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Factors determining change of antibiotic and prolong hospital stay in children with severe pneumonia in a tertiary care hospital, Dhaka, Bangladesh
Get PDFBackground: Pneumonia is one of the most common infections in the pediatric age group and one of the leading diagnoses that results in hospital admission for children. Severe pneumonia remains a common and serious condition worldwide. Various micro-organisms can cause pneumonia, and etiologies differ by age. Clinical manifestations vary, and diagnostic testing is frequently not standardized. Objective: To identify the factors determining the need of antibiotic change and prolong hospital stay in children Under Five Years of Age Hospitalized with Severe Pneumonia. Study design: Prospective observational cohort study. Study place and period: Dhaka Shishu (Children) Hospital, Dhaka, from December 2012 to May 2013. Study population: Children under 5 years of age admitted with severe pneumonia. Sample size: n= One Hundred Fifty included. Methods/ Procedure: All the data was collected and recorded systematically in a questionnaire and was analyzed using computer software SPSS (Statistical package for social sciences) and analysis was multivariate to find out the significant factors. Main outcome measures: Change of antibiotic and prolong hospital stay, in children Under Five Years of Age Hospitalized with Severe Pneumonia of this study. Results: The mean age was found 9.49±6.83 months with range from 2 months to 36 months and Male to female ratio was 2:1. The duration of hospital stay was >5 days in almost two third (62.7%) of the patients. The mean age of the mothers was 24.67±4.19 years. Regarding study of association of different factors with prolong hospital stay it was observed that patients who needed prolong hospital stay 53.2% of them live in an overcrowded environment and 32.1% patients live in an overcrowded environment who didn`t need prolong hospital stay. Among 150 study patients, 98(65.3%) needed a change in antibiotics, 94(62.7%) patients needed more than 5 days’ hospital stay. 34.7% of patients were exclusively breast fed of those who needed a change in antibiotic and 80.8% among those who didn`t need any change. 85.7% presented with head nodding among those who needed antibiotic change, on the other hand, 19.2% with head-nodding among those who didn`t need antibiotic change. Leukocytosis was found in 57.1% and 19.2% among patients who needed a change of antibiotics and didn`t need antibiotic change respectively. In patients who needed a change of antibiotic, positive blood culture was found in 20.4% of cases and it was 0% among patients who didn`t need a change. Radiological abnormality was found in 87.8% of patients who needed antibiotic change and 42.3% in patients who didn`t need antibiotic change. Statistically significant (p<0.05) factors associated with two groups of patients those who needed a change of antibiotics and those who didn`t need are overcrowding, exclusive breastfeeding, head nodding on presentation, leukocytosis, positive blood culture, and abnormal CXR. Conclusion: Children hospitalized with severe community-acquired pneumonia [as defined by World Health Organization (WHO)] who had not received exclusive breastfeeding, had stayed in overcrowded homes and had an abnormal chest radiograph were more likely to fail to respond with the primary antibiotic regimen and require change of antibiotics and prolonged hospital stay
Evaluation of early postoperative outcome of hepatico-duodenostomy and rouxen-y hepaticojejunostomy for the treatment of choledochal cyst: A comparative study
Get PDFPurpose: Choledochal cyst is a developmental defect of the biliary channel with a wide spectrum of complications. Excision of cyst & biliary reconstruction is the treatment of choice. In our country, Roux-en-Y hepaticojejunostomy (RYHJ) and Hepaticoduodenostomy (HD) both are performed for biliary reconstruction. In this study we have tried to compare the outcome of both of the procedures and whether anyone has superiority in terms of operative technique or early postoperative outcome. Methods: It is an observational type of prospective comparative study. The study period was from January 2016 to February 2017. The study has done in the Pediatric Surgery Department of BSMMU, Dhaka, Bangladesh. This included 36 patients with choledochal cyst. The study population was divided into two groups according to the method used for biliary reconstruction. Group A included 18 patients who underwent HD, while group B included 18 patients treated with RYHJ. Demographic and outcome data were compared using an unpaired t-test. Results: The mean operative time was shorter in group A in 87.78 ± 19.94 minutes than in group B, 166.11 ± 34.45 minutes, p-value <0.001, which is significant. Hospital stay was comparable in both groups 6.83 ± 1.88 days in group A and 9.23 ± 2.27 days in group B, the p-value is significant. There were no major intraoperative complications in either group. Four patients of group B and one patient of group A were prolonged ileus. Total four patients had anastomotic leakage, one from group A and three from the group. One patient of each group needed re-laparotomy, the rest of the two patients was improved after conservative management. Conclusions: In this study, HD required less operative time and avoidance of intestinal anastomosis, less hospital stay time, and no severe complications in comparison to RYHJ
Fibroepithelial hyperplasia of Gingiva: A report of two cases
Get PDFIntroduction- Fibromas are the most common fibrous overgrowths of the oral cavity that occur in response to a low-grade stimulus. The treatment involves; efficient plaque control, removal of etiological factors, and conservative excision of the tissue to avoid recurrence. Hence, it is necessary that clinicians have adequate knowledge about such fibrous overgrowths so as to differentiate them from other similar appearing lesions.
Case discussion- Two patients reported a chief complaint of overgrowth in the gums. On clinical examination, the overgrowths were diagnosed as Fibromas. Radiographic and hematological investigations were carried out. After thorough scaling and root planning, the overgrowths were excised and sent for histopathological examinations. A diagnosis of fibroepithelial hyperplasia was reported.
Conclusion- Fibromas show similar clinical and biological behavior; however, they have distinct histopathology. Excision is the treatment of choice along with the elimination of the etiological factors like plaque, calculus to avoid recurrence
Anomalies of the genetic complement and its role in C3 Glomerulopathies and development of Hemolithic Uremic Syndrome
Get PDFLet us remember that C3 glomerulopathy is the product of an abnormal activation in the alternative complement pathway, which leads to an excessive production of active C3 and its degradation product
Comparison of sensory and motor block outcome of fractionated versus single bolus dose administration of hyperbaric bupivacaine in elective cesarean section
Get PDFIntroduction: To achieve the best anesthetic outcome in pregnant women undergoing cesarean deliveries, spinal anaesthesia is the most popularly preferred method. The present study assessed the sensory and motor blockade outcome, following the administration of single bolus dose versus fractionated dose of bupivacaine as spinal anesthesia, in terms of the time of onset and regression, in cesarean section deliveries. Methods: With ethical approval from the corresponding authority and informed written consent from the patients, this study included 100 randomly selected, singleton, non-complicated pregnant women admitted in the Combined Military Hospital (CMH), Dhaka, during the period of July 2018 to June 2019, for elective LUCS. Patients were randomly divided into two equal groups- Group A and Group B, each comprised of 50 patients. Following the standard protocol to administer spinal anesthesia, Group A patients were given a single bolus dose of bupivacaine over 10 seconds and Group B patients were given fractionated dose of bupivacaine with two-third of the total calculated dose given initially, followed by one-third dose after 90 seconds. The age, height and physical status of the patients, the time of onset and regression of sensory and motor block were assessed and recorded. The post-operative pain was assessed with the linear visual analog scale (VAS) every 30 min after surgery for the first 2 hours then hourly up to 6 hours and the duration of analgesia was recorded. All the data has been analyzed with the help of IBM SPSS software (Statistical Package for Social Science) version-22. Results: The mean of the onset of sensory and motor block was faster in Group A than in group B, in case of sensory block onset it was 1.6 ± 0.5 min in Group A and 2.3± 0.8 min in Group B and in case of motor block onset it was 5.4 ± 1.1 min in Group A and 5.9± 1.2 min in Group B (p>0.05). The duration of sensory (Group A: 143.5 ± 23.7, Group B: 212.7 ± 38.6) and motor block (Group A: 118.5 ± 22.5, Group B: 175.2 ± 28.3 was significantly higher in group B than in group A, (p<0.05). Group A patients had a significantly higher mean of the VAS score than Group B patients at each time point (p<0.05). The mean of the duration of analgesia was statistically significantly higher in Group B (235.1± 29.2) than in Group A (198.5±21.3) (p<0.05). Conclusion: This study concludes with the findings that, fractionated administration of bupivacaine in spinal anesthesia provides better aesthetic outcomes in terms of prolonged duration of sensory and motor block
Prevalence and Characterization of Labial Cervical Vertical Groove in maxillary permanent Incisors: an observational, cross-sectional study
Get PDFObjective: To evaluate the prevalence and traits of Labial Cervical Vertical Groove in permanent maxillary incisors, its impact on accompanying gingiva, can cause periodontal, esthetic, and prosthetic concern.
Aim: The purpose of this study was to determine the frequency and attribute of LCVG in the specific tooth (central vs lateral incisor), side (unilateral vs bilateral, left vs right), and gender.
Settings and Design: An in vivo observational cross-sectional study.
Materials and Methods: An aggregate of 1800 people aged 18 and 60 were chosen at random and scrutinized for the existence of LCVG in an individual\u27s maxillary permanent incisors. According to predetermined criteria, the deformity was categorized as mild, moderate, or severe. Normal, partial, and irregular gingival covering at the groove site were classified. The inclusion of a Palato-Radial Groove was also detected.
Results: LCVG was diagnosed in 123 patients (6.83%). In 59 (47.97%) of the individuals, it was unilateral, while in 64 (52.03%), it was bilateral. There was no evidence of sexual dimorphism or side prevalence. LCVG was identified in 187 (38%) of the 492 teeth in 123 participants. Mild LCVG was detected in 72 incisors, moderate in 83 incisors, and severe in 32 incisors, with a central to lateral incisor ratio of 186:1. In 123 incisors, the gingival contour was normal, partial in 59 incisors, and in 5 incisors it’s irregular. In incisors with moderate or severe LCVG, the gingival recession was noted.
Conclusion: An LCVG is a malformation that affects the permanent central incisors of the maxilla. Increased severity of LCVG has deleterious repercussions on the periodontium, necessitating conscientious dental hygiene; accordingly, practitioners should be aware of this, and patients must be advised on the importance of maintaining good oral hygienic practices
Comparative study between FNAC and histopathology (HPR) in diagnosing thyroid swelling
Get PDFIntroduction: A multitude of diagnostic tests like ultrasound, thyroid nuclear scan, fine needle aspiration cytology (FNAC) and many more are available to evaluate thyroid swelling but confirmatory diagnosis requires morphological examination of lesions by FNAC and histopathology.
Material and Method: 60 patients of thyroid swellings admitted to indoor and undergoing thyroidectomy were enrolled. Fine needle aspiration cytology was done on an outpatient basis and thyroidectomy specimens preserved in 10 % formalin were sent for a histopathology examination
Result: Out of 28 cases of colloid goiter diagnosed on FNAC, 2 cases were later diagnosed as Papillary Ca on histopathology. Out of 6 cases of Follicular adenoma diagnosed on FNAC, 2 cases were later diagnosed as Follicular Ca on histopathology. 1 case of Follicular Ca diagnosed on FNAC was later diagnosed as Follicular adenoma on histopathology
Discussion: FNAC Sensitivity was 50 %, Specificity was 98.08 %, PPV was 26.00 and NPV was 0.51
Conclusion: FNAC is a safe, cost-effective method with excellent accuracy and specificity for investigating thyroid illnes
Quality Improvement project for management of Depression in Chronic Kidney Disease patients receiving haemodialysis
Get PDFAim: To apply quality improvement methodology and apply a few appropriate interventions to reduce the prevalence of depression. The NICE guidelines 2009 for depression management were used to guide the introduction of appropriate interventions. PHQ-9 was used to score depression before and after the intervention. The interventions included painting and decorating the unit in bright colors, adding a television facility, taking strict measures for maintaining cleanliness, allowing one attendant per patient inside the unit, making few quiet corners if the patient intends to sleep during the session. Methods: Diagrams, flowcharts were used to show aims and objectives. A PDSA cycle (Plan, Do, Study, Act) was used. The prevalence of depression in dialysis patients was calculated using the PHQ-9 questionnaire. A new plan for the dialysis department decoration and introduction of facilities was formulated with input from the dialysis department staff; including the nurses, technical staff, and the in-charge of the Nephrology Department. Results: 120 patients involved in the dialysis sessions were targeted in this project for the six months duration from April 2018-Sep 2018.40% of the patients (48) were found to be suffering from moderate-moderately severe depression (score range 10-19) via the filled PHQ-9 questionnaire. Four months after the introduction of various changes the PHQ-9 was filled by the same patients. Now the prevalence of depression reduced to 10% (12). Also, the patient\u27s still scored as being depressed were in the mild depression range(i.e. score on PHQ:5-9). Conclusion: Following the implementations especially focusing on the counseling sessions (as mentioned in NICE guidelines)and increasing the Doctor\u27s availability in the department with some environmental changes, there was an improvement in overall patient care. Especially the patient\u27s mental health improved and the overall mood of the patient was elevated. different facilities introduced along with the changes in the overall look of the department and focusing on patient\u27s mental health improvement by counseling and improved interaction of patients with their care providers like junior doctors helped a lot. 
Antidiabetic and Antihyperlipidemic activities of Feronia elephantum gum in streptozotocin induced diabetic rats.
Get PDFGum of the plant Feronia elephantum Correa (Rutaceae) is useful in the treatment of diabetes in primitive books and conventional medicine. The present study was aimed to evaluate antidiabetic effect of Feronia elephantum gum extract in different doses along with antihyperlipidemic activity. In vitro antidiabetic activity was studied by inhibition of alpha amylase and alpha glucosidase enzymes. We have tried to separate some of fatty material from the feronia gum and assessed the pharmacological activity. Polyethylene glycol was converted to PEG-COOH using succinic anhydride by using conjugation chemistry technique and then was allowed to react with NHS (n- hydroxyl succinimide) to synthesize PEG-NH2 complex. Conjugation of plant compound containing COOH terminal was synthesized in the final reaction. The presence of Nitrogen and oxygen was identified in elemental CHN analysis. The conjugated compound was studied by NMR spectroscopy to find out the compounds conjugated with PEG complex. Single intraperitoneal injection of STZ at 55 mg/kg was used for induction of diabetes. Feronia gum aqueous extract was studied for pharmacological activities at a dose of 200 mg/kg, 300 mg/kg and 400 mg/kg and was compared with diabetic control group using Metformin as a standard drug. Real Time Polymerase chain reaction was carried out to study the mRNA expression of IRS2 gene, PPARα gene and GRIA2 gene. FGE 400 showed significant inhibition for alpha amylase and alpha glucosidase enzymes. Increased blood glucose level, glycosylated hemoglobin, body weight and urine volume was significantly decreased by treatment with FGE 400. Antidiabetic activity of FGE 400 was supported by insulin content, liver glycogen, antioxidant enzymes (CAT, SOD, GPx , GST); hepatic glucose metabolic enzymes (Glucokinase, Glucose 6 phosphate dehydrogenase, glucose 6 phosphatase, fructose 1, 6 bisphosphatase), liver damage markers (SGOT, SGPT, ALP), histopathology study of pancreas and liver. FGE400 has positive effects for carbohydrate metabolism in liver (IRS2 gene), lowers the hepatic inflammation (PPARα gene) and increases insulin secretion (GRIA2 gene). From the study it can be concluded that Feronia elephantum gum extract is having prominent antidiabetic and antihyperlipidemic activities in dose dependent manner. Further studies are required for isolation and characterization of active chemical constituents
Notorious Covid-19 pandemic gives eye opening aid to detect Tuberculosis comorbidity
Get PDFThe coronavirus outbreak of 2019 (COVID-19) has arisen as a major challenge to global public health, necessitating immediate “action and resulting in unprecedented†global transformation in a brief period of time. This illness has wreaked havoc on economies around the globe, infringed on civil liberties, and wreaked havoc on the healthcare system in India