1,721,074 research outputs found
Pneumonia in severely malnourished children in developing countries - mortality rish, aetiology and validity of WHO clinical signs: a systematic review
No full textObjectives: to quantify the degree by which moderate and severe degrees of malnutrition increase the mortality risk in pneumonia, to identify potential differences in the aetiology of pneumonia between children with and without severe malnutrition, and to evaluate the validity of WHO-recommended clinical signs (age-specific fast breathing and chest wall indrawing) for the diagnosis of pneumonia in severely malnourished children.Methods: systematic search of the existing literature using a variety of databases (Medline, EMBASE, the Web of Science, Scopus and CINAHL).Results: mortality risk: sixteen relevant studies were identified, which universally showed that children with pneumonia and moderate or severe malnutrition are at higher risk of death. For severe malnutrition, reported relative risks ranged from 2.9 to 121.2; odds ratios ranged from 2.5 to 15.1. For moderate malnutrition, relative risks ranged from 1.2 to 36.5. Aetiology: eleven studies evaluated the aetiology of pneumonia in severely malnourished children. Commonly isolated bacterial pathogens were Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, and Haemophilus influenzae. The spectrum and frequency of organisms differed from those reported in children without severe malnutrition. There are very few data on the role of respiratory viruses and tuberculosis. Clinical signs: Four studies investigating the validity of clinical signs showed that WHO-recommended clinical signs were less sensitive as predictors of radiographic pneumonia in severely malnourished children.Conclusions: pneumonia and malnutrition are two of the biggest killers in childhood. Guidelines for the care of children with pneumonia and malnutrition need to take into account this strong and often lethal association if they are to contribute to the UN Millennium Development Goal 4, aiming for substantial reductions in childhood mortality. Additional data regarding the optimal diagnostic approach to and management of pneumonia and malnutrition are required from regions where death from these two diseases is commo
Feasibility and acceptability of bubble continuous positive airway pressure for treatment of Bangladeshi children with severe pneumonia
No full textThe dataset comprises 20 children of Bangladesh aged between 2 and 24 months with severe pneumonia and hypoxaemia. These were obtained in 2021 from two district level hospitals (1) Institute of Child and Mother Health, Matuail and (2) 250 bedded General Hospital, Kushtia. The retrospective data includes from 1st January 2020 to 31st December 2020 and prospective data were collected for 3 months in 2021 from each selected study site. The dataset includes screening information, eligibility checklist, baseline or enrolment information, patient follow-up, conclusion information and prospective and retrospective data. A brief description of the dataset is given below. Screening Log: This data was obtained from all the children aged between 2 and 24 months admitted to the Pediatric ward. Inclusion and Exclusion Form: It was collected according to the enrolment criteria. This data defines the match of inclusion criteria. Enrolled: This data was collected from all the enrolled participants who received bubble CPAP oxygen therapy. A total of 20 participants were enrolled (10 on each study site). Scheduled Follow-ups: This data denotes the scheduled vital records & clinical examination findings of the enrolled participants. These were obtained during the start of bCPAP oxygen therapy, one hour later and every four hours from the enrolment time point till the outcome of each participant. Conclusion: This data was obtained during the discharge or outcome of the enrolled participants. Prospective and Retrospective Data: The retrospective data was obtained from the selected hospital patient record files of children aged between 2 and 24 months who were admitted to the Pediatric ward. It comprises 1 year of data. Prospective data comprises 3 months of data and was collected from children aged between 2 and 24 months who came to the study sites for treatment.Dr. Chisti, Mohammod Jobayer. (2022). Feasibility and acceptability of bubble continuous positive airway pressure for treatment of Bangladeshi children with severe pneumonia, 2020-2021 [dataset]. The University of Edinburgh. Usher Institute. NIHR Global Health Research Unit on Respiratory Health (RESPIRE). https://doi.org/10.7488/ds/3410
Respiratory support for children with severe pneumonia and hypoxaemia in a developing country: a randomized trial of bubble CPAP, high flow nasal cannula therapy and standard flow oxygen
No full text© 2104 Dr. Mohammod Jobayer ChistiBACKGROUND: Mortality rate from very severe pneumonia in many hospitals is more than 10% even with appropriate antibiotics, standard low flow (LF) oxygen by nasal prongs as recommended by the World Health Organization (WHO) and good supportive care. Bubble CPAP (BCPAP) and humidified high flow nasal cannula (HFNC) oxygen are increasingly used in neonatal care for reducing respiratory distress and hypoxemia. However, there were no published controlled trials (RCT) of the use of BCPAP in children beyond the newborn period with severe pneumonia and hypoxemia in developing countries.
AIMS: Our aim was to evaluate the efficacy of BCPAP compared to LF or LF and HFNC therapy in managing children with severe pneumonia and hypoxemia.
REGISTRATION: Clinicaltrials.gov identifier: NCT01396759
METHODS: We conducted an open RCT in the Dhaka hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) between August 2011 and July 2013. Children under five years of age who had severe pneumonia and hypoxemia as defined by WHO were randomly allocated to BCPAP, LF or HFNC oxygen therapies. The primary outcome was to determine if there were differences in treatment failure, based on objective clinical criteria. Mortality was our secondary outcome. We established a DSMB which reviewed adverse events and reviewed the planned interim analyses.
RESULTS: During the study period 376 children were admitted with study criteria and 225 children were enrolled. There were two interim analyses. Two years into the study 79 children had been allocated to BCPAP, 79 to HFNC and 67 to the LF arms. Baseline and other characteristics were comparable between the 3 intervention groups, and all patients were available for analysis. At the second interim analysis the DSMB recommended stopping the study because of a significant difference in mortality. A total of 31 (14%) children fulfilled the criteria for treatment failure: among them 5 (6%) in BCPAP, 16 (24%) in LF and 10 (13%) in HFNC therapy. There were 23 deaths (10%): 3 (4%) in BCPAP therapy, 10 (15%) in LF therapy, 10 (13%) in HFNC therapy. Children who received BCPAP therapy had significantly lower treatment failure compared to those who received LF therapy (6% vs. 24%; p < 0.003) or LF and HFNC therapy (6% vs. 18%; p = 0.017). Mortality was significantly less in children who received BCPAP therapy compared to those who received LF therapy (4% vs. 15%; p = 0.040) or LF and HFNC therapy (4% vs. 13%; p = 0.035). In multiple logistic regression analysis, after adjusting for potential confounders, children who received BCPAP therapy had significantly less risk (OR = 0.29, 95% confidence interval = 0.09 – 0.88, p = 0.028) of developing treatment failure compared to other intervention groups and BCPAP therapy remained an independent predictor of survival (OR = 0.20, 95% confidence interval = 0.05 – 0.86, p = 0.031) in the management of children with severe pneumonia and hypoxemia.
CONCLUSION: In Bangladeshi children under five with severe pneumonia and hypoxemia, compared to standard LF oxygen therapy, BCPAP oxygen therapy was associated with a significant lower probability of treatment failure and mortality. BCPAP should be considered an important option for treating children under five with severe pneumonia and hypoxemia
Optimising the treatment of Bangladeshi adult patients with severe pneumonia and/or ARDS using adaptive version of locally made Bubble CPAP: Feasibility study
No full textThe dataset comprises 30 adult patients of Bangladesh aged between 18 and 65 years diagnosed with severe pneumonia and hypoxaemia and/or acute respiratory distress syndrome (ARDS) with or without COVID-19 infection. These were obtained from two tertiary level hospitals (1) Dhaka Medical College Hospital, Dhaka and (2) Dhaka Hospital of icddr,b, Dhaka.
The dataset includes screening data, inclusion and exclusion form, screening and baseline information, nurses follow-up, follow-up for physicians and conclusion/discharge information.
Screening data: This data was obtained from all the patients aged between 18 and 65 years admitted to the ward.
Inclusion and Exclusion Form: It was collected according to the enrolment criteria. This data defines the inclusion and exclusion criteria of the screened patients.
Screening and Baseline: This data was collected from all the enrolled participants who received bubble CPAP oxygen therapy. A total of 30 participants were enrolled.
Nurses Follow-up: This data denotes the scheduled vital records of the enrolled participants. These were obtained by nurses during the start of bCPAP oxygen therapy, one hour later and every four hours from the enrolment time point till the outcome of each participant.
Follow-up for physicians: Physicians recorded the vitals every 8 or 12 hours or on demand.
Conclusion: This data was obtained during the discharge or outcome of the enrolled participants
Childhood pneumonia and hypoxaemia in an urban diarrhoeal hospital, Dhaka, Bangladesh
Full text link© 2010 Dr. Mohammod Jobayer ChistiThe aim of this prospective cohort study was to evaluate clinical and socio-demographic predictors of pneumonia, deaths from pneumonia, and hypoxaemia in children. All under-five children who were admitted to the special care ward of ICDDR,B during September 2007-December 2007 were enrolled. Children sleeping in a bare bed and those having parents/caregivers with poor knowledge were at risk of pneumonia. Children with severe malnutrition, hypoxaemia, or severe sepsis were at higher risk of death. Chest wall-indrawing was the best predictor of hypoxaemia
Feasibility and acceptability of bubble continuous positive airway pressure for treatment of Bangladeshi children with severe pneumonia
No full textThe dataset comprises 20 children of Bangladesh aged between 2 and 24 months with severe pneumonia and hypoxaemia. These were obtained in 2021 from two district level hospitals (1) Institute of Child and Mother Health, Matuail and (2) 250 bedded General Hospital, Kushtia.
The retrospective data includes from 1st January 2020 to 31st December 2020 and prospective data were collected for 3 months in 2021 from each selected study site.
The dataset includes screening information, eligibility checklist, baseline or enrolment information, patient follow-up, conclusion information and prospective and retrospective data. A brief description of the dataset is given below.
Screening Log: This data was obtained from all the children aged between 2 and 24 months admitted to the Pediatric ward.
Inclusion and Exclusion Form: It was collected according to the enrolment criteria. This data defines the match of inclusion criteria.
Enrolled: This data was collected from all the enrolled participants who received bubble CPAP oxygen therapy. A total of 20 participants were enrolled (10 on each study site).
Scheduled Follow-ups: This data denotes the scheduled vital records & clinical examination findings of the enrolled participants. These were obtained during the start of bCPAP oxygen therapy, one hour later and every four hours from the enrolment time point till the outcome of each participant.
Conclusion: This data was obtained during the discharge or outcome of the enrolled participants.
Prospective and Retrospective Data: The retrospective data was obtained from the selected hospital patient record files of children aged between 2 and 24 months who were admitted to the Pediatric ward. It comprises 1 year of data. Prospective data comprises 3 months of data and was collected from children aged between 2 and 24 months who came to the study sites for treatment.1. N/A
Screening Log: This data was obtained from all the children aged between 2 and 24 months admitted to the Pediatric ward.
Inclusion and Exclusion Form: It was collected according to the enrolment criteria. This data defines the match of inclusion criteria.
Enrolled: This data was collected from all the enrolled participants who received bubble CPAP oxygen therapy. A total of 20 participants were enrolled (10 on each study site).
Scheduled Follow-ups: This data denotes the scheduled vital records & clinical examination findings of the enrolled participants. These were obtained during the start of bCPAP oxygen therapy, one hour later and every four hours from the enrolment time point till the outcome of each participant.
Conclusion: This data was obtained during the discharge or outcome of the participants.
Prospective and Retrospective Data: The retrospective data was obtained from the selected hospital patient record files of children aged between 2 and 24 months who were admitted to the Pediatric ward. It comprises 1 year of data. Prospective data comprises 3 months of data and was collected from children aged between 2 and 24 months who came to the study sites for treatment
Optimising the treatment of Bangladeshi adult patients with severe pneumonia and/or ARDS using adaptive version of locally made Bubble CPAP: Feasibility study
No full textThe dataset comprises 30 adult patients of Bangladesh aged between 18 and 65 years diagnosed with severe pneumonia and hypoxaemia and/or acute respiratory distress syndrome (ARDS) with or without COVID-19 infection. These were obtained from two tertiary level hospitals (1) Dhaka Medical College Hospital, Dhaka and (2) Dhaka Hospital of icddr,b, Dhaka. The dataset includes screening data, inclusion and exclusion form, screening and baseline information, nurses follow-up, follow-up for physicians and conclusion/discharge information. Screening data: This data was obtained from all the patients aged between 18 and 65 years admitted to the ward. Inclusion and Exclusion Form: It was collected according to the enrolment criteria. This data defines the inclusion and exclusion criteria of the screened patients. Screening and Baseline: This data was collected from all the enrolled participants who received bubble CPAP oxygen therapy. A total of 30 participants were enrolled. Nurses Follow-up: This data denotes the scheduled vital records of the enrolled participants. These were obtained by nurses during the start of bCPAP oxygen therapy, one hour later and every four hours from the enrolment time point till the outcome of each participant. Follow-up for physicians: Physicians recorded the vitals every 8 or 12 hours or on demand. Conclusion: This data was obtained during the discharge or outcome of the enrolled participants.Chisti, Mohammod Jobayer. (2022). Optimising the treatment of Bangladeshi adult patients with severe pneumonia and/or ARDS using adaptive version of locally made Bubble CPAP: Feasibility study, 2021-2022 [dataset]. The University of Edinburgh. Usher Institute. NIHR Global Health Research Unit on Respiratory Health (RESPIRE);. https://doi.org/10.7488/ds/3437
PLoS One
Full text linkBackgroundPredictors of death in hospitalized HIV-infected patients have not been previously reported in Bangladesh.ObjectiveThe primary aim of this study was to determine predictors of death among hospitalized HIV-infected patients at a large urban hospital in Bangladesh.MethodsA study was conducted in the HIV in-patient unit (Jagori Ward) of icddr,b's Dhaka Hospital. Characteristics of patients who died during hospitalization were compared to those of patients discharged from the ward. Bivariate analysis was performed to determine associations between potential risk factors and death. Multivariable logistic regression was used to identify factors independently associated with death.ResultsOf 293 patients admitted to the Jagori Ward, 57 died during hospitalization. Most hospitalized patients (67%) were male and the median age was 35 (interquartile range: 2\u201365) years. Overall, 153 (52%) patients were diagnosed with HIV within 6 months of hospitalization. The most common presumptive opportunistic infections (OIs) identified were tuberculosis (32%), oesophageal candidiasis (9%), Pneumocystis jirovecii pneumonia (PJP) (8%), and histoplasmosis (7%). On multivariable analysis, independent predictors of mortality were CD4 count 64200 cells/mm3 (adjusted odds ratio [aOR]: 16.6, 95% confidence interval [CI]: 3.7\u201374.4), PJP (aOR: 18.5, 95% CI: 4.68\u201373.3), oesophageal candidiasis (aOR: 27.5, 95% CI: 5.5\u2013136.9), malignancy (aOR:15.2, 95% CI: 2.3\u201399.4), and bacteriuria (aOR:7.9, 95% CI: 1.2\u201350.5). Being on antiretroviral therapy prior to hospitalization (aOR: 0.2, 95% CI: 0.06\u20130.5) was associated with decreased mortality.ConclusionThis study showed that most patients who died during hospitalization on the Jagori Ward had HIV-related illnesses which could have been averted with earlier diagnosis of HIV and proper management of OIs. It is prudent to develop a national HIV screening programme to facilitate early identification of HIV.20141018
Patient Prefer Adherence
No full textBackgroundPharmacies in Bangladesh serve as an important source of health service. A survey in Dhaka reported that 48% of respondents with symptoms of acute respiratory illness (ARI) identified local pharmacies as their first point of care. This study explores the factors driving urban customers to seek health care from pharmacies for ARI, their treatment adherence, and outcome.MethodsA cross-sectional study was conducted among 100 selected pharmacies within Dhaka from June to December 2012. Study participants were patients or patients\ue2\u20ac\u2122 relatives aged >18 years seeking care for ARI from pharmacies without prescription. Structured interviews were conducted with customers after they sought health service from drug sellers and again over phone 5 days postinterview to discuss treatment adherence and outcome.ResultsWe interviewed 302 customers patronizing 76 pharmacies; 186 (62%) sought care for themselves and 116 (38%) sought care for a sick relative. Most customers (215; 71%) were males. The majority (90%) of customers sought care from the study pharmacy as their first point of care, while 18 (6%) had previously sought care from another pharmacy and 11 (4%) from a physician for their illness episodes. The most frequently reported reasons for seeking care from pharmacies were ease of access to pharmacies (86%), lower cost (46%), availability of medicine (33%), knowing the drug seller (20%), and convenient hours of operation (19%). The most commonly recommended drugs were acetaminophen dispensed in 76% (228) of visits, antihistamine in 69% (208), and antibiotics in 42% (126). On follow-up, most (86%) of the customers had recovered and 12% had sought further treatment.ConclusionPeople with ARI preferred to seek care at pharmacies rather than clinics because these pharmacies were more accessible and provided prompt treatment and medicine with no service charge. We recommend raising awareness among drug sellers on proper dispensing practices and enforcement of laws and regulations for drug sales.28293104PMC534598
Recurrent Sclerema in a Young Infant Presenting with Severe Sepsis and Severe Pneumonia: An Uncommon but Extremely Life-threatening Condition
Full text linkA one month and twenty-five days old baby girl with problems of acute
watery diarrhoea, severe dehydration, severe malnutrition, and reduced
activity was admitted to the gastrointestinal unit of Dhaka Hospital of
icddr,b. The differentials included dehydration, dyselectrolytaemia and
severe sepsis. She was treated following the protocolized management
guidelines of the hospital. However, within the next 24 hours, the
patient deteriorated with additional problems of severe sepsis, severe
pneumonia, hypoxaemia, ileus, and sclerema. She was transferred to the
Intensive Care Unit (ICU). In the ICU, she was managed with oxygen
supplementation, intravenous antibiotics, intravenous fluid, including
a number of blood transfusions, vitamins, minerals, and diet. One month
prior to this admission, she had been admitted to the ICU also with
sclerema, septic shock, and urinary tract infection due to Escherichia
coli and was discharged after full recovery. On both the occasions,
she required repeated blood transfusions and aggressive antibiotic
therapy in addition to appropriate fluid therapy and oxygen
supplementation. She fully recovered from severe sepsis, severe
malnutrition, ileus, sclerema, and pneumonia, both clinically and
radiologically and was discharged two weeks after admission.
Consecutive episodes of sclerema, resulting in two successive
hospitalizations in a severely-malnourished young septic infant, have
never been reported. However, this was managed successfully with blood
transfusion, broad-spectrum antibiotics, and correction of electrolyte
imbalance
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