Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. MethodsIn this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middleincome countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42•4% vs 44•2%; absolute difference -1•69 [-9•58 to 6•11] p=0•67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H 2 O; p=0•0011). ICU mortality was higher in MICs than in HICs (30•5% vs 19•9%; p=0•0004; adjusted effect 16•41% [95% CI 9•52-23•52]; p<0•0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0•80 [95% CI 0•75-0•86]; p<0•0001).Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status.

Background: Sepsis was a life-threatening situation affecting roughly 27 million individuals globally every year. Devoid of proper management, sepsis could develop to austere sepsis and septic shock that reason certain eight million expiries every year. Initial identification and analysis of contaminations and quick introductions of antimicrobial management had long been predictable as essential principles of treatment. Methods: All patients were evaluated thoroughly by history, clinical and laboratory findings. Serum lactate levels were collected at 0 hr and 24 hrs of the total admission in the ICU. Blood culture and sensitivity was performed prior to antibiotic administration in this study. Results: In this research, total sample was 1367 patients. Among these sepsis patients were 305 (nearly 22%). These 305 studied sepsis cases, majority 128 (42%) of the patients were within the age group of 41-65 years, followed by 18-30 years consisting of 116 (38%) and the least number of sepsis patients were in the age group of >65 years (20%). This study found that 129 (42.3%) out of 305 blood samples screened from assumed sepsis infection were affirmative for the presence of sepsis causing pathogens. Among the 129 culture positive samples, majority of the isolated microorganisms were gram negative bacteria 58% (75), followed by gram positive bacteria 38% (49), and 3.8% (5) were the fungi Candida albicans. Conclusion: At present, mortality & morbidity of sepsis subject was too big due to late identification, wrong & inadequate management of sepsis in the ward and also in the intensive care unit of Bangladesh.

Coronary arteries supply blood and nutrients to the heart. Coronary Artery Disease (CAD) develops by narrowing of the arteries. Once the inner walls of the arteries are damaged, fatty deposits made of cells, connective tissue elements, lipids and debris decrease their lumens which block blood flow to distal tissues. This process is called arteriosclerosis. This study intends to detect the composition of human coronary atheroma collected from the arteries during bypass surgeries in Bangladesh. It shows that all lesions are present in the advanced types, namely, type 4, 5 and 6. Infrequently thrombotic materials and necrotic debris were found in type 6 plaque. The mean length of plaque was 3.36 ± 1.71 cm and mean weight was 0.13 ± 0.12 gm. Insufficient lipid was obtained from each atheroma. Few raised areas were lipid laden whereas most of the strands were fibrous. Biochemical assessment was formidable. The cholesterol composition of coronary plaque ranged between 0.20% -9.83% with mean 3.06% ± 2.09% and total fatty acids ranged between 0.47% -3.04% with mean 1.31% ± 0.63%. The most abundant fatty acid was oleic acid (unsaturated) closely followed by palmitic acid (saturated). The mean calcium content was 41,180.20 ± 34,918.59 ppm and ranged from 1148.00 -140,311.00 ppm or, 0.115% -14.031%. This study was undertaken to detect the composition of human coronary atheroma in Bangladesh which revealed that it depended upon the type of lesion.

Cross-sectional descriptive study at Dhaka Medical College Hospital from January to December 2013. This study evaluated the medical supply chain in a Dhaka public tertiary hospital. Respondents were hospital shop employees who kept data on medicine procurement, storage, and distribution. 51-59-year-olds made up 36.6% of respondents. 68.3% of the store's workforce were pharmacists. 82.9% of respondents have a diploma or degree. 70% of personnel lacked retail management training. The investigated store had no AC or chiller. Store had a fridge. The pharmacy's drug procurement and selection committee was present. More than half (55%) of drugs were purchased using open tender. Direct purchases made up 30%, donations 13%, and other methods 2%. The store has an expiration-date section. The store contains updated volatile drug storage, safety stock, a stock ledger, vouchers, and invoicing. The shop had no electronic ledger. Lack of space, shelves, a damp or cracked wall, and a refrigerator were issues. Labor was scarce. Shop managers say improve quality management. During the drug receiving procedure, analytical testing ensures preservation and efficacy. Store management in our nation can be improved by giving refresher training on regulations and legislation and maintaining an electronic ledger via a database system.

No abstract

No abstract

No abstract

No abstract