Specific: a. To identify the appropriate effective dose of CP therapy in severe patients b. To identify the efficacy of the therapy with their end point based on clinical improvement within seven days of treatment or until discharge whichever is later and in-hospital mortality c. To assess the clinical improvement after CP transfusion in severe COVID-19 patients d. To assess the laboratory improvement after CP transfusion in severe COVID-19 patients TRIAL DESIGN: This is a multicentre, multi-arm phase II Randomised Controlled Trial. PARTICIPANTS: Age and sex matched COVID-19 positive (by RT-PCR) severe cases will be enrolled in this trial. Severe case is defined by the World Health Organization (W.H.O) clinical case definition. The inclusion criteria are 1. Respiratory rate > 30 breaths/min; PLUS 2. Severe respiratory distress; or SpO2 ≤ 88% on room air or PaO2/FiO2≤ 300 mm of Hg, PLUS 3. Radiological (X-ray or CT scan) evidence of bilateral lung infiltrate, AND OR 4. Systolic BP < 90 mm of Hg or diastolic BP <60 mm of Hg. AND/OR 5. Criteria 1 to 4 AND or patient in ventilator support Patients' below18 years, pregnant and lactating women, previous history of allergic reaction to plasma, patients who have already received plasma from a different source will be excluded. Patients will be enrolled at Bangabandhu Sheikh Mujib Medical University (BSMMU) hospital, Dhaka medical college hospital (DMCH) and Mugda medical college hospital (MuMCH). Apheretic plasma will be collected at the transfusion medicine department of SHNIBPS hospital, ELISA antibody titre will be done at BSMMU and CMBT and neutralizing antibody titre will be checked in collaboration with the University of Oxford. Patients who have recovered from COVID-19 will be recruited as donors of CP. The recovery criteria are normality of body temperature for more than 3 days, resolution of respiratory symptoms, two consecutively negative results of sputum SARS-CoV-2 by RT-PCR assay (at least 24 hours apart) 22 to 35 days of post onset period, and neutralizing antibody titre ≥ 1:160. INTERVENTION AND COMPARATOR: This RCT consists of three arms, a. standard care, b. standard care and 200 ml CP and c. standard care and 400 ml CP. Patients will receive plasma as a single transfusion. Intervention arms will be compared to the standard care arm. MAIN OUTCOMES: The primary outcome will be time to clinical improvement within seven days of treatment or until discharge whichever is later and in-hospital mortality. The secondary outcome would be improvement of laboratory parameters after therapy (neutrophil, lymphocyte ratio, CRP, serum ferritin, SGPT, SGOT, serum creatinine and radiology), length of hospital stay, length of ICU stay, reduction in proportion of deaths, requirement of ventilator and duration of oxygen and ventilator support. RANDOMISATION: Randomization will be done by someone not associated with the care or assessment of the patients by means of a computer generated random number table using an allocation ratio of 1:1:1. BLINDING (MASKING): This is an open level study; neither the physician nor the patients will be blinded. However, the primary and secondary outcome (oxygen saturations, PaO2/FiO2, BP, day specific laboratory tests) will be recorded using an objective automated method; the study staff will not be able to influence the recording of these data. NUMBER TO BE RANDOMISED (SAMPLE SIZE): No similar study has been performed previously. Therefore no data are available that could be used to generate a sample size calculation. This phase II study is required to provide some initial data on efficacy and safety that will allow design of a larger study. The trial will recruit 60 participants (20 in each arm). TRIAL STATUS: Protocol version 1.4 dated May 5, 2020 and amended version 1.5, dated June 16, 2020. First case was recruited on May 27, 2020. By August 10, 2020, the trial had recruited one-third (21 out of 60) of the participants. The recruitment is expected to finish by October 31, 2020. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT04403477 . Registered 26 May, 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trial's website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.


Assuntos
Betacoronavirus/genética , Transfusão de Sangue/métodos , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Bangladesh/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Relação Dose-Resposta Imunológica , Feminino , Mortalidade Hospitalar/tendências , Humanos , Imunização Passiva/efeitos adversos , Imunização Passiva/métodos , Masculino , Pandemias , Alta do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Segurança , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Ventiladores Mecânicos/estatística & dados numéricos
4.
Mymensingh Med J ; 29(4): 764-770, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116075

RESUMO

Among general population sub-clinical primary hypothyroidism is common. The cross sectional descriptive type of observational study was conducted in medicine and allied wards in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2010 to December 2010; among 230 purposively selected hospitalized pre-dialysis patients with chronic kidney disease. The purpose of the study was to find out the prevalence of sub-clinical hypothyroidism in hospitalized pre-dialysis patients with chronic kidney disease. Data were collected from the patients using a case record form by face to face interview, clinical examination and laboratory investigations. The collected data were entered into SPSS version 20.0 and analyzed accordingly. Mean age of the patients was 47.2 years with a SD of ±2.05 years. Maximum patients were male with a male female ratio of 5:1. A significant number of patients were smoker- 11.8% of sub-clinical hypothyroidism group and 13.6% of euthyroid group. Among the patients 40 (17.40%) had sub-clinical hypothyroidism while the majority 190 (82.60%) did not have it. Estimated prevalence of sub-clinical hypothyroidism in hospitalized pre-dialysis patients with chronic kidney disease was 17.40%. Co-morbidities found in the patients were hypertension, diabetes mellitus, chronic glomerulonephritis and obstructive uropathy. All the patients (40, 100.0%) with sub-clinical hypothyroidism were hypertensive. On the other hand, 184 (97.1%) patients without sub-clinical hypothyroidism were hypertensive. Presence of co-morbidities in patients with sub-clinical hypothyroidism did not differ significantly (p>0.05) from patients without sub-clinical hypothyroidism. Patients in group with sub-clinical hypothyroidism were more over weight in comparison to patients without sub-clinical hypothyroidism (p<0.05). Biochemical parameters of patients with sub-clinical hypothyroidism differed significantly (p<0.05) from those of patients without sub-clinical hypothyroidism. There was no significant difference between urinary albumin of two groups of patients (p>0.05). Stage 4 CKD patients were more in sub-clinical hypothyroidism group in comparison to euthyroid group. As this study may not reflect the actual picture, further large scale multi-centric study is recommended to explore the real situation of sub-clinical hypothyroidism in patients with chronic kidney disease.


Assuntos
Hipotireoidismo , Insuficiência Renal Crônica , Bangladesh/epidemiologia , Estudos Transversais , Diálise , Feminino , Humanos , Hipotireoidismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia
5.
Mymensingh Med J ; 29(4): 865-870, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116089

RESUMO

The Coronavirus disease 2019 (COVID-19) resulted severe respiratory illness such as pneumonia and lung dysfunctions that was first identified at Wuhan, the capital of Hubeiin China during the end of December 2019. The etiological cause of COVID-19 has been confirmed as a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which was similar with the zoonotic virus SARS-CoV (2002). Now a days for early diagnosis of COVID-19 the nucleic acid based test like RT PCR (real time reverse transcription polymerase chain reaction) is most consistent and used all over the world. In this study among 11,280 cases 825(7.31%) were positive by molecular RT PCR method on June 2020 at Microbiology department of Mymensingh Medical College and the samples are collected from different areas of Northern part of Bangladesh. Among this positive cases 588(71%) N gene, 10 ORF1ab (2%) and 227(27%) both N and ORF gene showed significant curve which is specific for COVID-19 positive patients. Because N and ORF gene of this virus inhibit immune system of human body especially interferon. Out of SARS-CoV-2 positive cases maximum number of N gene were found in male patients and above 40 years old aged group. So, Molecular diagnosis of this pandemic virus especially by N and ORF gene might be helpful to reduce the spread of SARS-CoV-2 as well as early treatment for saving many lives.


Assuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Pneumonia Viral , Adulto , Idoso , Bangladesh/epidemiologia , Betacoronavirus , China , Técnicas de Laboratório Clínico , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas do Nucleocapsídeo , Proteínas Virais Reguladoras e Acessórias
6.
Mymensingh Med J ; 29(4): 901-905, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116094

RESUMO

Infant massage is a traditional practice for newborns in some parts of the world; its beneficial effects in reduction of jaundice in the neonates are a matter of investigation. This study aims to find out the effects of massage therapy in term neonates with neonatal jaundice receiving phototherapy compared with a control group. This randomized controlled trial (RCT) includes total 100 term newborns evenly divided into the massage group and control group after obtaining informed consent and was conducted in the Neonatal ward of the Sher-e-Bangla Medical College, Barisal, Bangladesh from 1st January 2018 to 30th June 2018. The massage group received both massage therapy and phototherapy for neonatal jaundice whereas the control group received only phototherapy. Data were collected and analyzed and results were prepared by student's 't' test for continuous variables and chi-square test for categorical variables and statistical significance was found if p value <0.05. Both the massage group and control group were comparable in birth weight, weight at admission, gestational age, sex ratio, mode of delivery and hospital stay (p>0.05). The defecation frequency was significantly more in massage group than control group and serum bilirubin levels were significantly lower in massage group than control group on day 3 onward (p<0.05). Infant massage is a safe, effective and economic practice, which can be an adjunct to phototherapy in the management of neonatal jaundice.


Assuntos
Icterícia Neonatal , Massagem , Bangladesh , Bilirrubina , Humanos , Lactente , Recém-Nascido , Icterícia Neonatal/terapia , Fototerapia
7.
Mymensingh Med J ; 29(4): 956-963, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116102

RESUMO

This study was done to find out the frequency of gastrointestinal manifestations among adult COVID-19 patients in Bangladesh. This descriptive cross sectional retrospective study was conducted from 27 May till 20 June 2020. Data were collected retrospectively from three different hospitals of Dhaka, Bangladesh. Patients were interviewed over telephone and verbal consents were taken. Their demographic and clinical profiles were put in the questionnaires by the investigators themselves. Statistical analysis was done thereafter. Out of 226 patients diagnosed with COVID-19, 145(61.4%) patients had gastrointestinal symptoms. Five of them had none other than gastrointestinal symptoms. Twenty six patients were asymptomatic. Mean age of the patients with were 41.6±14.8 years. Males were affected almost equally as the females (51.72% vs. 48.27%) (Ratio 1.1:1). Anorexia (44.7%) followed by diarrhoea (35%) and nausea (22.6%) were the predominant symptoms. Patients with co-morbidities (74.7%) were more prone to develop GI symptoms. Family members (71.6%) of COVID-19 patients with GI symptomatic patients were more affected than the others. Hospitalizations (77.6%) were more among GI symptomatic patients than the others. Thirty Five percent (35%) patients had diarrhoea. Mean duration of diarrhoea was 2.7±1.7 days with a frequency of were 4±1.8 days per day. Gastrointestinal manifestations are common among patients with COVID-19. Clinicians need to be aware of the GI features amongst COVID-19 patients so that they can be addressed and treated effectively and immediately. Further large scale study is needed to predict the disease outcome among COVID 19 patients with GI symptoms.


Assuntos
Infecções por Coronavirus , Diarreia , Pandemias , Pneumonia Viral , Adulto , Bangladesh/epidemiologia , Betacoronavirus , Estudos Transversais , Diarreia/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Epidemiol Infect ; 148: e263, 2020 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-33115547

RESUMO

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.


Assuntos
Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bangladesh/epidemiologia , Betacoronavirus , Criança , Pré-Escolar , Comorbidade , Doença Hepática Terminal/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Morbidade , Neoplasias/epidemiologia , Pandemias , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
Mymensingh Med J ; 29(4): 756-763, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116074

RESUMO

Caesarean section (CS) is the most frequently performed major operation in obstetrics. Its frequency is gradually increasing because of extended indications. Now-a-days, caesarean section is also being performed at patient's request in absence of a medical indication. It is necessary to assess the risk and benefits to take a judicious decision to select cases for caesarean section. The cross sectional descriptive type of observational study was carried out among purposively selected 100 pregnant women admitted to the department of Obstetrics and Gynaecology of Community Based Medical College Hospital, Mymensingh, Bangladesh during the period of August 2011 to January 2012 to identify elective and emergency indications of caesarean section, to identify the common complications to identify the risk factors associated with complications and to establish a comparison between complications of elective and emergency caesarean section. The median age group of patients being operated was 20 to 25 years and operation were carried out on patients due to various indications. Principal indications were faetal distress (26%), PROM (15%), failed progress of labour and breech presentation were 8% each, other indications were eclampsia (4%), obstructed labour (5%), scar tenderness (4%), history of previous 2 caesarian section 5%. The rate of elective caesarean section was 21% while emergency operations were done in 79% of cases. Among the 100 patients 19% patients developed complications. Among the complications wound infection was most common (37%), then post partum haemorrhage and urinary tract infection 26% and 11% respectively. Other complications were abdominal distension, Puerperal sepsis, anaemic heart failure, wound dehiscence and Wound haematoma 5% each. We should try to keep the rate of caesarean section within optimum ranges (10%) as recommended by World Health Organization.


Assuntos
Apresentação Pélvica , Hemorragia Pós-Parto , Adulto , Bangladesh/epidemiologia , Cesárea/efeitos adversos , Estudos Transversais , Feminino , Humanos , Gravidez , Adulto Jovem
10.
Mymensingh Med J ; 29(4): 771-778, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116076

RESUMO

This study describes the molecular detection of human brucellosis among patients with pyrexia of unknown origin. It was a cross-sectional descriptive study and was carried out in the Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh. Non-probability purposive type of sampling technique was used. Blood samples were collected from 400 pyretic patients from September 2018 to August 2019. BCSP31 Brucella genus-specific TaqMan real-time PCR and SYBR Green real-time PCR were undertaken for molecular detection. Out of 400 samples, 22 (5.5%) samples found BCSP31 Brucella genus-specific real-time PCR positive. The study revealed that a considerable number of brucellosis is present in rural areas among risk as well as non-risk group study population having definite male predominancy, most prone to develop among >40-80 years age group. Brucella genus and species-specific real-time PCR might be performed for confirmation and also to avoid unjustified costs, drug toxicity, and un-masking of other potentially dangerous diseases.


Assuntos
Brucella , Brucelose , Bangladesh/epidemiologia , Brucelose/complicações , Brucelose/diagnóstico , Brucelose/epidemiologia , Estudos Transversais , Febre , Humanos , Masculino
11.
Mymensingh Med J ; 29(4): 779-783, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116077

RESUMO

Chronic kidney disease (CKD) is a common condition in which there is a loss of kidney function over time. CKD is associated with increased risks of several co morbidities, not limited to but including cardiovascular disease and chronic renal failure. Hypercreatininemia is associated with low level of estimated glomerular filtration rate (eGFR) in chronic kidney diseased patients. Objective of the study was to assess the relationship of eGFR and serum creatinine in chronic kidney diseased patients in order to compare this parameter with healthy subjects. This analytical type of cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 200 subjects, age range (30-70 year) were included in this study. Among them, 100 healthy subjects were taken as control group (Group I) and 100 chronic kidney diseased patients were taken as study group (Group II). Control group (Group I) again subdivided into male healthy subject (Group IA) and female healthy subject (Group IB). Study group (Group II) also subdivided into male chronic kidney diseased patient (Group IIA) and female chronic kidney diseased patient (Group IIB). The results were calculated and analyzed by using SPSS. Data were expressed as mean(±SE) and statistical significance of difference among the group was calculated by unpaired Student's t-test. In this study we found that eGFR was significantly decreased and serum creatinine was significantly increased in study groups in comparison with control groups. Therefore, by this study we recommended that routine estimation of these parameters is important for prevention of complications related to chronic kidney disease.


Assuntos
Insuficiência Renal Crônica , Bangladesh/epidemiologia , Creatinina , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia
12.
Mymensingh Med J ; 29(4): 784-792, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116078

RESUMO

This cross-sectional descriptive study was conducted at the neonatal intensive care unit (NICU) in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2017 to December 2017 to determine antimicrobial sensitivity pattern in neonatal sepsis. Ninety four neonates (0-28 days) who were admitted in NICU with suspected sepsis were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained and then septic screening along with blood culture and antimicrobial sensitivity was done. All data were compiled, tabulated and then analyzed by SPSS version 21.0. Among 94 cases, 68(72.3%) were preterm and 26(23.4%) were term. There was male predominance and male female ratio was 1.9:1. Most of the patient admitted within 72 hours of birth. Most (84%) had low birth weight (<2500gm). Pre-mature onset of labour, pre-mature rupture of membrane >18 hours, vaginal route of delivery, instrumental resuscitation, pre-lacteal feeding, bottle feeding were the major perinatal risk factors in this study. Early onset sepsis (76.6%) was most prevalent in this study. Blood culture yielded positive growth in 20(21.3%) cases. Among them, Klebsiella was found in 7(35%). E. coli in 6(30%), Acinetobacter was in 3(15%), Staphylococcus aureus in 2(10%) cases. Pseudomonas and Enterobacter were found in rest 2(10%) of the cases. Gram negative bacteria were found in 18(90%) cases. Klebsiella was sensitive to Imipenem (85.7%), Colistin (85.7%) and Ciprofloxacin (77.5%). Sensitivity of E. coli was Imipenem (100%), Colistin (100%), Amikacin (66.7%), Ciprofloxacin (66.7%), Netilmicin (66.7%) and Gentamicin (50%). Acinatobecter had sensitivity to Netilmicin, Colistin, Imipenem (100%). Staphylococcus was 100% sensitive to Imipenem, Netilmicin and Vancomycin. Pseudomonas was found sensitive to Imipenem (100%), Amikacin (100%), Netilmicin (100%) and Colistin (100%). Enterobacter was found highly sensitive to Ciprofloxacin, Colistin and Imipenem. Almost all organisms were resistant to Ampicillin, Gentamicin, Cefotaxime and Ceftazidime. Based on result it is concluded that Klebsiella pneumoniae and Escherichia coli are the leading cause of neonatal sepsis in this study and most of them resistant to multiple antibiotics. Organisms found more sensitive to Imipenem, Colistin, Ciprofloxacin and Netilmicin.


Assuntos
Anti-Infecciosos , Sepse Neonatal , Sepse , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bangladesh/epidemiologia , Estudos Transversais , Escherichia coli , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Testes de Sensibilidade Microbiana , Sepse Neonatal/diagnóstico , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Gravidez , Sepse/diagnóstico , Sepse/tratamento farmacológico , Sepse/epidemiologia
13.
Mymensingh Med J ; 29(4): 800-806, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116080

RESUMO

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.


Assuntos
Encefalopatia Hepática , Adolescente , Adulto , Bangladesh , Estudos Transversais , Feminino , Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/etiologia , Humanos , Cirrose Hepática , Masculino , Pessoa de Meia-Idade , Fatores Desencadeantes
14.
Mymensingh Med J ; 29(4): 807-814, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116081

RESUMO

Diabetic retinopathy (DR) is the most frequent microvascular complication of diabetes mellitus (DM). DR remains a leading cause of blindness, currently accounting for 4.8% of the world's 37 million blindness cases. DR is one of the critical preventable causes of blindness. In Bangladesh, the number of studies reporting the prevalence and risk factors of DR in type 2 DM (T2DM) is limited. We conducted this cross-sectional study in a tertiary hospital in Bangladesh from March 2017 to August 2019 among 200 patients with T2DM for the presence and severity of DR by using color fundus photography in a dilated pupil. The diagnosis and grading of DR were made using the Early Treatment of Diabetic Retinopathy Study (ETDRS) Chart. Out of 200 subjects with T2DM, 35.5% had DR; the frequencies of NPDR and PDR were 19.0% and 16.5%, respectively. The mean age, diabetes duration, FPG, HbA1c, TG, TC, LDL-C, and serum creatinine were statistically higher, and eGFR was lower in the study subjects with DR than those without DR; BMI and HDL-C were indifferent in the two groups. The frequencies of males, subjects having monthly income of 10,000 Bangladeshi Taka (BDT) or more, smokers, hypertensives, and subjects having uncontrolled diabetes (HbA1c ≥7%), were higher in the DR group than the no DR group. Higher age (≥50 years), higher monthly income (≥10,000 BDT), urban residence, smoking, uncontrolled diabetes, and high LDL-C (≥100mg/dL) were found to be independent risk factors of DR in the study subjects. A large-scale nationwide study is needed to find out the actual prevalence of DR in Bangladesh.


Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Bangladesh/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/etiologia , Humanos , Masculino , Prevalência , Fatores de Risco
15.
Mymensingh Med J ; 29(4): 815-822, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116082

RESUMO

More than 120,000 anterior cruciate ligament (ACL) injuries occur every year in the United States, mostly during the high school and college years. The incidence of these injuries is slowly increasing, especially in females. This is likely caused by their increasing participation in high school and other organized sports. In addition, several studies have shown that female athletes are at an increased risk of ACL injury in sex comparable sports. The goal of this study was to evaluate the functional outcome of Arthroscopic anterior cruciate ligament reconstruction using Bone-Patellar tendon- Bone autograft. 25 patients with chronic ACL deficient knee presenting to Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2018 to December 2019 were included in the study. The patients with severe osteoarthritis (OA) knee, local active infection and systemic disease, intraarticular fracture of knee that might influence the study results were excluded from the study. Bone patellar tendon bone graft was harvested from ipsilateral knee. The patient was followed till 6 months with specified program of rehabilitation. Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using Lysholm's score was 50 (42-63) preoperatively and 90.8 (63-97) at the latest follow up (p<0.005). No patient complained of instability at latest follow up. The quadriceps muscle showed atrophy at final follow-up. Five Patients complained of anterior knee pain. We found no graft displacement on follow up radiographs. Osteo-integration occurred in all cases. ACLR with a BPTB graft can stabilize the knee without loss of motion by closely mimicking the native ACL without any hazards and additional complications. It is useful in high demand patients and cost effective option with high patient satisfaction rate for reconstruction of ACL.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Ligamento Patelar , Autoenxertos , Bangladesh , Feminino , Seguimentos , Humanos , Articulação do Joelho
16.
Mymensingh Med J ; 29(4): 823-828, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116083

RESUMO

Femoral fractures are frequent in the pediatric population. Treatment options are based on the patient's age, fracture pattern, type of trauma and associated soft tissue injury. The traditional treatment method for pediatric femoral shaft fracture has been traction and spica casting. The immediate spica cast is safe and effective for children up to 6 years of age with isolated femoral fracture and acceptable reduction. Patients between 6 and 10 years of age can also be treated with spica casting with or without traction. This prospective study was done in the department of Orthopaedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh form from July 2015 to June 2019 to evaluate the outcome of closed reduction and internal fixation by titanium elastic nailing for fracture shaft of femur. Twenty patients, all presenting with fresh diaphyseal fractures of femur, treated with closed reduction and internal fixation by titanium elastic nailing. These patients were prospectively evaluated over a period of at least 18 months. Fractures were classified according to Association of Orthopaedics (AO) classification of shaft of femur fractures. According to AO classification, all were A1, A2, A3 fractures. Average age of the patients was 11±2.7 years; range was 6 to 16 years. There were 15 males and 5 females. Out of 20 cases treated with this method, stable fixation and union was achieved in all of them. Radiological union was achieved at an average of 10±2.3 weeks (8-15 weeks). The results were excellent in twelve patients (60%), successful in five (25%) and poor in three patients (15%) as per the scoring criteria for TEN. The effective treatment of diaphyseal fractures of the femur is intramedullary fixation by titanium elastic nailing in patients of the 6-16 years age group.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Adolescente , Bangladesh , Criança , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Humanos , Masculino , Estudos Prospectivos , Titânio , Resultado do Tratamento
17.
Mymensingh Med J ; 29(4): 829-837, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116084

RESUMO

Acute myocardial infarction has many risk factors and etiologies. Different factors are responsible for adverse in-hospital outcome after acute MI. Status of plasma vitamin D level has been found to be a good predictor of future adverse cardiovascular outcomes in patients with acute MI. Plasma vitamin D level has been considered as a potential marker for identifying individuals under risk of CAD and associated events. This study was done to investigate the role of plasma vitamin D level in predicting in-hospital adverse cardiac events in patients with acute MI. This cross sectional descriptive type of study was conducted in the cardiology department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from October 2017 to March 2019. Total 257 patients of first attack of acute MI were included considering inclusion and exclusion criteria. Fasting blood samples were analyzed for plasma vitamin D level. Sample population were grouped at first into two, normal and low vitamin D level, taking 30ng/ml as cut-off value, low vitamin D level is further subdivided into insufficiency (21-29ng/ml), deficiency (10-20ng/ml) and severe deficiency (<10ng/ml). Adverse in-hospital cardiac outcomes were observed. In-hospital adverse outcomes occurred in 42.9% patients having normal vitamin D level (>30ng/ml), 66.2% of patients having vitamin D insufficiency (21-29ng/ml), 78.2% of patients having vitamin D deficiency (10-20ng/ml) and 94.4% patients having severe vitamin D deficiency (<10ng/ml), which was statistically significant (p<0.05). Heart failure (30.3%, 47.7%, 63.6% and 77.8%, p<0.05), cardiogenic shock (12.6%, 27.7%, 34.5% and 33.3%, p<0.05), Arrhythmias (14.3%, 21.5%, 23.6% and 22.2%, p>0.05), death (2.5%, 0%, 3.6% and 11.1%, p>0.05) occurred more in low vitamin D groups. Mean vitamin D level was significantly different between Group I and Group II (42.59±10.08 vs. 18.64±6.54, p<0.0001). Multivariate regression analysis showed vitamin D is an independent predictor of in-hospital adverse cardiac events (p=0.001). Age (p=0.001) and obesity (p=0.048) were also other predictors of in-hospital adverse cardiac events. Low plasma vitamin D level is an important predictor for in-hospital adverse cardiac events in patients hospitalized with first attack of acute MI.


Assuntos
Infarto do Miocárdio , Vitamina D , Bangladesh , Estudos Transversais , Humanos , Infarto do Miocárdio/epidemiologia , Fatores de Risco , Vitaminas
18.
Mymensingh Med J ; 29(4): 838-846, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116085

RESUMO

Urinary tract infection (UTI) is commonly encountered in both community and hospital settings and is often associated with significant morbidity. The inappropriate administration of antibiotics to treat UTI increases the development of antimicrobial resistance to antibiotics. This cross-sectional study was conducted at the gynecology outpatient department (OPD) of Mymensingh Medical College Hospital, Bangladesh, from January 2018 to November 2019 to determine the frequency of causative micro-organisms of UTIs and their antibiotic resistance pattern. Four hundred eight women presenting with the symptoms of UTI referred with a diagnosis of UTI based on a urine routine examination, culture, and sensitivity reports to the OPD were included in the study. Antibiotic sensitivity testing was done in the microbiology department of the hospital following the Kirby-Bauer disc diffusion method. E. coli was the most common (48.5%) organism isolated, followed by Proteus (21.6%), Klebsiella (15.0%), Enterococcus spp. (4.7%), S. aureus (3.9%), Acinetobacter spp. (3.9%), and Pseudomonas (2.5%). The distribution of the causative organisms in various age groups of the patients was similar. Overall, most (>80%) of the organisms were resistant to Erythromycin (93%), Ampicillin (92%), Amoxycillin (90%), and Cefuroxime (84%); the highest sensitivity was found for Meropenem (85%), Amikacin (81%), Gentamycin (79%), and Nitrofurantoin (71%). The highest sensitivity of E. coli was found for Meropenem (90%), Amikacin (83%), Gentamycin (83%), and Nitrofurantoin (76%). E. coli were resistant to Ampicillin (100%), Amoxycillin (100%), and Erythromycin (100%), Cephalexin (85%), and Cefuroxime (85%). Proteus was highly sensitive to Meropenem (90%) and Gentamycin (82%), whereas highly resistant to most of the antibiotics. Klebsiella was found sensitive to Amikacin (90%), Gentamycin (77%), Meropenem (74%), and Ciprofloxacin (74%) and resistant to Ampicillin (100%), Erythromycin (87%), Cefixime (80%), and Cefuroxime (76%). The results of this study showed that resistance is likely to be against the most commonly used antibiotics. Most of the uropathogens showed sensitivity to injectable antibiotics, namely Meropenem, Gentamycin, and Amikacin.


Assuntos
Anti-Infecciosos , Ginecologia , Infecções Urinárias , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bangladesh/epidemiologia , Estudos Transversais , Escherichia coli , Feminino , Humanos , Testes de Sensibilidade Microbiana , Pacientes Ambulatoriais , Staphylococcus aureus , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia
19.
Mymensingh Med J ; 29(4): 847-851, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116086

RESUMO

This prospective study was conducted at Department of ENT, Mymensingh Medical College Hospital, a tertiary care center in Bangladesh January 2017 to December 2018 to report hearing results and post operative complications of cartilage interposition ossiculoplasty in one-stage intact canal wall (ICW) tympanoplasty for cholesteatoma where ossicular chain is eroded or has to be removed either partially or totally. Total 42 patients underwent Intact canal wall (ICW) tympanoplasty for cholesteatoma with at least intact stapes footplate and in conjunction, cartilage ossiculoplasty was done during the same procedure. Patients were followed up regularly at 1 week, 1 month, 3 month, 6 month and at 1 year as usual follow up protocol to note complications and hearing status in 1 year follow up. In intact stapes suprastructure group, in the preoperative period, the mean air conduction thresholds (AC), bone conduction threshold (BC) and air-bone gap (ABG) were 48.3db, 9.5db and 38.8db respectively. Postoperatively, with a mean follow-up of 12 months, AC, BC and ABG were 27.6db, 9.7db and 17.9db respectively. In missing stapes supra structuregroup, in the preoperative period, the mean air conduction thresholds (AC), Bone conduction threshold (BC) and air-bone gap (ABG) were 57.4db 13.5db and 43.9db respectively. Postoperatively, with a mean follow-up of 12 months, AC, BC and ABG, were 33.9db, 14.2db and 19.7db respectively. For management of cholesteatoma cases, cartilage ossiculoplasty can be done effectively in conjunction with of intact canal wall tympanoplasty in a single setting. Complications are a few and easily manageable. Hearing results are at least as good as with other prosthesis and helps in avoiding subsequent surgery, discomfort and cost to the patients.


Assuntos
Colesteatoma , Timpanoplastia , Bangladesh , Cartilagem , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Estribo , Resultado do Tratamento , Membrana Timpânica
20.
Mymensingh Med J ; 29(4): 859-864, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116088

RESUMO

With the advancement of age, the production, metabolism and action of thyroid hormone are also changed. The incidence of thyroid dysfunction is increased greatly with age. Aim of the study was to assess the age-related change in thyroid function status in elderly male in order to compare it with younger male. This analytical type of cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2019 to December 2019. A total number of 140 male subjects were included in this study. Among them seventy (70) younger male were taken as control group (Group I) and seventy (70) elderly male were taken as study group (Group II). For assessment of thyroid function, serum free tri-iodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) levels were estimated by RIA method. Data were expressed as mean (±SD) and statistical significance of difference among the group was calculated by unpaired student's t-test. Pearson's correlation coefficient test was done to find the correlation of serum FT3, FT4 & TSH with age. In this study we found that mean serum free tri-iodothyronine (FT3) & free thyroxine (FT4) levels were significantly lower and serum thyroid stimulating hormone (TSH) level was significantly higher in elderly male persons in comparison to younger male. Again, serum FT3, FT4 was negatively correlated with age of the subjects whereas serum TSH level was positively correlated with age of the subjects. Based on the study carried out it is concluded that there is a progressive decrease in thyroid function with advancement of age.


Assuntos
Testes de Função Tireóidea , Tireotropina , Idoso , Bangladesh , Estudos Transversais , Humanos , Masculino , Tiroxina , Tri-Iodotironina
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