The Planet

Rational Use of Antimicrobials to Preserve Sensitivity

Thu, 10 Aug 2023 00:00:00 -0400

Introduction: Antibiotic resistance has increaseddramatically over the past 10 years. Antibiotics arecommonly prescribed, leading to frequent overuse, whichposes a risk of developing resistance and escalatingexpenses. Rational drug prescribing is essential forminimizing healthcare costs and for reducing resistance.This study aimed to assess the rational use ofantimicrobials to preserve their sensitivity. Methods andMaterials: This prospective study was conducted at theCritical Care Department in Bangladesh Shishu Hospital.The study duration was 1 year; from January 2021 toJanuary 2022. The blood samples were taken for asensitivity test. Necessary data were collected from theparents of the children by a pre-designed data collectionsheet. Confidentiality of all data was maintained, and itsutilization was solely confined to the purpose of this study. Result: Concerning thedistribution of respondents according to sensitivity to antimicrobial agents, all patients100.0% were resistant to amoxicillin, 49.0% were resistant, and 3.0% patients were sensitiveto piperacillin, 27.0% were sensitive and 12.5% were resistant to ceftriaxone, 32.5% patientswere resistant and 25.0% patients were sensitive to chloramphenicol. The tendency of selfmedication was 40.0% of the total study population, followed by lack of public knowledgeand awareness in 35.0% of patients, and access to antibiotics without prescription in 25.0%of patients. Conclusion: This study concluded that antimicrobial resistance was most prevalent in patients with low socio-economic status. Furthermore, to preserve the sensitivity ofantimicrobials, rational use of antimicrobials should be ensured by addressing public knowledge andawareness, preventing access to antibiotics without prescription, and stopping the practice of selfmedication.

Diaphragm Thickening Fraction Measurement in Successful Weaning from Mechanical Ventilation

Thu, 10 Aug 2023 00:00:00 -0400

Background: Among the most common problems inmodern intensive care units is having trouble getting off ofartificial ventilation. The diaphragm is a key muscle forbreathing, and problems with it may be very common inpeople who need motorized ventilation. Long-termmechanical breathing and inability to wean are linked todiaphragm dysfunction. Objectives: The goal of thisresearch was to establish whether or not a higherdiaphragm thickening fraction is a reliable indicator of asmooth transition away from mechanical ventilation.Methods: This observational study was performed among89 critically ill patients on mechanical ventilation for 48hours who planned for weaning in the ICU at theDepartment of Anaesthesia, Analgesia, Palliative andIntensive Care Medicine, Dhaka Medical College Hospital,in Dhaka. The patients were all critically sick and had been on mechanical ventilation for atleast 48 hours. Results: DTF >30% was discovered in 38 (95.0%) patients in the successfulweaning group, while DTF 30% was detected in 46 (93.8%) patients in the failed weaninggroup, according to ultrasound findings of the diaphragm. Predicting weaning success with aDTF>30% had a sensitivity of 95.0% and a specificity of 93.8%. Likewise, its positive predictive value was 92.6% and its negative predictive value was 95.8%. Furthermore, thepercentage of accuracy was 94.3%. Conclusion: The results of the current experimentshowed that DTF was an efficient measure for successfully weaning patients off ofmechanical breathing

Assessment of Risk Factors for Distant Metastases of Breast Cancer

Thu, 10 Aug 2023 00:00:00 -0400

Background: Breast cancer is the most prevalent canceramong Bangladeshi women (27.4%) and the second mostcommon among both sexes (12.5%). Late-stage illnesswith distant metastases in low-income communities has apoor prognosis. Objective: The purpose of this researchwas to identify potential causes of distant metastases.Materials and Methods: This case control study was donefrom July 2017 to June, 2018 in National Institute ofCancer Research and Hospital (NICRH), Mohakhali,Dhaka. Results: In the case group, about 25% involvedlymph node numbers > 5, whereas in the control group itwas nearly 13%; the p-value was 0.035 (<0.05).Theprimary tumor involved the underlying blood vessel in35.7% of participants in the case group and only 15.5% ofparticipants in the control group; the p-value was 0.05(i.e., 0.029). Primary tumors of stages III and IV were present in 54.7% of patients in thecase group and only 22.6% of patients in the control group. On the other hand, I was more inthe control (28.5%) group than the case group (11.9%). Positive surgical margin (p = 0.034,OR = 4.8; 95% CI: 1.126–20.460); positive lymph node > 5 (p = 0.007, OR = 4.11; 95% CI:1.48–11.41); involvement of vessels (p = 0.016, OR = 2.99; 95% CI: 1.227–7.317); stage ofprimary tumor (p = 0.002, OR = 5.81; 95% CI: 1.85–18.15). Conclusion: The highernumber of affected lymph nodes (>5), involvement of underlying vessels, positive surgicalmargin and higher stage (stage III & IV) at diagnosis are statistically significant risk factors for distance metastases of breast cancer.

Comparison of LVEF between Acute Anterior and Inferior Wall MI and its Impact on Early Hospital Outcome

Thu, 10 Aug 2023 00:00:00 -0400

Objective: In this study, our main goal is to evaluate andcomparethe LVEF of acute anterior & inferior wall MI &their early hospital outcome. Method: From April 1, 2022,through March 31, 2023, researchers from the cardiologydepartment at MMCH in Mymensingh, Bangladesh,conducted a cross-sectional study. This was a researchwhere 120 hospitalized individuals with AMI may takepart. The fourth global definition of myocardial infarctionwas used to establish the criteria for diagnosing an AMI. Atotal of 60 patients were included in the study: 20 withanterior MI (n=23 with complications) and 40 with inferiorMI (n=16 with complications; n=44 withoutcomplications). Results: Patients older than 50 made upthe bulk of the sample in this study, with malepredominance in both groups, Moreover, the prevalencetobacco use, type 2 diabetes, high blood pressure, abnormal lipid profiles, and BMI are morecommon incomplicated groups. Reduced LVEF and LV failure was found more in AnteriorMI, (35%)& (30%) whereas in inferior MI it was seen in (25%)& ( 16.67%) respectively. Butmechanical complication (Ischemic MR) was seen more in Inferior MI (25%) than Anterior MI (18.33%) similarly Arrhythmia was found higher in inferior the MI group (20% )thananterior MI group ( 5%). No death case was noticed between the two groups. Conclusion:Based on our results, we can say that LVEF is more affected in superior MI in the front to MIin the back and so Left ventricular failure as a complication of MI is more prevalent in acuteanterior MI, whereas mechanical complication (Ischemic MR) & arrhythmia was seen morein Inferior MI.

Assessment of the Risk Factors Related to Seborrheic Dermatitis and Treatment Methods

Thu, 10 Aug 2023 00:00:00 -0400

Background: Common in clinical practice is a skindisorder known as seborrheic dermatitis (SD). There areseveral different names for this disorder, which illustratesits complexity: sebopsoriasis, seborrheic dermatitis,seborrheic eczema, dandruff, and pityriasis capitis. Thepathogenesis of SD is still highly debated despite thedisease's prevalence. Objective: The primary objective ofthis research was to evaluate the prevalence of andexposure to risk factors for seborrheic dermatitis inBangladesh. Methods: A total of 300 patients wereincluded in the cross-sectional study that was carried outat the 250-bed general hospital in Jamalpur, Bangladesh.The research was carried out between January 2020 andDecember 2021. Results: In our investigation, maximumpatients (21.3%) were between 20 to 29 years of agegroup. Minimum number of patients (5.7%) were below 20 years of age group. 62%patients were male and 38% patients were female. Among them (40%) are child and (60%)are adult.Maximum patients involved sites (60%) of seborrheic dermatitis were scalp. 20%patients had seborrheic dermatitis in anterior hairline.15% had seborrheic dermatitis incentral chest. And only 5% patients had dermatitis on other sites (eyebrows,genitalregion,glabella region of forehead,ears,nasal alar creases).Maximum munber of patientshad concurrernt acne(30%) and minimum number of patients (8%) had folliculitis in ourstudy. Conclusion: SD patients have different clinical features depending on their age, sex or medical history, which can lead to severity changes or scalp involvement in the clinicalsetting.

The Effect of Thumb Spica Splint in Management of De Quervain's Disease

Thu, 10 Aug 2023 00:00:00 -0400

Background: De Quervain's disease is characterized bypain in the wrist and hand, and it is brought on by theentrapment of the tendons of the extensor pollicis brevisand abductor pollicis longus in the first dorsalcompartment of the wrist. Immobilization, heat and coldtherapy, an electrical nerve stimulator, a thumb stabilizersplint, posture correction, and tool and equipmentadjustments are all examples of non-pharmaceuticaltreatments. Objective: To see the impact of Spica SplintTreatment on De Quervain's Disease Management.Materials and Methods: A clinical trial with 60 adultpatients diagnosed with De Quervain's disease wasconducted for six months at DMCH's Physical Medicineand Rehabilitation outpatient department. Both groupswere told to follow ADL instructions for the affected hand.Results were assessed using VAS and PRWE scales. Patients were evaluated weekly for 6weeks. Significance levels were evaluated using paired t-tests and chi-square tests as needed.Results: argest age range was 41–45 (36.67%), followed by 46–50 (33.33%), with a meanage of 41.775.43 years. More women than men by a factor of 1: 7.6. 53% had the disease in their right hand, 42% in their left, and 5% in both. Both groups had similar VAS and PRWEscores before treatment. The two patient groups had noteworthy mean changes in all threefollow-ups (p=<0.001). Thumb splint helped 36.67% of patients with pain. Conclusion: Athumb spica splint, combined with standard treatments, reduces morbidity and relieves painin de Quervain's tenosynovitis patients, as per study.

The Effect of Phonophoresis and Therapeutic Exercise in the Treatment of Adhesive Capsulitis

Thu, 10 Aug 2023 00:00:00 -0400

Background: Adhesive capsulitis is a painful condition thatcan be treated with shock waves, phonophoresis, physicaltherapy, oral corticosteroids, and anesthetic manipulation.Aim: The purpose of this research is to determine the effectof phonophoresis and therapeutic exercise in the treatmentof adhesive capsulitis. Method and Materials: Thisrandomized clinical trial Study conducted in DhakaMedical College Hospital for six months. 74 eligiblePatients with adhesive capsulitis attending the rehabdepartment were studied and selected as a sample size.This patients received Diclophenac gel was pulsed at 1 MHzand 1.5 W/cm2 over the joint for 5 mins, 5 times a week for4 weeks. NSAIDs, omeprazole, and exercise were commontreatments. An evaluation made at first, second, and sixthweek. Two follow-up visits, same investigator. Pain anddisability were measured using VAS, ROM, and DASH in each visit. Result: Flexion started at102.160, rose to 113.920 (2nd week), then 126.930 (6th week). Abduction started at 85.700,increased to 108.240 (2nd week), and peaked at 125.410 (6th week). Initially, internal rotationwas 41.270, then increased to 45.920 (2nd week) and 50.410 (6th week). External rotationincreased from 44.380 to 55.840 in 4 weeks. VAS score decreased from 7.590 to 5.380 (2nd week) and 3.680 (6th week). Phonophoresisworks better for reducing pain in earlyadhesive capsulitis. DASH score droppedfrom 67.140 to 31.170 over 6 weeks.Conclusion: Phonophoresis and exerciseare essential for reducing adhesivecapsulitis symptoms, avoiding permanentdeformity, and achieving better results.

Perioperative Outcomes of the Patients with Obstructive Sleep Apnoea

Samar Chandra Saha, Shariful Islam Seraji — Thu, 10 Aug 2023 00:00:00 -0400

Background: Obstructive sleep apnea (OSA) is a chronicmedical disorder that causes the upper airway to becomepartially or completely blocked while the patient is sleeping.This syndrome is associated with high rates of death andincreases the risks faced by patients during surgery.Objective: The study aims to observe the perioperativeoutcomes of the patients with obstructive sleep apnoea.Method: The present cross-sectional investigation wascarried out over a four-year period, spanning fromFebruary 2019 to February 2023, at the Department ofAnaesthesiology located at the Holy Family Red CrescentMedical College & Hospital in Dhaka, Bangladesh. Thesample size for this study was intentionally chosen to consistof 200 cases. Results: In our study, maximum patients (43%)were between 30 to 40 years age group and minimumpatients (4.5%) were more than 60 years old. Maximum patients (54%) were female patientsand minimum patients (46%) were male patients. Maximum patients (35.5%) had sleepinessand minimum patients (8.5%) had personality change. Maximum patients (49%) usedsevoflurane and minimum patients (6%) used isoflurane in our study. Maximum (46%)anesthetists had more than 20 years’ experience and minimum (5%) anesthetists had 6 to 10years’ experience. Conclusion: There is a need for updating the medical knowledge pertainingto OSA. It is recommended that a pragmatic manual be developed to assist medicalpractitioners in identifying individuals with obstructive sleep apnea (OSA) and to establish auniform approach to preoperative and perioperative care.

Postoperative Hypotension and Adverse Clinical Outcomes in Patients without Intraoperative Hypotension during noncardiac surgery

Thu, 10 Aug 2023 00:00:00 -0400

Background: The incidence of postoperative hypotension(POH) is linked to serious complications. Postoperativepatients in the general-care unit who did not experienceIOH had a lower threshold for blood pressure monitoring,although the relationship between this threshold andoutcomes is poorly understood. Objective: To determinewhether or not postoperative hypotension is linked toserious clinical complications in those whose bloodpressure didn't drop while they were having surgery.Method: The location of this cross-sectional study, whichtook place between January 2020 and January 2023, wasthe Department of Anaesthesiology at the Holy Family RedCrescent Medical College Hospital in Dhaka, Bangladesh.This study was carried out between the years of 2020 and2023. The inquiry called for a sample size of 200participants, and that number was intentionally chosen. Results: In our study, 34% werebetween 50 to 59 years age group and 3.5% were more than 80 years old. Maximum patients(54%) were female patients and minimum patients (46%) were male patients. Maximumpatients (32%) had undergone a open reduction of fracture surgery and the minimum numberof patients (5%) had undergone colon surgery. Maximum patients had hypertension (51.75%)and diabetes (36.25%). And a minimum number of patients (4.5%) had myocardial infarction.Conclusion: Patient and surgical variables, such as age and kind of operation, have beenshown to affect the association between IOH and bad result in clinical practice.

A Study of Hanging Cases in a Tertiary Hospital

Kishoara Binte Quader, Nazmun Nahar Nahida, Borhan Uddin Ahamed, Anjan Kumar Das — Thu, 10 Aug 2023 00:00:00 -0400

Background: When a person commits suicide by hangingthemselves, they suffer death similar to that caused bysevere hypoxia caused by the ligature material tighteningaround the neck structures and cutting off ventilation to thelungs. Objective: To evaluate the prevalence and causes ofHanging Cases in Sylhet Osmani Medical College Hospital.Method: A study on hanging victims at Sylhet OsmaniMedical College from July 2015 to July 2017 was conductedretrospectively. The inquest report accompanying the deadbodies gathered data on 60 victims, including incidencelocations, times, causes of death, suspension type, andrelated information from attendants. Results: Mostparticipants were aged 21-30 and 66.67% were female. 35%of hangings were caused by marital discord. Dopatta wasthe top choice (50%) for ligature, with jute rope (18.3%)and shari (10%) following close behind. There were 43% on the right side, 40% on the left,10% towards the back of the neck, and 7% under the chin.. Neck injuries were observed inmost cases, including stretching and elongation in 70%, skin hemorrhage in 50%, and musclehemorrhage in 40%. In 36.67 % of the patients, the platysma and sternocledo mastoid musclesruptured. The majority of participants were right-handed. 50% of cases had a solitary ligaturemark, while 33.33% had a double mark, and 10% had a barely visible one. Conclusion:Younger women were found to be more prone to suicide by hanging. It's the top cause ofrelationship turmoil. Most were right-necked and right-handed. Usually, patients have just oneligature mark. We require extensive research across multiple centers to ascertain our true stance.