Background : This study is a sub analysis of data submitted on behalf of Bangladesh to an international study (2013-2014) involving Asian ICUs and merits comparison with prior study done in Bangladesh in 2007 which had similar objective. Objective : To assess structure, organization and delivery of ICU care in ICUs of Bangladesh with attention to hospital organizational characteristics, ICU organizational characteristics, staffing etc. Method : Prospective cohort study involving ICUs of 51 hospitals of Bangladesh done in 2013-2014. The hospitals in our study were divided into three groups : clinics/hospitals less than 50 beds (n =18), clinics/hospitals more than 50 beds(n=24) and Govt. hospitals/academic hospitals/ medical colleges hospitals (n=9). Results : Most respondent hospitals were from Dhaka (77.4%). Only 17.6% hospitals were university affiliated. The average number of hospital beds were 225. The average number of ICU beds were 14. 19.6 % hospitals had infection control committees. Basic life support training was required for doctors and nurses in 31.4 % and 27.5 % hospitals respectively. Small clinics/ hospitals (less than 50 bed capacity [n=18]) had significantly less government funding (p < 0.0001), were less attached to university hospital (p < 0.0001), had fewer referral centers (p < 0.001), had less total hospital beds (p < 0.004) and were less in case of ICU beds : hospital beds percentage (p < 0.003). 28 ICUs had no single room. Govt. hospitals/academic hospitals/Medical colleges had relatively more ICU beds .(12.33% - p < 0.004). 60.8% ICUs were operated as open units. Open units were more likely present in hospitals/clinics more than 50 beds. Multivariable analysis showed that the presence of 1:1 nursing staff was much lower in private hospitals. Funding sources and types of hospitals were independently associated with lower percentage of ICU beds (p < 0.002) and (p < 0.0001) respectfully. University affiliations was more likely associated with closed ICU (p < 0.002). Presence of MD CCM qualified intensivists are more in government funded hospitals (p < 0.003) than those of private hospitals Conclusions : Our study demonstrates considerable variation in the organization and staffing among Bangladeshi ICUs. Compared to 2007 study it shows increased trend in number of closed units( 39% vs 15%) and percentage of ICU beds relative to number of hospital beds (6.5% vs 4.8%) . Bangladesh Crit Care J March 2019; 7(1): 3-11
The world is heavily suffering from the COVID-19 pandemic for more than a year, with over 191 million confirmed cases and more than 4.1 million deaths to date. Previous studies have explored several risk factors for coronavirus disease 2019 (COVID-19), but there is still a lack of association with ABO blood type. This study aimed to find out the relationship between the ABO blood group and COVID-19 outcomes in Bangladesh. Subjects and Methods: This retrospective cross-sectional study was conducted in the intensive care unit (ICU) of a tertiary-level COVID-dedicated hospital in Dhaka city, Bangladesh, between April 2020 and November 2020. Records from 771 critically ill patients were extracted who were confirmed for COVID-19 by reverse transcriptasepolymerase chain reaction (RT-PCR) assay, and blood grouping records were available in the health records. Results: The blood groups were 37.35%, 17.38%, 26.46%, and 18.81% for A, B, AB, and O type, respectively. Clinical symptoms were significantly more common in patients with blood type A (p < 0.05). Patients with blood type A had higher WBC counts and peak serum ferritin levels and both were statistically significant (p < 0.001). Patients with blood type A had a greater need for supplemental oxygen, and they were more likely to die in comparison to the patients with other blood types (p < 0.05). In multivariable analysis, our primary outcome death was significantly associated with blood type A (AOR: 3.49, 95% CI: 1.57-7.73) while adjusting for age, male gender, and non-communicable diseases. Conclusion:Based on this study results, it can be concluded that the COVID-19 patients with blood type A have a higher chance of death and other complications. The authors recommend blood grouping before treating the COVID-19 patients, and healthcare workers should prioritize treating the patients based on that result.
Lightning injuries are injuries caused by lightning strikes. Lightning delivers a massive electrical pulse over a fraction of a millisecond. It can kill a person by instantaneously short-circuiting the heart. Lightning injuries have been the second most common cause of storm-related death in the United States1,2,3. Far more injuries and deaths occur in tropical and subtropical countries. Here we present the case report of a 45 year old Bangladeshi lady who was struck by lightning. Patient presented with immediate loss of consciousness and some superficial skin burn about 1 hour following the event. Over the next few days she was found to have intracerebral haemorrhage and infarct, tympanic membrane rupture and bilateral cataract. Surprisingly patient did not suffer from any cardiac or renal injury. All lightning strike victims should receive emergency medical support on site of injury and be treated in intensive care units (ICU) equipped with multiple organ support facility.Bangladesh Crit Care J September 2017; 5(2): 132-134
Background: For assessment of unconscious state in Medical Intensive Care Unit, physician mostly rely on Glasgow Coma Scale (GCS). But its verbal component has limitations in aphasic and intubated patient. More over its predilection ability to mortality is hardly challenged. The FOUR (Full outline of unresponsiveness) score, a new coma scale, evaluates 4 components: Eye, motor responses, brain stem reflexes and respiration. Aim of this study was to compare Full Outline of Unresponsiveness (FOUR) scale for prediction of mortality among patients admitted in Medical Intensive Care Unit (MICU) of a tertiary care hospital of Bangladesh with Glasgow Coma Scale (GCS). Objectives: To compare prediction of mortality between Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) scale. Methods: This is a prospective observational study was carried out in the Department of Critical Care Medicine, BIRDEM General Hospital to compare the mortality predilection in between FOUR score and GCS score. All consecutive adult unconscious patients over the age of 18 years were included in this study. Sedated patients were examined while they were not getting sedation or during routine sedation window period. Altered conscious level was examined by both GCS and FOUR scales. Data were collected using a check list containing demographic information, preexisting chronic illness, biochemical markers, imaging findings etc. Later patients were followed up and data regarding ICU stay, mortality and time of discharged from ICU were recorded. Both GCS and FOUR score were compared between survivor and non-survivor group and compared both score in between non-survivor group. Ultimately data were analyzed by using Statistical Package for Social Sciences (SPSS) software (version 20). Results: Total 105 unconscious patients were enrolled within the study after fulfilling inclusion & exclusion criteria. Among them 34 patients were survivor and 71 patient were non-survivor. The mean and SD of age in this study were 64 .55 ±14.65 years. The peak age distribution was (61-70) 39%. Among them 54.3 % (n=57) were male and 45.7 % (n=48) were female. DM (82.85%) was the most common comorbidity and the predominant diagnosis was Septic shock 33% followed by Ischemic stroke 29%, Meningo encephalitis 19.04 %, and Electrolytes imbalance 17.14%, Cardiogenic shock 12.38% etc. In both GCS and FOUR score their value significantly differ in case of both survival ([7.15± 1.56]; P<.0001 and [7.74± 2.26]; P<.0001) and non-survival group ([5.38± 1.96]; P <0.0001) and ([5.35± 2.83]; P <0.0001). But comparison of FOUR score (5.35± 2.83) with GCS (5.38± 1.96) in terms of predicting mortality their value not significantly differ (P <0.93). So both GCS and FOUR score is equally effective predicting mortality among unconscious patients. Conclusion: Both GCS and FOUR score significantly vary among survivor and non-survivor groups of unconscious patients but while comparing them regarding predicting mortality there is no significant differences in both score. Finally we conclude that both GCS and FOUR score equally good at predicting in hospital mortality among unconscious patients admitted in MICU. Bangladesh Crit Care J September 2022; 10(2): 76-81
Ascites is an infrequent presentation of poorly controlled congestive cardiac failure. Tense ascites due to heart failure is more infrequent. Whenever there is tense ascites, intra-abdominal hypertension should always be considered. The most deleterious effect of intra-abdominal hypertension is abdominal compartment syndrome. It is a condition that is frequently overlooked and underdiagnosed. Abdominal compartment syndrome is a medical as well as surgical emergency which should be promptly diagnosed and adequately managed; otherwise, it may lead to multiple organ failure and death. Here we present a patient with congestive cardiac failure leading to huge ascites, intra-abdominal hypertension and abdominal compartment syndrome. Bangladesh Crit Care J September 2022; 10(2): 149-153
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