Background: Patients admitted with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) are often prescribed ipratropium bromide in combination with a β2 agonist like salbutamol. Many studies have not shown any benefit in adding ipratropium bromide to salbutamol in acute exacerbations of COPD. Objectives: To compare the response of combination therapy with two drugs vs. salbutamol alone in the treatment of acute exacerbations of COPD during hospital admission. Materials and Methods: This cross-sectional comparative study was conducted among one hundred patients of acute exacerbation of COPD admitted in Rajshahi Medical College Hospital from January 2012 to July 2012. The patients were randomly allocated to receive either solution-1 (salbutamol 5mg alone) or solution-2 (salbutamol 5mg plus ipratropium bromide 500μgm) (all four times a day) on admission. All other treatment was prescribed at the discretion of the attending physician.FEV1 and FVC values at baseline, at 1 hour, on day 1, day three, and on discharge date were assessed. Patients completed a subjective symptom score at 1 hour, Day 1, Day 3, and on the discharge date. Length of stay in hospital was assessed. Results: There was no significant difference in spirometric values at 1 hour, Day 1, Day 3, and during discharge between the two groups. The subjective improvement was similar with both treatments. There was no difference between the two groups in the mean (±SD) length of hospital stay (salbutamol 5.98(±1.67) days, salbutamol plus ipratropium bromide 5.8(±1.39) days; t=0.586, p>0.05). Conclusion: The routine addition of nebulized ipratropium bromide to salbutamol appears to be of no benefit in the treatment of acute exacerbations of COPD. TAJ 2021; 34: No-2: 56-63
Background: Hepatitis C virus (HCV) has been described as a significant causative agent of chronic hepatitis since its characterization in 1989. HCV may remain latent or become activated, leading to persistent infections and, in some cases, cirrhosis and hepatocellular carcinoma HCV is most commonly transmitted through direct contact with infected blood. Other, less common routes of transmission of HCV include sexual intercourse with infected individuals and mother to child transfer. Materials and Methods: This is a cross-sectional descriptive type study which was carried out in the Department of Transfusion Medicine of Rajshahi Medical College Hospital for six months from January to June 2014 to determine the prevalence of hepatitis C virus in the apparently healthy blood donors. All apparently healthy blood donors fulfilling the inclusion and exclusion were included in this study. The blood donors who were positive for anti-HCV antibodies were seropositive. Anti HCV antibody screened by ICT and confirmed by ELISA method. Results: Among 1712 apparently healthy blood donors, 36 (2.1%) donors were anti-HCV positive, and 1676 (97.9%) donors were negative. The mean age of the study patients was 34.05 years (SD = ± 8.79). 66.7% of the study patients were male, whereas 33.3 % of donors were female among the 36 blood donors. Conclusion: It is absolutely necessary to avoid the transmission of infection from repeat donors who are asymptomatic HCV positive. Policymakers and public health stakeholders need to introduce and implement further preventive measures targeting the routes of HCV transmission. TAJ 2021; 34: No-2: 24-31
Background: Depression is one of the most common comorbid psychiatric disorders associated with diabetes mellitus (DM), and it impacts glycemic control. Optimal management of depression may lead to better control of glucose levels in DM. Objectives: The aim of this study was to assess depression in patients with DM and to compare it with healthy control and to determine the association of depression with glycemic control and socio-demographic profile in patients with DM and healthy control. Patients and methods: This cross-sectional comparative study was conducted among 140 patients with DM attending Rajshahi Medical College Hospital and Diabetic Association Hospital, Rajshahi, from July 2014 to June 2016. Subsequently, 140 age-matched healthy controls were included in this study. The DSM-V criteria were used to diagnose depression and the severity of depression was assessed by the Hamilton rating scale for depression. Blood glucose control was assessed by measuring HbA1c and categorized as: good glycemic control <7%, fair glycaemic control 7-8% and > 8% considered as poor glycemic control. Results: The proportion of depression was significantly higher in the patient (51, 36,4%) than in the control (20,14.3%) (X2= 18.256, df= 2, p <0.001). Among patients 13 (9.28%) had mild depression, 23 (16.42%) had moderate depression and 15 (10.70%) had severe depression. But among control 11 (7.87%) had mild depression, 7 (5%) had moderate depression and 2 (1.43%) had severe depression. Depression was more in patients aged 40-60 years (45,42.1%) than in those aged 18-39 years (6,18.2%) which was statistically significant (t = - 3.947, p < 0.001). Both mild, moderate and severe depression were more common among singles, obese, Type 2 DM & patients who were taking both insulin & OHA. Statistically significant depression were observed in poorly controlled DM (HbA1c>8%) compared to fair control (HbA1c 7-8%) (p <0.001, 95% CI = 2.29 to 3.82) and good control (HbA1c < 7%) (p <0.001, 95% CI = 4.25 to 5.98).The likelihood of depression was not significantly associated with different occupation, level of education, residence and duration of DM. Significant positive correlation was observed between DSM-V score and age (r = 0.295, p<0.001),BMI (r = 0.473, p<0.001), duration of DM and HbA1c (r = 0.734, p<0.001) in patients with DM. Conclusion: Our findings demonstrate that there is a higher proportion of depression in patients with DM, which is almost thrice than healthy control. Since patients with DM are at higher risk of developing depression, assessment of depression should be part of the initial and ongoing evaluation of these patients to improve their quality of life. TAJ 2021; 34: No-1: 47-54
Acute pyelonephritis (APN) is the most common bacterial infection involving the upper urinary tract system, including the renal parenchyma and pelvis. Complications of APN include renal abscess, septic shock, and renal impairment, including AKI. At the same time, antibiotic resistance of uropathogens Resulted in unfavorable clinical responses in APN. The objective of the study was to evaluate the clinical characteristics of patients with APN and antimicrobial susceptibility of causative bacteria. It was a cross-sectional type of observational study which included 100 diagnosed patients of APN admitted into the department of nephrology, Rajshahi Medical College Hospital, Rajshahi, from January 2018 to December 2018. In both males and females, E. coli was the major causative bacteria (51.1% vs. 48.9%). Renal failure was present in 87% of patients, and among them, AKI was present in 81.6% and CKD in 18.4%). Infection with klebsiella was significantly more common among CKD patients as compared to AKI (p<0.05). Commonly used antibiotic ceftriaxone was found significantly resistant in the case of E. coli (p<0.01) and klebsiella (p<0.05). In the majority of cases (>50%), E. coli was susceptible to nitrofurantoin, amikacin, imipenem, meropenem, and piperacillin-tazobactam. Resistance to antibiotics may complicate the condition. Antibiotic resistance to several commonly used antibiotics TAJ 2021; 34: No-2: 32-42
Coronary artery disease is one of the commonest causes of death of our hospitalized patients. It has a number of risk factors such as age, sex, family history, smoking, hypertension, diabetes, dyslipidemia and obesity. Serum uric acid appears to be another risk factor found in several researches. This study was done to find out the prevalence of high serum uric acid in hospitalized acute myocardial infarction patients. This was a descriptive cross-sectional study carried out in department of Cardiology, Rajshahi medical college hospital from January 2015 to December 2016. 115 (one hundred fifteen) AMI patients were included. Baseline characteristics such as age, sex, body mass index, blood pressure, risk factors-hypertension, diabetes mellitus, smoking, family history of IHD, dyslipidemia was recorded. We measured serum uric acid of this patient at admission. Out of 115 patients, 83.5% were male and 16.5% were female. Among risk factors 65.2% had history of hypertension, 20.9% diabetes mellitus, 64.3% smoking, 16.5% family history of IHD and 47.8% dyslipidemia. Out of 115 patients, 35.7% had high serum uric acid and 64.3% had normal serum uric acid. There was no significant difference of confounding variables between high and normal serum uric acid level patients. We found larger number of AMI patients with high serum uric acid. So, high serum uric acid may be a risk factor for acute myocardial infarction. TAJ 2021; 34: No-2: 102-107
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