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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
3.
Ann Glob Health ; 86(1): 129, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33102149

RESUMO

In August 2017, Bangladesh saw a massive influx of Rohingya refugees following their violent persecution by the Myanmar authorities. Since then, the district of Cox's Bazar has been home to nearly 900,000 Rohingya refugees living in the densely populated and unhygienic camps. The refugees have been living in makeshift settlements which are cramped into one another, making it extremely difficult to maintain "social distance". The overcrowded conditions coupled with the low literacy level, lack of basic sanitation facilities, face masks and gloves and limited communication make these camps an ideal place for the virus to spread rapidly. As nations struggle to contain the SARS-CoV-2 virus, refugees are one such population who are extremely vulnerable to the effects of this outbreak. If issues are not addressed at an early stage, its effects can be catastrophic.


Assuntos
Infecções por Coronavirus , Aglomeração , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções , Pandemias , Pneumonia Viral , Campos de Refugiados , Refugiados/estatística & dados numéricos , Bangladesh/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Acesso aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Mianmar/epidemiologia , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Campos de Refugiados/normas , Campos de Refugiados/provisão & distribução , Saneamento/normas
4.
J Glob Health ; 10(2): 020509, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33110592

RESUMO

Background: The COVID-19 pandemic has overwhelmed hospitals in several areas in high-income countries. An effective response to this pandemic requires health care workers (HCWs) to be present at work, particularly in low- and middle-income countries (LMICs) where they are already in critically low supply. To inform whether and to what degree policymakers in Bangladesh, and LMICs more broadly, should expect a drop in HCW attendance as COVID-19 continues to spread, this study aims to determine how HCW attendance has changed during the early stages of the COVID-19 pandemic in Bangladesh. Methods: This study analyzed daily fingerprint-verified attendance data from all 527 public-sector secondary and tertiary care facilities in Bangladesh to describe HCW attendance from January 26, 2019 to March 22, 2020, by cadre, hospital type, and geographic division. We then regressed HCW attendance onto fixed effects for day-of-week, month, and hospital, as well as indicators for each of three pandemic periods: a China-focused period (January 11, 2020 (first confirmed COVID-19 death in China) until January 29, 2020), international-spread period (January 30, 2020 (World Health Organization's declaration of a global emergency) until March 6, 2020), and local-spread period (March 7, 2020 (first confirmed COVID-19 case in Bangladesh) until the end of the study period). Findings: On average between January 26, 2019 and March 22, 2020, 34.1% of doctors, 64.6% of nurses, and 70.6% of other health care staff were present for their scheduled shift. HCWs' attendance rate increased with time in 2019 among all cadres. Nurses' attendance level dropped by 2.5% points (95% confidence interval (CI) = -3.2% to -1.8%) and 3.5% points (95% CI = -4.5% to -2.5%) during the international-spread and the local-spread periods of the COVID-19 pandemic, relative to the China-focused period. Similarly, the attendance level of other health care staff declined by 0.3% points (95% CI = -0.8% to 0.2%) and 2.3% points (95% CI = -3.0% to -1.6%) during the international-spread and local-spread periods, respectively. Among doctors, however, the international-spread and local-spread periods were associated with a statistically significant increase in attendance by 3.7% points (95% CI = 2.5% to 4.8%) and 4.9% points (95% CI = 3.5% to 6.4%), respectively. The reduction in attendance levels across all HCWs during the local-spread period was much greater at large hospitals, where the majority of COVID-19 testing and treatment took place, than that at small hospitals. Conclusions: After a year of significant improvements, HCWs' attendance levels among nurses and other health care staff (who form the majority of Bangladesh's health care workforce) have declined during the early stages of the COVID-19 pandemic. This finding may portend an even greater decrease in attendance if COVID-19 continues to spread in Bangladesh. Policymakers in Bangladesh and similar LMICs should undertake major efforts to achieve high attendance levels among HCWs, particularly nurses, such as by providing sufficient personal protective equipment as well as monetary and non-monetary incentives.


Assuntos
Infecções por Coronavirus , Mão de Obra em Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Pandemias , Pneumonia Viral , Atenção Secundária à Saúde/estatística & dados numéricos , Atenção Terciária à Saúde/estatística & dados numéricos , Adulto , Bangladesh/epidemiologia , Betacoronavirus , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Atenção Secundária à Saúde/organização & administração , Atenção Terciária à Saúde/organização & administração
5.
PLoS One ; 15(10): e0240709, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064771

RESUMO

At present nearly half of the world's population is under some form of government restriction to curb the spread of COVID-19, an extremely contagious disease. In Bangladesh, in the wake of five deaths and 48 infections from COVID-19, between March 24 and May 30, 2020, the government imposed a nationwide lockdown. While this lockdown restricted the spread of COVID-19, in the absence of effective support, it can generate severe food and nutrition insecurity for daily wage-based workers. Of the 61 million employed labor force in Bangladesh, nearly 35% of them are paid on a daily basis. This study examines the food security and welfare impacts of the COVID-19 induced lockdown on daily wage workers both in the farm and nonfarm sectors in Bangladesh. Using information from more than 50,000 respondents complied with the 2016-17 Household Income and Expenditure Survey (HIES) in Bangladesh, this study estimates daily wage rates as Bangladesh Taka (BDT) 272.2 in the farm sector and BDT 361.5 in the nonfarm sector. Using the estimated daily wage earnings, this study estimates that a one-day complete lockdown generates a US$64.2 million equivalent economic loss only considering the wage loss of the daily wage workers. After estimating the daily per capita food expenditure separately for farm and nonfarm households, this study estimates a minimum compensation package for the daily wage-based farm and nonfarm households around the US $ 1 per day per household to ensure minimum food security for the daily wage-based worker households.


Assuntos
Betacoronavirus , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Abastecimento de Alimentos , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Política Pública/economia , Quarentena/economia , Populações Vulneráveis , Adulto , Bangladesh/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Características da Família , Fazendas , Feminino , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , Pobreza , Quarentena/métodos , Salários e Benefícios , Inquéritos e Questionários , Desemprego
6.
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
7.
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
8.
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
9.
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
10.
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
11.
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
12.
Mymensingh Med J ; 29(4): 879-886, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116091

RESUMO

Visceral Leishmaniasis is the most severe form of leishmaniasis and can be fatal in the absence of treatment. Mortality is very high in untreated cases 90%. Clinical case series document a 5% case fatality rate for kala-azar patients in the hospital as complication of the disease. Nepal, India, Bangladesh, Brazil and Sudan constitute five countries of the world where more than 90% of visceral leishmaniasis occurs. Mymensingh accounted for more than 50% of total kala-azar case reported in Bangladesh. This observational study was done at SKKRC under Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 1st august 2013 to 28th February 2014, to find out various clinical features and hematological picture in visceral leishmaniasis. Total 100 diagnosed case of visceral leishmaniasis was taken. Among total patient male and female were nearly equally affected by kala-azar. All age group were affected by kala-azar from below 2 years to above 50 years. Poor people in the society were affected more by kala-azar. Mymensingh was the highest incidence of kala-azar among different district in Bangladesh. Pyrexia, pallor, weight loss were the main symptoms of visceral leishmaniasis. Abdominal distension, jaundice, vomiting, cough, bleeding manifestation were less frequent symptoms of kala-azar. Hepatosplenomegaly were the frequent sign of kala-azar. Majority of patient had anemia, leucopenia and thrombocytopenia. ESR was frequently raised in kala-azar patient among those patient many had high ESR more than 100 mm in 1st hour. In conclusion prolong fever, progressive pallor, anorexia, weight loss, hepatosplenomegaly in endemic area were the main clinical features of visceral leishmaniasis. Anemia, leucopenia, thrombocytopenia, bi-cytopenia, pancytopenia and high ESR were frequently found hematological pictures in visceral leishmaniasis.


Assuntos
Leishmaniose Visceral , Bangladesh/epidemiologia , Feminino , Humanos , Índia , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/epidemiologia , Masculino , Nepal/epidemiologia , Esplenomegalia
13.
Mymensingh Med J ; 29(4): 887-894, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116092

RESUMO

The aim of this prospective study was to evaluate the role and application of laparoscopy in the management of acute appendicitis and its complications. The study was conducted between January 2011 to February 2019 in Bangabandhu Sheikh Mujib Medical University (BSMMU) and some private hospitals of Dhaka, Bangladesh. A total of 641 patients who presented with acute appendicitis and its complications were treated by laparoscopic method. Around 70% (449) patients had classical presentation, 20% (128) were atypical and 10% (64) were recurrent or chronic presentation. Maximum (527, 82%) came with acute appendicitis. Eighty eight (13.72%) patients had burst (perforated) appendicitis, 12(1.87%) patients had appendicular abscess, 11(1.71%) showed early appendicular lump, 2(0.4%) had stump appendicitis and 1(0.2%) had previous laparoscopic clip control of stump. Energy source was unipolar diathermy. Intracorporeal knotting, endoloop and haemoclip were used for haemostosis and ligation of appendicular stump. Mean duration of surgery was 20minutes and mean hospital stay was 36 hours. Histopathological patterns were acute appendicitis (554, 86.42%), gangrenous appendicitis (58, 9.04%), catarrhal (13, 2.02%), chronic appendicitis (10, 1.56%) lymphoid hyperplasia (6, 0.93%) and carcinoid tumor (1, 0.15%), among the complications (25) were single or multiple port infections, port TB, paralytic ileus and diarrhea. Conversion was 1(0.15%) for controlling haemorrhage of burst appendicitis. The rest of the patients recovered quickly and uneventfully. In conclusion, it can be stated that laparoscopic appendicectomy is safe, convenient and achievable and can become the gold standard of management of acute appendicitis and its complications.


Assuntos
Apendicite , Laparoscopia , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Bangladesh/epidemiologia , Humanos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
14.
Mymensingh Med J ; 29(4): 895-900, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116093

RESUMO

This cross-sectional study was conducted to determine the prevalence of AmpC beta-lactamase enzyme producing Escherichia coli and Klebsiella species in a tertiary care hospital of Bangladesh, as well as to observe the patterns of antibiotic resistance and AmpC beta-lactamase resistance genes among them. This study was conducted in the Department of Microbiology of Dhaka Medical College, Dhaka, Bangladesh from January 2015 to December 2015. Total 166 Escherichia coli, Klebsiella pneumoniae and Klebsiella oxytoca were isolated from urine, wound swab, pus, sputum and blood samples of patients of Dhaka Medical College Hospital. Antibiotic susceptibility test was performed by disk-diffusion technique. AmpC beta-lactamase producers were detected phenotypically by Modified three-dimensional test (MTDT). AmpC beta-lactamase genes (DHA, ACC, EBC, CIT, MOX, FOX) among the cefoxitin resistant Escherichia coli and Klebsiella species were detected by polymerase chain reaction (PCR). Sixty seven cefoxitin resistant Escherichia coli, Klebsiella pneumoniae and Klebsiella oxytoca were isolated during disk-diffusion technique. Among the 67 cefoxitin resistant strains, 30(44.78%) AmpC beta-lactamase producers were detected by MTDT and 59(88.06%) were detected by PCR. The dominant genotype found was CIT (62.69%) followed by DHA (53.73%). The results of this study showed high proportion of AmpC beta- lactamase enzyme producing Escherichia coli and Klebsiella species in Bangladesh. Regular surveillance of antibiotic resistance should be done in every tertiary care hospital to prevent spread of these strains.


Assuntos
Escherichia coli , Klebsiella , Antibacterianos/farmacologia , Proteínas de Bactérias , Bangladesh/epidemiologia , Estudos Transversais , Escherichia coli/genética , Humanos , Klebsiella/genética , Testes de Sensibilidade Microbiana , Centros de Atenção Terciária , beta-Lactamases/genética
15.
Mymensingh Med J ; 29(4): 906-913, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116095

RESUMO

Coronary artery disease (CAD) is the leading cause of mortality and morbidity both in developed and developing countries. The body mass index (BMI), waist hip ratio (WHR) and waist height ratio (WHtR) are some of the clinical tools enabling clinicians to assess obesity. Although for decades there have been controversy regarding the relationship between obesity and CAD; it has been assumed that high BMI is a risk factor for CAD. However, the findings of some recent studies were paradoxical. The aim of this study was to identify the best tool among BMI, WHtR and WHR to evaluate angiographically severe CAD in myocardial infarction patients. This was a cross-sectional analytical study carried out in the Department of Cardiology, Chattogram Medical College and Hospital (CMCH), Chattogram, Bangladesh from January 2017 to December 2017. Three hundred and thirty two consecutive MI patients undergoing CAG during the study period were included in the study as per inclusion and exclusion criteria. Severity of CAD was calculated by using Gensini score. Patients were categorized and compared according to anthropometric indices and CAD severity. The mean±SD of the age of study population was 53.62±10.36 years (range 25-92) and 276(83.1%) were male. Regarding cardiovascular risk factors, 113(34%) patients had diabetes mellitus, 108(32.5%) had dyslipidaemia, 137(41.3%) had hypertension, 205(61.7%) were current or ex-smokers and 59(17.8%) had a family history of CAD. The mean±SD of the patients' BMI was 24.05±3.24kg/m² (range 16.14-32.72), mean±SD of their WHR was 0.964±0.052 (range 0.823-1.125) and mean±SD of their WHtR was 0.546±0.059 (range 0.389-0.748). The mean±SD of the severity of CAD according to the Gensini score was 41.11±28.66 (ranged from 2 to 244). Study findings showed a positive correlation between the severity of CAD with WHtR and WHR but not with BMI, according to Gensini scores (p=0.004, p=0.023 and p=0.43 respectively). Receiver Operating Characteristics (ROC) curve analysis revealed that waist height ratio had the highest area under the curve (AUC) among the three anthropometric parameters for predicting presence of severe CAD. Study showed the superiority of WHtR over WHR and BMI for predicting angiographic severity of CAD in patients with MI. WHtR should therefore be considered as a screening tool.


Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio , Bangladesh/epidemiologia , Estatura , Índice de Massa Corporal , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Estudos Transversais , Humanos , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Fatores de Risco , Razão Cintura-Estatura , Relação Cintura-Quadril
16.
Mymensingh Med J ; 29(4): 920-925, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116097

RESUMO

Infections are well recognized cause of morbidity and mortality in people with diabetes. This study was done to observe the pattern of infections and microorganism with sensitivity pattern in patients with diabetes admitted at a specialized referral hospital in Dhaka. This cross-sectional study was carried out in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka from March 2014 to April 2015. It included 309 patients of diabetes (male-169, female-140; age mean±SD- 49.3±14.7 years) admitted in medicine or endocrinology department, who were screened for clinical evidence of infections according to revised McGeer criteria. Culture and sensitivity pattern of responsible microorganisms were sought from clinically appropriate specimen. Among the participants 25.9% (80 out of 309) had evidence of infection. The most common of them were urinary tract infection (53.8%) and respiratory tract infection (30.0%). E. coli and Klebsiella were the most common organisms that were isolated by urine (55.3% and 13.2%) and blood culture (57.1% and 42.9%). Acinetobacter was the most common pathogen in tracheal aspirate (80%) and Klebsiella in sputum (100%). Culture of wound swab exclusively revealed growth of Staphylococcus. E. coli was fairly sensitive to meropenem (100%), amikacin (93.5%) and nitrofurantoin (93.1%), while sensitivity of Klebsiella was almost similar to that of E. coli. Acinetobacter was fully resistant to ceftazidime, nitrofurantoin and meropenem while only modestly sensitive to ciprofloxacin and amikacin (25% and 20% respectively). Pseudomonas was 100% sensitive to ceftazidime, amikacin and meropenem, but 100% resistant to ciprofloxacin and nitrofurantoin. One in four admitted diabetes patient had evidence of infection, most commonly involving urinary and respiratory tracts. E. coli and Klebsiella both fairly sensitive to common antibiotics, were common isolates from urine and blood culture; whereas Acinetobacter isolated from tracheal aspirates and urine, was only modestly sensitive.


Assuntos
Diabetes Mellitus , Infecções Urinárias , Antibacterianos/uso terapêutico , Bangladesh/epidemiologia , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Escherichia coli , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Centros de Atenção Terciária , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia
17.
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
18.
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
19.
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
20.
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
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