Bangladesh shares many socio-cultural, financial, and health issues typical of developing countries. Despite some encouraging developments in health measures at grass-roots level, medical education in Bangladesh faces many challenges. This article provides a snapshot of the current situation of undergraduate and post-graduate medical education with particular emphasis on pedagogical issues, highlighting challenges faced and suggesting an immediate five-point action plan.
Purpose: In order to achieve the Sustainable Development Goal (SDG) 3 target of reduction in under-five mortality below 25 per thousand live birth by the year of 2030, major reductions are going to be required in neonatal mortality. Congenital anomalies have become the fourth cause of neonatal deaths and most of these are curable. The largest public hospital of Bangladesh is serving the poor and lower middle class people where surgery and medical facilities are mostly free of cost. This study was done to see the types of neonatal surgical patients admitted in this hospital and their management out come with limited facilities and find out some new ideas and information and the ways to improve the scenario to contribute in achieving the SDG 3. Materials & Methods: This was a descriptive study with retrospective record review of all admitted neonates done over a period of 17 years from July 2001 to June 2018 and carried out in the Department of Pediatric Surgery. A total of 2492 neonates were admitted during this period and it was the 16.16% of total number of 15414 pediatric surgical admission upto12 years of age. Data was collected from hospital records and analyzed retrospectively. Detail history of each patient was collected and recorded in a pre-designed, semi-structured questionnaire. Statistical assessments were done by SPSS version 22. An Ethical clearance had been sought. Results: Out of these 2492 neonates, 1932 (77.53%) were admitted for Neonatal Intestinal Obstruction (NIO) and Intestinal atresia 246 (09.87%), Omphalocele 163 (06.54%), Meconium ileus 154 (06.18%), Volvulous neonatoram 125 (05.02%), Septicemia 114 (04.57%), Posterior urethral valve 78 (03.13%), Gastroschisis 75 (03.01%), Abscess 57 (02.29%), Congenital Diaphragmatic Hernia 54 (02.17%), Ectopia vesicae 50 (02.01%), Infantile pyloric stenosis 42 (01.68%), Tracheo-oesophageal fistula 24 (0.96%), Prune belly syndrome 8 (0.32%), Neonatal injury 5 (0.20%), Conjoint twin 4 (0.16%). The most common cause of NIO was anorectal malformation (ARM) 806 (32.34%). Among them 516 (64.02%) patients had high variety and 290 (35.98%) patients had low variety ARM. Next was Hirschsprungs disease and 487 (19.54%) neonates presented with this. One hundred and forteen (4.57%) patients presented with septicemia and 246 (9.87%) presented with intestinal atresia, 154 (6.18%) neonates had meconium ileus and 125 (5.02%) patients presented with volvulus neonatorum. Total 1791 (71.86%) patients were managed surgically. Most of the surgerical procedures were pelvic colostomy 541 (21.71%), transverse colostomy and biopsies 376 (15.09%), resection and anastomosis 261(10.47%), anoplasty 239 (9.59%), primary repair 135 (5.42%) and ileostomy 104(4.17%). Out of 2492 patients, 351 died, so mortality was 14.09%, before surgery 127 (5.10%) and after surgery was 224 (14.85%). Conclusion: Pediatric surgeons by their skill and teamwork greatly improved the neonatal surgical service and contributing significantly in reducing infant mortality rate to achieve SDG 3. But to improve further, neonatal intensive care unit (NICU) and other support systems are essential as well as support from UNICEF and World Health Organization (WHO) to include pediatric surgery and surgeons in their activities especially in developing countries. Due to socio-political and economic reasons of the developing countries the roll of pediatric surgeons are multidimensional. Bangladesh Med Res Counc Bull 2020; 46(1): 05-11
:Purpose: In order to achieve the Millennium Development Goal (MDG) 4 target of a two-thirds reduction in under-five mortality from 1990 to 2015, major reductions are going to be required in neonatal mortality. Congenital anomalies have become the fourth cause of neonatal deaths and most of these are curable. Dhaka Medical College Hospital is the largest public hospital of the country and serving the poor and lower middle class people where surgery and medical facilities are mostly free of cost. This study was done to see the types of neonatal surgical patients admitted in this hospital and their management out come with limited facilities and find out the ways to improve the scenario to contribute in achieving the MDG. Materials
Thorough clinical examination may identify the anatomical variations of male H-type ARM, and for the treatment of which primary ASAP or ASARP gives good results.
This cross-sectional study was conducted to explore the views of intern doctors regarding reviewing & updating of MBBS curriculum 2002. This study was conducted upon 257 intern doctors of different government and non government medical colleges in Bangladesh. Data were collected using self administered structured questionnaire using purposive sampling. Study revealed that the contents of the course, the teaching methods and the assessments system for the undergraduate medical students needs few improvement as majority of the intern doctors viewed those areas of the curriculum are all right and few of them opined for change. Study revealed that the formative & summate assessments, carry on system, block posting and duration of internship should be redesigned & rethink to make the curriculum more user friendly and effective as intern doctors have different opinions regarding these issues. Study also recommended that more extensive study is needed to get unanimous opinion from the intern doctor's of the medical colleges to review and update the MBBS curriculum 2002. Key words: Review; Update; MBBS Curriculum DOI: http://dx.doi.org/ 10.3329/bja.v9i1.8146 Bangladesh Journal of Anatomy January 2011, Vol. 9 No. 1 pp 35-40
Proximal hypospadias with chordee usually requires two stage procedures: 1 st stage is orthoplasty and ventral parking of prepucial skin and 2 nd stage is urethroplasty after 6 months of 1 st stage. The aim of this study is to describe and report the outcome of a single stage repair-Koyanagi Nanamura procedure for proximal hypospadias with chordee. Between January 2006 to December 2010, 44 boys with proximal hypospadias underwent repair using the Koyanagi Nanamura technique in Paediatric Surgery Department of Faridpur Medical College Hospital and Dhaka Medical College Hospital. The boys' age ranged from 1 to 7 years. The technique employs the use of lateral penile skin and extends into the inner preputial skin. This flap enjoys double blood supply from the base of the meatus as well as the preputial vessels. Follow-up period was 6 months. Satisfactory results were obtained in 39 (88.6%) patients. Three patients developed fistulae. Two patients developed meatal stenosis. Results were considered satisfactory when the boy achieves a glanular meatus, single forward stream, unimpeded voiding, good cosmesis, and no need for secondary surgery for the urethra. Koyanagi Nanamura procedure is a reliable procedure in which the lateral flaps have dual blood supply, which produces good results (88.6%) and is suitable for proximal forms of hypospadias with chordee.
Abstract:Objective: The authors present their experiences in the management of extradural haematoma in children which involved an aggressive diagnostic approach, prompt surgical evacuation of the haematoma results in an excellent outcome.
Abstract:The aim of this study was to determine the feasibility, safety, cost effectiveness and functional outcome between single stage and multiple stage operation of anorectal malformation (ARM) with rectovestibular fistula (RVF).
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