Bangladesh Medical Research Council Bulletin (Vol. 49, No. 01, 2023)

Abstract

Background: Respiratory tract infections (RTIs) are significant health concern for mortality and morbidity in many developing countries. Proper identification of causative pathogens and their antibiotic susceptibility testing is needed to select appropriate antibiotic therapy for management of the patient suffering from RTI. The study was aimed to determine the spectrum of bacterial pathogen causing respiratory tract infections with their antibiogram in Dhaka Medical College hospital (DMCH), Dhaka, Bangladesh.

Methods: This observational study was conducted from October 2018 to March 2019 in DMCH. Respiratory tract specimens (sputum, tracheal aspirate and throat swab) sent to the Microbiology laboratory for culture and sensitivity test were included in this study. Data regarding information of the patients, isolated organisms and sensitivity reports were collected from the records of the Microbiology laboratory.

Results: Out of 580 processed specimens, 64.66% yielded significant growth of organisms of which 88.80% were gram negative and 11.20% were gram positive bacteria. Pseudomonas spp was the most commonly (31.47%) isolated organism followed by Klebsiella spp (23.47%), Escherichia coli (15.20%) and Staphylococcus aureus (8.53%). Gram negative bacteria were mostly resistant to amoxicillin followed by fluoroquinolones, co-trimoxazole, cephalosporins whereas colistin, carbapenems and piperacillin/tazobactum were the most sensitive antibiotics against them. Among gram negative bacteria, 31.23% were extended spectrum beta lactamase (ESBL) producing organisms and Klebsiella spp were the most commonly isolated ESBL producers. Majority of gram positive bacteria were resistant to fluoroquinolones and co-trimoxazole but all Staphylococcus aureus were susceptible to vancomycin and linezolid followed by teicoplanin (84%) and 37.5% of them were Methicillin resistant (MRSA).

Conclusion: Gram negative bacteria were predominant where Pseudomonas spp and Klebsiella spp were most commonly isolated organisms. Most of the bacteria showed high resistance to commonly used antibiotics and this antimicrobial resistance is a matter of concern for the treatment of respiratory tract infections.

Keywords: Antibiotic susceptibility, ESBL RTI, Bangladesh.

Abstract

Background: An association of multisystem inflammatory syndrome in children (MIS-C) with SARS-CoV-2 infection is now a well-established serious phenomenon and been increasingly reported from different countries.

Objectives: The present study documents the presentation, management and immediate outcome of MIS-C patients from Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh.

Study design: This was a retrospective study.

Methods: This retrospective study was conducted in the department of pediatrics, BSMMU, Dhaka, Bangladesh. It included all the eligible MIS-C patients diagnosed during the study period (August 2020 to February 2022). Sixty cases fulfilled the diagnostic criteria and they had been included in the study. Data were collected using a pre- designed and pre-tested questionnare from hospital records and also by interviewing the patients/parents over telephone when required.

Results: Mean age of the children was 6.8year with F: M ratio of 1.2:1. All the sixty cases presented with fever associated with gastro-intestinal complications in 68% followed by other symptoms. Fifty two cases (87%) had known contacts. Laboratory evidence ofSARS-CoV-2 infection was present in 55% cases having positive serology or RT-PCR. Twelve patients (20%) had pre-existing co- morbidities. Majority of patients (48%) presented with Kawasaki Disease (KD) like illness. Mean neutrophil count, ESR, CRP, ferritin, LDH and D-dimer were higher and mean platelet and lymphocyte count were lower in this series. Interleukin-6 (IL-6) level was raised in all the seventeen (28%) patients, who were tested. Sixteen patients (27%) had chest X-ray abnormalities and ten of them had HRCT involvement. Fifteen (25%) patients had abnormalities in abdominal ultrasonogram. Coronary artery dilatation and ventricular dysfunction was present in seventeen (28%) and thirteen (22%) of MIS-C cases.

IVIG and intravenous steroid was used in forty one (68%) and thirty nine (65%) children. Aspirin was given to twenty eight (47%) cases. Inotropic support was needed in 17% cases. Antibiotics were prescribed to all the patients. Fifty seven percent and 37% children were discharged without and with complications respectively. Mechanical ventilation was required in 6.6 % children who had pre-existing co-morbidities and all of them expired.

Conclusion: Forty eight percent of MIS-C cases presented with KD like illness. Mortality was 6.6% and all the cases had preexisting comorbidities. MIS-C is a pediatric emergency and is of a great concern especially in children with pre-existing co-morbidities. Early diagnosis and referral to tertiary center for optimum management is essential.

Keywords: ACR,CDC, COVID-19, MIS-C, KD like illness, Severe MIS-C.

Abstract

Background: De Querveins' tenosynovitis affects the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment of the wrist. Corticosteroid injection is the mainstay of treatment for those patients who do not respond to conservative management. Platelet-rich plasma (PRP) is a currently used strategy in the clinical practice to provide a regenerative stimulus for tendon healing.

Objective: To evaluate the effects of Platelet-rich plasma in the treatment of DQVD in comparison with corticosteroid (CS) injection.

Materials and Methods: The present randomized clinical trial had been conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka. A total of 100 patients with pain and swelling over the radial aspect of the wrist with positive Finkelstein test were randomly allocated into three groups: group A (received platelet-rich plasma injection), group B (received corticosteroid injection) and group C (received conservative management). The severity of pain and functional status of the wrist joint were recorded according to VAS and Mayo’s wrist score both pre-procedurally on day 0 and post-procedurally at the end of 1^st, 3^rd and 6^th month.

Results: The mean age of the participants in group A, B and C were 45.6 (±10.4), 46.9 (±11.3) and 42.4 (±6.3) years respectively. In all groups, majority of the study participants were female and housewives. No significant statistical difference was observed among the groups regarding VAS scores and Mayo’s Wrist Scores at baseline. At the end of 6 months, the reduction of pain in group A was significantly lower than group B (p<0.001). Again, at the end of 6 months, the improvement of Mayo’s Wrist Scores in group A group was significantly higher than group B (p<0.001). In group A, 77.8% reduction of pain score was achieved while in group B, 68.4% reduction of pain score was achieved after 6 month of treatment (p<0.001).

Conclusions: Platelet-rich plasma provides better functional outcome than corticosteroid in the treatment of de Quervain tenosynovitis.

Keywords: de Quervain’s Tenosynovitis, Corticosteroid injection, Platelet-rich Plasma.

Abstract

Background: Breakfast is acommonly skipped meal especially for young adult during their university study period.

Objective: This study aimed to determine the factors related to skipping breakfast among medical students in this study.

Methods: This cross-sectional study was conducted among the 4th year medical students of Sher-e-Bangla Medical College, Barishal in January 2022 using a self-administered questionnaire recording the demography, breakfast consumption habits, and other factors like physical condition, appetite, sleep quality, social relation with others and learning.

Results: A good proportion of the students (63.3%, 95% CI: 56.18-70.38%) skip breakfast. Waking up late (OR-11), sleeping late (OR-7), and staying in hostels (OR- 8) were the important factors significantly associated (p<0.05) with break­fast skipping.

Conclusions: Breakfast skipping behavior is high among undergraduate medical students. The students should be encouraged to eat regular breakfast through health promotion campaigns.

Keywords: Breakfast skipping, medical students, hostel staying, late sleeping, late waking up.

Abstract

Background: Vaccination against COVID-19 is paramount to protect the sanitation and waste workers of Bangladesh during this pandemic as they work in a variety of hazardous conditions. To avail the successful coverage it is also essential to identify the factors regarding facilitating the process including their willingness for COVID-19 vaccination.

Objective: This study was aimed to explore the factors related to willingness for COVID-19 vaccination among this worker group.

Methods: A cross-sectional study with a mixed-method approach was conducted among 800 sanitation and waste workers and 20 administrative authorities from the sanitation and waste management department of Dhaka city. Quantitative data was collected from the sanitation and waste workers of both North and South City Corporations of Dhaka and qualitative information was gathered from the respective administrative authorities. Logistic regression analysis and Chi-square test were used for the quantitative analysis, while the thematic analysis was used to extract results from qualitative data.

Results: Although, most authorities were found to be knowledgeable, while workers had poor knowledge and misconceptions about COVID-19 vaccination. Majority workers (94.6%) had willingness to be vaccinated, owing to the effective implementation of the COVID-19 vaccine policy of Bangladesh government such as various motivational programs, assistance in vaccine registration process, establishment of special vaccine administration etc. Willingness towards vaccination found significant among the workers who were married (AOR=2.93), had more than two children (AOR=2.97), had monthly family income more than 30,000/- BDT (AOR=4.94), consumed smokeless tobacco (AOR=2.77) and who got all the necessary personal protective equipment available in their job (AOR=2.60).

Conclusion: This study reflected the incredible success in willingness to vaccinate against COVID-19 among sanitation workers of Bangladesh. It is important to develop and implement action plan at policy level to protect the vulnerable groups through various relevant programs that would ensure the full coverage of vaccination across the country.

Keywords: Willingness to vaccinate, COVID-19, vaccination, Bangladeshi sanitation and waste workers, workplace setting, vaccination coverage.

Abstract

Background: The coronavirus disease 2019 (COVID-19) is a threat to human health. The World Health Organization (WHO) stated it as a Public Health Emergency. It affects the respiratory system and may cause pneumonia.

Objective: The aim of this study was to find out the effects of pulmonary rehabilitation (PR) on patients with COVID-19.

Methods: A total of 155 patients with COVID-19 were included and divided into two groups in this randomized clinical trial. The intervention group was treated with standard treatment along with PR and the control group was treated with standard treatment only. Evidence of improvement was assessed weekly for four weeks. The student’s ‘t’ test and Chi-square test were done to observe the level of significance as required.

Results: There was an improvement of symptoms in both groups after treatment. But in comparison between groups, there was more improvement found in PR receiving group than the control group. Finally, O₂ requirement was same in both groups. Peripheral oxygen saturation was increased in the PR group than the control group after treatment. More improvement of dyspnea was found after treatment in PR group. Significant improvement in breathing was found after treatment in PR receiving patients than in the control group.

Conclusions: PR receiving patients showed more improvement in this study. So, PR may be advocated to improve the symptoms of COVID-19.

Keywords: Pulmonary Rehabilitation (PR), Dyspnea, COVID-19.

Abstract

Background: In Bangladesh, in 2020 estimated number of new cancer cases were 156775 and number of deaths were 108990. Carcinoma pharynx and larynx in 2020 were 7.86% and 3.4% of total new cancer cases, 5.71% and 3% of total cancer deaths. Fiber optic laryngoscopy (FOL) has been established as a valuable diagnostic tool and its accuracy is 80.65%.

Objectives: The primary objective of this study was to see the topographic and histological distribution of pharyngeal and laryngeal cancers and secondary objective was to assess the role of Flexible Endoscopic Biopsy (FEB) in the diagnosis of cancers.

Methods: This descriptive cross-sectional study was done from March 2021 to October 2022 at Mount Adora Hospital, Akhalia, Sylhet, Bangladesh. All suspected pharyngeal and laryngeal cancer patients attending in this hospital for FOL and FEB were included in this study in a convenient sampling method. Benign, recurrence and residual cases were excluded from this study.

Results: Total 700 patients of suspected pharyngeal and laryngeal cancer underwent FOL. FEB was taken from 92.6% cases. Histopathological examination of biopsy specimens revealed malignancy in 98.3% cases. Sensitivity of FEB was 98.3%. FOL and FEB were 91% successful in acquiring a definite diagnosis. Nasopharyngeal cancer affected the younger age group (mean age 39.6 year, SD=17.5). Pharyngeal cancer was more common (62.9%) than laryngeal cancer (37.1%). Hypopharynx (63.2%) was the most common site for pharyngeal cancers. In laryngeal cancer, supraglottic was more common (60%). In hypopharyngeal cancer, pyriform fossa was the most common site (87%). Squamous cell carcinoma (99.2%) was the most common histological diagnosis.

Conclusion: Pharynx was more frequent site than larynx for cancers. Supraglottic region was the most common site for laryngeal and pyriform sinus was the most common site for hypopharyngeal cancers. Nasopharyngeal cancer affected the younger age group. Common histological diagnosis was squamous cell carcinoma. Flexible Endoscopic Biopsy (FEB) was highly sensitive.

Key words: Laryngeal cancer, Hypopharyngeal cancer, Laryngoscopy, Squamous cell carcinoma.