We describe the palliative care needs of children with chronic conditions and their caregivers in an urban slum in Bangladesh. In this cross-sectional study, we interviewed 25 caregivers whose children receive support from a community-based program lead by community health workers, that provides medication, medical supplies, food, caregiver training, and psychological support free of charge. The chronic conditions of children in the program included cerebral palsy (80%), congenital heart disease (8%), neurodegenerative conditions (4%), cancer (4%), and intellectual disabilities (4%). Common symptoms included cough or breathing problems (64%), fever (56%), and pain (56%). Most caregivers (96%) reported they were unable to do any paid work due to their child’s needs and in all families, the child’s condition had a significant impact on their financial situation. Community-based palliative care programs can be developed to support children with chronic conditions who may not access care from acute care facilities.
Introduction: Stroke is the leading cause of disability among adults globally. The importance of early intervention is well known to prevent permanent disability and mortality otherwise caused by the ischemic stroke or hemorrhagic stroke. Objective: Aims of this study are to assess the level of pre-hospital delay and reasons for such delay in acute stroke patients. Methods and Materials: An observational study was carried out in the Department of Medicine, Dhaka Medical College Hospital between December 2012 to January 2013 among stroke patients (Age greater than 18 years, both gender, with Clinical features and neuroimaging findings consistent with stroke). The questionnaire regarding patients age, sex, occupation, presenting symptoms, associated disease like DM, HTN etc., duration of symptoms, mode of transportation, type of consultation sought, causes of delay, their socio-economic status were filled up by investigator. Result: In our study out of 100 patients 55 (55%) had ischaemic stroke and 45 (45%) had haemorrhagic stroke. The median delay from onset of symptoms to hospital arrival was 6 hours. The main cause of delay in reaching hospital was identified as indecision (40%). The other causes include financial constrain (30%), non-availability of transport (22%), traffic jam (10%), lack of manpower (20%) and consultation with rural medical practitioners (30%). Conclusion: Early intervention is very important to prevent permanent disability and mortality in case of stroke. So, it is important to take necessary steps to raise awareness among health care professionals and general population reagarding handling stroke patients and sending them to specialized hospitals where adequate facilities are present.DOI: http://dx.doi.org/10.3329/jom.v14i2.18459 J Medicine 2013, 14(2): 106-109
Diabetes mellitus is one of the most common medical complications of pregnancy; gestational diabetes mellitus (GDM) accounts for approximately 90-95% of all cases. The incidence of gestational diabetes is increasing. It has been demonstrated that good metabolic control maintained throughout pregnancy can reduce maternal and fetal complications in diabetes Traditionally, insulin therapy has been considered the gold standard for management There has been a traditional reluctance to recommend oral antidiabetic drugs for the management of hyperglycaemia in gestational diabetes mellitus. The medical management of gestational diabetes is still evolving, and recent randomized controlled trials have given a glimse of hope for woman who likes to avoid insulin and prefer oral agents. The current short acting insulin analogs lispro and aspart are safe, but there are only limited data to support the use of long acting insulin analogs. There are randomized controlled trials which have demonstrated efficacy of the oral agents glyburide and metformin. Whilst shortterm data have not demonstrated adverse effects of glyburide and metformin on the fetus, and they are increasingly being used in pregnancy, there remain long-term concerns regarding their potential for harm. This controversy related article gives an overview of the rationale for use of oral antidiabetic agents in the treatment of gestational diabetes. DOI: 10.3329/jdmc.v17i2.6596J Dhaka Med Coll. 2008; 17(2) : 127-130
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