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Knowledge and practice of mothers regarding breastfeeding-A hospital-based study
Get PDFIntroduction: The first six months of an infant\u27s life are critical in terms of mental and physical health development; therefore, the World Health Organization (WHO) encourages mothers to initiate breastfeeding early and keep exclusively alone in this period. Breastfeeding significantly reduces infant morbidity and mortality.
Objective: To assess the knowledge and practice of mothers regarding breastfeeding-A Hospital Based Study.
Material and Methods: A cross-sectional study was conducted in OPD and Pediatric Ward at Uttara Adhunik Medical College Hospital (UAMCH), Uttara, Dhaka, Bangladesh from January to December 20212021. A total of 101 mothers of infants were enrolled in the study and non-probability consecutive sampling technique was used. Inclusion criteria included mothers of infants and premature babies born on 34 weeks of gestation and above requiring admission at the time of study, age up to 24 months of both genders, without any major birth defects such as congenital heart disease and cleft lip/cleft palate. Those not meeting up the inclusion criteria were excluded from the study.
Results: Out of 101 mothers, 75% (n=76) belonged to the age group 20-30 years, 13.8% (n=14) were of 30-40 years, 9.9% (n=10) were less than twenty years of age and 1% (n=1.9) were above forty years. Table-1 describes the demographic characteristics of the infants. Half (49.5%) of the infants were from 2-12 months of age at the time of study. About fifty-seven percent infants were delivered through normal vaginal delivery. About 44% (n=67) mothers had only one child under five, 38% (n=58) had two children under five years of age, 15% (n=23) of mothers had three children under five while 3% (n=5) had four children under five years of age including the infant under study. There was a discrepancy between knowledge and practice. There was a low prevalence of exclusively breastfed infants up to six months. About 10% (n=11) of infants of age 6-12 months were wrongly exclusively breastfed although 81.1% knew age of weaning was six months, remaining were using other types of feeding alone or in combination with breastfeeding. About 54.4% (n=55) mothers were using formula milk but 58.1% (n=32) were aware of correct method of making formula feed i.e. 1 scoop in 1-ounce water. Similarly, there were 27.2% (n=15) of mothers gave buffalo/cow milk alone or in combination with breast milk but then again 8.6%(n=4) were over diluting it i.e. 1 part of buffalo/cow milk to 2 parts of water. Moreover, majority of the mothers showed encouraging attitude as 81.1% mothers considered breastfeeding to be more convenient than other types of feeding. There was an association of early initiation of breastfeeding with mode of delivery (p=0.034 i.e. p<0.05).
Conclusion: Majority of the mothers had the knowledge of breastfeeding. But there was a noticeable deficit in the implementation of knowledge in their breastfeeding practice. The percentage of exclusive breastfeeding practice was remarkably low. Mixed feeding was the predominant approach after exclusive breastfeeding in infants up to six months while third being the formula feeding
Cardiovascular Risk in Women with Diabetes in a Single Centre Study
Get PDFBackground: Among both men and women, diabetes is one of the strongest cardiovascular risk factors. It has been established that type 1 and type 2 diabetes, which both raise the risk of cardiovascular disease (CVD) in women, are more common. Objectives: The aim of the study was to investigate the impact of cardiovascular disease (CVD) Risk in women with diabetes among patients. Methods: This study was a cross-sectional, observational study contained both descriptive and analytical components. The study comprised 160 purposively selected diabetic patients over 45 years old diagnosed from January 2020 to December 2020 in Bangladesh admitted in BIRDEM hospital, Dhaka. After reviewing and rechecking the data, SPSS version 26 was used to do statistical analysis. The level for statistical significance was set at 0.05. Results: Most of the patients belong to 40-49 years age group. Smoke status of the population where 4(2.5%) were current status, 148(92.5%) were never and 8(5.0%) ware former smoker. Most of the patients belong to 148 women of never smoke of this population. Most of the patients belong to 127 women of high-risk of this population. Large scale clinical findings of cardiovascular diseases of the patients Mean±SD HbA1c mmol/mol of 54.6±11.6 and low scale clinical findings of cardiovascular diseases of the patients Mean±SD HDL-c mmol/l of 1.2±0.3. Drugs of the population where 108(67.5%) were Glucose-lowering drugs, 57.5(92.0%) were Lipid-lowering drugs and 108(67.5%) ware Antihypertensive drugs. Most of the patients belong to 108 women using Glucose-lowering drugs and Antihypertensive drugs. Conclusion: The study shows a high prevalence of multiple cardiovascular risk factors among participants with diabete
A study of the prognostic value of red cell distribution width and neutrophil: lymphocyte ratio in adults with sepsis
Get PDFIntroduction: Sepsis continues to be a major cause of morbidity and mortality in Intensive Care Units (ICU) despite the better understanding of its pathophysiology in recent years. This may manifest as organ dysfunction such as hypotension, altered mental status, abnormal coagulation, increase in bilirubin levels, deranged renal function and increase in oxygen requirements. With this background, the current study of the relationship between RDW and neutrophil: lymphocyte ratio with severity of illness in patients admitted to medical ICUs with sepsis, has been undertaken.
Objectives: To study the prognostic value of red cell distribution width and neutrophil: lymphocyte ratio in sepsis.
Materials and Methods: This study was conducted on adult patients, who were admitted in ICUs of Tertiary care hospitals attached to Dr. VVP RMC, Loni, Maharashtra and whose haematological investigations were done within 24 hours of ICU admission. Patients with haematological disorders, immunocompromised patients, patients whose haematological investigations were not done within 24 hours of admission and who were not admitted in ICU were excluded from the study. The study was conducted for a two-year timespan, from September 2020 to September 2022. On admission, patients were stratified according to q-SOFA scoring10 and SOFA score were calculated. Haematological investigations were done within 24 hours of admission. q-SOFA score and SOFA score were calculated at the fifth day of admission to ICU, to assess progress of the patient.
Results: Majority of the patients with sepsis were over 50 years of age. Hypertension, diabetes and obstructive airway diseases were the most common comorbidities present in the patients that were present in the study. Pulmonary infections were the most common source of infection in majority of sepsis cases, followed by tropical/ non- localised infections. RDW was found to be between 14.2 and 15.2 in majority of patients with sepsis in the study group. It was found that higher the RDW, higher the q-SOFA score and worse is the outcome at the end of 5 days. RDW at admission vs Outcomes assessed using ANOVA obtained a p value of p<0.0001 (highly significant). Patients with worse outcomes had a high RDW at admission. NLR vs q-SOFA assessed using Kruskal Wallis and then checked using Mann Whitney U test showed a significant p value of 0.006. It was found in the study that as the q-SOFA score increases, median NLR increases.
Conclusion: The study implies that patients with sepsis having an RDW more than 15.050 may benefit from early interventions and more aggressive management. In low resource settings, the RDW, in the emergency department could afford the earliest opportunity to identify patients at risk of bacteremia and the administration of antimicrobials at the appropriate time
Role of Serum Lactate Dehydrogenase (LDH) and endometrial thickness in the detection of endometrial carcinoma in perimenopausal bleeding
Get PDFIntroduction: Postmenopausal bleeding (PMB) refers to any uterine bleeding in a menopausal patient (other than the expected cyclic bleeding that occurs in patients taking combined (ie, estrogen-progestin), cyclic, postmenopausal hormone therapy. Perimenopausal bleeding (PMB) occurs in approximately 3% of women and it is the usual presenting symptom of endometrial carcinoma in approximately 93% of cases. Objective: To assess the role of serum lactate dehydrogenase (LDH) and endometrial thickness in the detection of endometrial carcinoma in perimenopausal bleeding. Methods: This prospective cross-sectional study was carried out at Obstetrics and Gynecology Department, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from January 2020 to June 2022. This study included 102 women with perimenopausal bleeding admitted to Obstetrics & Gynecology Department at RMCH. All cases were subjected to full history, full clinical examination, transvaginal sonography, serum LDH, and Diagnostic endometrial biopsy was taken for histopathological examination. Result: In this study, endometrial thickness at 11.5mm cut-off value showed 80.6% sensitivity, 53.7% specificity, PPV 53.7%, NPV 80.5%and diagnostic accuracy 64.4%. It was found that TVS evaluation of endometrial thickness is not sensitive enough to detect cancer of the endometrium and therefore, could not replace the histological evaluation of the endometrial tissue in women with postmenopausal bleeding. LDH level cutoff value of 430 U/L could differentiate malignant from benign lesions with a sensitivity of 80.6%, specificity of 57.4%, PPV of 55.7% and NPV of 81.5% with a diagnostic accuracy of 66.7%. Thus, total serum LDH can be used as a good negative test using the cut-off level (430 U/L). A combination of evaluation of endometrial thickness by TVS (with a specificity of 53.7% and accuracy of 64.4%) and serum LDH (with a specificity of 57.4% and accuracy of 66.7%) increase the specificity to 72.2%. also, increase the accuracy to 67.7%. Conclusion: Measurement of serum LDH is considered another simple method to be combined with TVS if endometrial cancer is suspected. However, further studies are needed using LDH isoenzymes profile and TVS endometrial morphology
Peroperative renal pain lower in upper spinal block of proximal (upper) ureteric stone management by URS + ICPL under spinal anesthesia
Get PDFIntroduction: Proximal (upper) Ureteric stone management by URS + ICPL under Spinal Anesthesia; Upper Spinal Block (USAB) reduces / lowers the Renal pain than Lower Spinal Block (LSAB). Objective: To ensure patients compliance and or to reduce renal and flank pain due to high irrigation fluid pressure and or due to rigid ureteroscopy through ureter during URS + ICPL of Upper ureteric stone operation under Spinal Anesthesia. Material & Methods: Randomized prospective study of 60 patients admitted in National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, Bangladesh from early January 2019 to late January 2020 with the diagnosis of proximal (upper) ureteric stone for URS + ICPL under Spinal Anesthesia. Demographic study of the patients age, sex, ASA Score having no spinal deformity. Every patient was properly informed & counselled about the whole procedures & outcomes including Spinal anesthesia (SAB) and URS +ICPL. Written informed consent was taken from all patients and their legal guardians as well. Patients with contraindications to SAB (Coagulopathy, local infection. etc.), allergies to local anesthetic sol, opioids, drugs used, and significant spine, hepatic, cardiovascular, respiratory or psychiatric disorders were excluded from the study. Results: 60 patients were randomly selected of which 30 pt\u27s selected for Group-A and 30 pt\u27s for Group B. Finally, 26 patients in each Group i.e., total 52 patients were done URS+ICPL under SAB subject for our study. 13 Patients had complained of mild to moderate pain (VAS: 0-6) of which 4 patients Group: A and 9 patients Group: B. In Group: A; 2 of 4 pt\u27s had complained of mild pain (VAS:<3) and required analgesic i.e., Inj ketorolac 30mg IV & 2 pt\u27s had complained of moderate pain (VAS: >3-6) required potent analgesic i.e., Inj Pethidine 50mg IV slowly in addition to Inj ketorolac 30mg. In Group: B; 5 of 9 pt\u27s had complained of mild pain (VAS:<3) and required analgesic i.e. Inj ketorolac 30mg IV & 4 pt\u27s had complained of moderate pain (VAS:>3-6) required potent analgesic i.e. Inj pethidine 50mg IV slowly in addition to IV Inj ketorolac 30mg. 8 patients had developed hypotension of which 6 in Group: A where 3 pt\u27s had developed moderate hypotension and required vasopressor (Inj Ephedrine HCl 10-30mg) with the increased IV fluid respectively & 3 pt\u27s had developed mild hypotension hadn\u27t got vasopressor but got increased IV fluid. And 2 pt\u27s in Group: B had developed mild hypotension hadn\u27t gotten any vasopressor but got increased IV fluid. 5 Patients had developed bradycardia (HR: >45-60 beat/min) of which 4 in Group: A & 1in Group: B had required inj Atropine 0.3-0.6mg. 14 Patients had developed tachycardia (HR: >90 beat/min) of which 5 in Group: A & 09 in Group: B. The tachycardia was usually accompanied by pain during procedures & little with hypotension. 3 Patients developed little anorexia without vomiting of only Group: A & neither of Group: B following moderate hypotension & bradycardia which were managed respectively. 
QOL improvement with in adolescents with facial acne vulgaris before and after treatment
Get PDFBackground: Acne is a common adolescent problem, affecting more than 85 percent of teenagers, as well as some adults. Although some consider acne to be merely a cosmetic problem, it may have significant and enduring emotional and psychological effects. Adolescent facial acne vulgaris impairs their quality of life (QOL). Objective: To assess QOL improvement with in adolescents who have facial acne vulgaris. Materials and Methods: This was a cross-sectional comparative study carried out at Dept. of Dermatology and venatarology, Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur, Bangladesh from March to September 2022. Total of one hundred (100) adolescents aged 15-20 years clinically examined for facial acne vulgaris were studied. Study was explained to the subjects and their parents via a letter and an informed consent was obtained from the parents. Quality of life before and after 6 weeks of treatment with 10% benzoyl peroxide was assessed using the Cardiff acne disability index. Data was analyzed using SPSS 19. The differences in quality of life scores were tested using non-parametric tests. Level of significance of all tests was p<0.05. Results: Total One hundred (100) adolescents completed were study. Study population was made up of 42 (42%) males and 58 (58%) females. Before treatment, 90% of the adolescents had an impaired QOL and this decreased to 76% of adolescents’ post- treatment. Post-treatment, the median CADI score improved to 2 from a pre-interventional score of 4, p<0.001. Improvement was observed in all the components of the CADI especially with the question, “how bad do you think your acne is now†with a percentage reduction from 82% to 56% and this improvement was in more males with improvement from 95% to 67%. Also, post-treatment, moderate to severe clinical severity of acne improved from 49.1% to 10.3%, p<0.001. Conclusion: Acne is a highly prevalent condition, affecting the majority of people at some point in their lifetimes, most often during adolescence. Treatment of adolescent facial acne leads to improvement of QOL especially in the perception of facial skin appearance and the severity of acne
Osteoporosis awareness among perimenopausal women-A cross-sectional study
Get PDFIntroduction: Osteoporosis is a global public health problem currently affecting more than 200 million people worldwide. Osteoporosis is characterized by low bone mass and is associated with deterioration of bone microarchitecture. Osteoporosis causes the bones to be fragile and increases susceptibility to fracture even with trivial trauma. Objective: To assess the knowledge of pre-and post-menopausal women on osteoporosis. Methods: A cross sectional study was carried out at the Dept. Obstetrics and Gynaecology, Sheikh Sayera Khatun Medical College & Hospital, Gopalganj, Bangladesh from November 2021 to June 2022. One hundred (100) patients included in our study. Fifty premenopausal women and fifty post-menopausal women were selected using purposive sampling. Baseline data was collected and the knowledge was assessed using the knowledge questionnaire respectively developed by the researcher. Fifty pre-menopausal women between the age of 25-45 years and fifty post-menopausal women between the ages of 46-65 years were selected using purposive sampling technique. Results: Majority of the pre-menopausal women 38 (76%) had average knowledge, 10 (20%) had poor knowledge and 2(4%) had good knowledge when compared to post-menopausal women 35 (70%) had average knowledge, 14(28%) had poor knowledge and 1(2%) had good knowledge regarding risk factors and prevention of osteoporosis. Both premenopausal 76% and postmenopausal 70% women demonstrated average knowledge of osteoporosis based on their awareness questionnaire score. Comparison of the knowledge level in pre and post-menopausal women showed the mean knowledge score of pre-menopausal women is 11.37±3.26 SD and mean knowledge score of post-menopausal women is 10.243±.24 SD The ‘p’ value was >0.05 Hence, there was no difference in the knowledge level between the pre and post-menopausal women. Conclusions: Although half of the pre- and postmenopausal women reported having some awareness of OP, their level of knowledge was average, particularly with regard to the concept, risk factors associated, treatment with the condition and its complications. Having information or creating awareness regarding the risks of OP, screening for OP and a better understanding of the diet during the post-menopausal period of those at risk are important, as both may play a major role in influencing an individual\u27s OP-preventing behaviors
Supraclavicular brachial plexus block using 0.5% bupivacaine with and without fentanyl
Get PDFIntroduction: Brachial plexus block is good alternative to general anesthesia for upper limb surgery. This avoids the unwanted effect of anesthetic drugs used during general anesthesia and the stress of upper airway instrumentation. Objective: To assess the supraclavicular brachial plexus block using 0.5% bupivacaine with and without fentanyl. Materials and Methods: This study design was a prospective randomized controlled double-blinded clinical study was carried out at Department of Anaesthesiology, Shaheed M. Monsur Ali Medical College and Hospital, Sirajganj, Bangladesh from January to June 2021. Fifty (50) patients with American Society of Anesthesiologists physical status Classes I and II, aged 18–50 years, scheduled for upper limb surgery were randomly divided into Two study groups each group contains 25 patients: A Group: receive 0.4 ml/kg bupivacaine up to a maximum of 30 ml volume plus 1ml of normal saline. The dose of bupivacaine was 2 mg/kg. B Group: Bupivacaine as control group plus 1 mcg/kg fentanyl. Patients were excluded if they had sepsis at the site of injection, body wt<50kg, pregnant women, known hypersensitivity, circulatory instability, diabetes, coagulopathy, history of neurological, renal & liver diseases, mental disease and malignancy. Results: Total 50 patient were included both groups. The groups were comparable with respect to age, height, and weight, and ASA physical status. There was no significant difference in the type and duration of surgery. The characteristics of sensory block are summarized. Demographic characteristics and duration of surgery were comparable in both the groups and the difference was not statistically significant (p>0.05). Duration of sensory and motor blockade was longer in group B and shorter in group A. The differences in duration of sensory and motor blocks were statistically significant in both groups. Pulse rate, blood pressure, oxygen saturation was monitored throughout the surgery and also postoperatively. All values were within the normal range. There was no statistically significant difference between the mean preoperative, intra-operative and postoperative values. The vitals were well maintained in all the patients. The timing of the first rescue analgesia was significantly late and the total consumption of analgesia was significantly less in the first 24 hours in Bupivacaine group. Conclusion: Supraclavicular brachial plexus block using local anesthetic, with or without fentanyl revealed that addition of fentanyl to bupivacaine significantly causes early onset of anesthesia and longer duration of analgesia without any side effects. On the basis of the results of the present study, integrated with understanding from the available literature it may be recommended that, this technique will open new perspective for upper limb surgery under regional anesthesia
Implications of the outcome of EMPA-REG outcome on type 2 diabetes mellitus management
Get PDFDiabetes has been implicated in micro-and macro-vascular complications. Glycaemic controls have been found to reduce the risk of microvascular complications in type 2 diabetes. However, studies suggest a possible relation between glycaemic control in decreasing macrovascular complications. The traditional approach of aggressive glycaemic management often leads to hypoglycaemia. Hypoglycaemia induces a series of physiological effects that increase cardiovascular disease risk (CVD). In fact, most of the hypoglycaemic agents such as thiazolidinediones, sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium-glucose cotransporter 2 (SGLT2) inhibitors have been approved based on their ability to decrease glycosylated haemoglobin A1c (HbA1c) rather than their ability to prevent CV morbidity and mortality. In the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients Removing Excess Glucose (EMPA-REG OUTCOME®) trial, Empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, have been proven to exert a cardioprotective effect in type 2 diabetes patients. This paper discusses the outcome of EMPA-REG OUTCOME® and its implication in the management of type 2 diabetes patients that are at risk for CVD
Evaluation of outcome of Enhanced Recovery After Surgery (ERAS) versus conventional method in colostomy closure in children
Get PDFEnhanced Recovery After Surgery (ERAS) is a multimodal perioperative care protocol that represents a fundamental shift from the conventional management of the gastrointestinal surgical patient. Although ERAS protocol has been shown to improve outcomes in the adult surgical population, its application is still limited in pediatric surgery. This prospective observational study was carried out in the Department of Pediatric Surgery of Dhaka Medical College Hospital, Bangladesh from July 2019 to June 2021 aiming to compare the outcomes between ERAS and conventional perioperative care protocol in colostomy closure in children. A total of 60 patients of both sexes admitted for elective colostomy closure were included in this study. The patients were divided in two groups; 30 patients in the Enhanced Recovery After Surgery(ERAS) perioperative care group were considered as Group A and another 30 patients in the Conventional Method group were considered as Group B. Statistical analyses of the results were obtained by using Statistical Packages for Social Sciences (SPSS-22.0). We found Postoperative outcome (return of bowel movement and commencement of oral feeding) was 4.13 times better in group A than that of group B which was statistically significant (p<0.05). More than two third (66.7%) of subjects needed only 7 days of postoperative hospital stay in group A whereas only 5(16.7%) subjects showed 7 days of postoperative hospital stay in group B. The difference was statistically significant (p<0.05) between two groups