There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO ‘Watch’ list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.

BackgroundViolence affects 15–75% of women across the globe and has a significant impact on their health, well-being, and rights. While quantitative research links it to poor mental health, there is a lack of qualitative enquiry in how women experience it, and how it is related to the mental disorders in Bangladesh. This information is important in understanding the situation and structuring a locally appropriate and culturally sensitive program.MethodsWe adopted a phenomenological approach and conducted 16 in-depth interviews, three informal interviews, one focus group discussion, and one key informant interview. We also reviewed published reports and documents. We followed criterion sampling in selecting women with mental disorders who experienced violence. We explored their experiences and understanding of the issues and described the phenomenon.ResultsWe found that Bangladesh society was largely controlled by men, and marriage was often forced on women. Women often were blamed for any mishap in the family and married women were under social and emotional pressure to keep the marital relationship going even when painful. We found all forms of violence (physical, emotional, sexual etc.) and most of the time found more than one type in women with mental disorders. Sexual violence is a reality for some women but rarely discussed. We found the society very tolerant with mental disorder patients and those who resorted to violence against them.We identified four theoretical understandings about the role of violence in mental disorders. Sometimes the violence predisposed the mental illness, sometimes it precipitated it, while other times it maintained and was a consequence of it. Sometimes the violence may be unrelated to the mental illness. The relationships were complex and depended on both the type of mental disorder and the nature and intensity of the violence. We found most of the time that more than one type of violence was involved and played more than one role, which varied across different types of mental disorders. Interestingly, not all violence that mentally disordered women faced was because they were women, but because of mental disorders, which brought violence to them as a consequence.ConclusionsThe findings of this first ever qualitative study into the experiences of violence by women with mental disorder in Bangladesh can be used in developing a culturally specific intervention to reduce both violence and mental disorders in women.

A high proportion of poly-substance use was found in the study population. Our findings could help in the management and development of prevention strategies for substance use in Bangladesh.

Abstract

Neonatal sepsis is a major cause of mortality and morbidity in newborn. The spectrum of bacteria which causes neonatal sepsis varies in different parts of the world. The organisms responsible for early onset and late onset sepsis are different. The objective of the study was undertaken to determine the pattern of bacterial isolates responsible for early and late onset neonatal sepsis. A prospective descriptive study over the period of one year was conducted at the Department of Neonatal Intensive care unit of Ad-din Women’s Medical College and Hospital, Dhaka, Bangladesh.Organisms were isolated from 8.7% of collected blood samples. The male female ratio of culture proven sepsis was 1.7:1. More than half (52.8%) of the evaluated neonates were preterm. & 56.3% had low birth weight. The gram positive and gram negative bacteria accounted for 24.1% and 75.9% of the isolates respectively. Around three fourth of the neonates (75.8%) presented with early onset sepsis, while 24.2% presented with late onset sepsis. Acinetobacter was the most common pathogen both in early onset (70%) and late onset (30%) sepsis. Pseudomonas (89.4%) was the second most common pathogen in early onset sepsis. Total mortality rate was 5.7%. Pre term, low birth weight and gram negative sepsis contributes majority of mortality.Gram negative organism especially Acinetobacter found to be commonest cause of sepsis. Pseudomonas was second most common but contributed highest in late onset sepsis and neonatal death due to sepsis. DOI: http://dx.doi.org/10.3329/cbmj.v2i1.14184 Community Based Medical Journal Vol.2(1) 2013 49-54

Introduction: Pneumothorax occurs more frequently in the neonatal period than in any other period of life & is associated with increased mortality and morbidity. Several risk factors for pneumothorax, including respiratory pathology, invasive and non-invasive respiratory support & predictors of mortality have been described. Objective: To evaluate the prevalence of pneumothorax, to identify underlying causes & to describe the clinical characteristics, management and outcome of neonates with pneumothorax, as well as to identify predictors of mortality in these neonates. Methods: A retrospective chart review of neonatal records included all neonates hospitalized in the NICU of 'Ad-din Women’s Medical College' Dhaka, between January 2016 & December 2017 with the diagnosis of pneumothorax. The collected data included: demographics & perinatal data, characteristics of pneumothorax, classification, treatment & clinical outcomes. All statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 16. Results: Our study included 83 neonates, of whom 48 were male (57.83%) & 60 (72.29%) born by lower uterine caesarean section (LUCS). Median gestational age(GA) was 36 (32-41) weeks & the median birth weight(BW) was 2,558 (1500-3800) grams. The prevalence of neonatal Pneumothorax in our centre was 2.60% & that of Spontaneous Pneumothorax was 1.53%. The analysis of perinatal data showed statistically significant differences in APGAR score at 5th minute (p = <0.00001) & in resuscitation at birth (p < 0.00001). Pneumothorax was significantly associated with RDS, pneumonia, Meconium aspiration syndrome (MAS) & Perinatal asphyxia (PNA), (p=0.235893) and all (n=6) death were observed in neonates who had coexisting diseases, (p=0.00226). Forty nine (59.04%) was SP (p = 0.002) & mainly observed in the right lung (77.11 %( (p=0.00011). To treat the pneumothoraces, 64 (77.11%) neonates only received oxygen therapy, 16 (19.28%) neonate needed MV along with chest tube (CT) drain, 02(2.41%) thoracentesis with needle aspiration, and 01 (1.20%) needle aspiration & chest tube (CT) drain (p <0.00001). Clinical data suggest that complications such as sepsis, severe hypotension, Necrotizing enterocolitis (NEC), DIC, Intraventricular haemorrhage (IVH) can negatively affect immediate outcomes (p=0.00025). The mortality rate was 7.23%. All the mortalities observed in neonates who got respiratory support with mechanical ventilation (MV) along with CT insertion (p=<0.00001). Hypotension, sepsis, DIC, IVH, MV and thoracentesis followed by a CT insertion were found to be predictors of mortality in neonates with pneumothorax. Conclusion: NP may develop during the neonatal period, especially in the presence of underlying clinical conditions, and neonates with pneumothorax managed with CT drain and respiratory support (MV), despite treatment have a high mortality rate. Bangladesh Crit Care J March 2019; 7(1): 12-19

Introduction: There is a growing focus on researching the management of children with COVID-19 admitted to hospital, especially among developing countries with new variants alongside concerns with the overuse of antibiotics. Patient care can be improved with guidelines, but concerns with the continued imprudent prescribing of antimicrobials, including antibiotics, antivirals, and antimalarials.Objective: Consequently, a need to document the current management of children with COVID-19 across India. Key outcome measures included the percentage of prescribed antimicrobials, adherence to current guidelines, and mortality.Methodology: A point prevalence study using specially developed report forms among 30 hospitals in India.Results: The majority of admitted children were aged between 11 and 18 years (70%) and boys (65.8%). Reasons for admission included respiratory distress, breathing difficulties, and prolonged fever. 75.3% were prescribed antibiotics typically empirically (68.3% overall), with most on the Watch list (76.7%). There were no differences in antibiotic prescribing whether hospitals followed guidelines or not. There was also appreciable prescribing of antimalarials (21.4% of children), antivirals (15.2%), and antiparasitic medicines (27.2%) despite limited evidence. The majority of children (92.2%) made a full recovery.Conclusion: It was encouraging to see low hospitalization rates. However, concerns about high empiric use of antibiotics and high use of antimalarials, antivirals, and antiparasitic medicines exist. These can be addressed by instigating appropriate stewardship programs.

Background: Autonomic nerve function status may be changed during follicular and late luteal phases of menstrual cycle due to fluctuations of serum estrogen and progesterone levels. This alteration in autonomic nerve functions may affect cardiovagal control and usually associated with decreased parasympathetic activity in late luteal phase. Objective: To observe the parasympathetic nerve function status during follicular and late luteal phases of menstrual cycle and also their relationships with serum estrogen and progesterone levels in healthy young women. Methods: This cross-sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka from 1 st January 2009 to 31 st December 2009. A total number of thirty (30) apparently healthy unmarried women age ranged from 20-25 years were studied in both follicular (phase A, control) and late luteal (phase B, study) phases of menstrual cycle. Simple autonomic nerve function tests like heart rate (HR) response to valsalva maneuver (valsalva ratio), HR response to deep breathing, HR response to standing (30 th :15 th ratio) were done to assess parasympathetic activity and serum estrogen and progesterone levels were also measured by AxSYM method. All these tests were performed in both follicular and late luteal phases of menstrual cycle of the same subject. Data were analysed by paired student's 't' test and Pearson's correlation coefficient test as applicable. Results: Mean values of both HR response to valsalva ratio and HR response to standing (30 th :15 th ) were non-significantly decreased but HR response to deep breathing was significantly (p<0.05) decreased in late luteal phase than those of follicular phase. Conclusion: From this study it can be concluded that parasympathetic activity is decreased in late luteal phase of menstrual cycle.