Background: Community clinics have been restarted in 2009 by government of Bangladesh through a project called “Revitalization of Community Health Care Initiatives in Bangladesh” (RCHCIB) to enhance provision of healthcare services at community level. We have conducted a survey on provision of health care service to recognize the availability and extent of health services provided in a community clinic of Bangladesh.Methods: 25 respondents who usually receive primary health care service from Raicho community clinic situated in Comilla district of Bangladesh were included in the survey.Results: The highest number of respondents was male (52%) and the majority of them were literate (96%).36% of study population were included in no income group, whereas 20% belong to rich population group. 32% people presented with fever (32%) followed by weakness (24%) in the community clinic. 32% respondents went to community clinic for him/her and that was the highest. The highest number of people were referred to private clinic (32%). 70% respondents think that women are receiving maternal service in the clinic. 88% respondents have participated in EPI vaccination program. 80% respondents use contraceptive method and majority used contraceptive pill. 68% people received sufficient medicine, whereas 32% respondents did not receive medication from the clinic. 75% respondents think that during working hours CHCP and HA are available in the clinic. 48% population mentioned corruption is the most possible responsible factor for heath service inequalities at grass-root level.Conclusions: Although standards are lacking in providing services, community clinics have opened a new era in health service of Bangladesh.
<p class="abstract">Parotid gland cancer (PGC) are rare and accounts for 3% of all head and neck malignancies.The classification of parotid tumour is complex and comprises both benign and malignant neoplasms of epithelial and non-epithelial origin.There is marked variation in the histological features of these tumours,therefore treatment options of parotid cancer is widely varied.Lymph node metastasis to the neck is one of the most important factors in therapy and prognosis for patients with parotid malignancy. This article reviews the literature regarding neck management of parotid cancer in cases of both clinically positive (cN+) and clinically negative (cN-) neck nodes. The literature search was performed using Google search engine, PUB Med to identify relevant articles on recommendations for neck management in patients with parotid cancer in cases of both clinically positive (cN+) and negative (cN-) neck nodes. Due to the rarity of parotid cancer and the wide histopathological varieties, the literature was hard to interpret. There is a consensus about managing clinically positive neck with therapeutic neck dissection. Most studies agree on elective neck dissection in certain indications which are high T stage, high grade histology, facial paralysis, age, extraglandular extension, peri-lymphatic invasion. Level II to IV appears to be at higher risk and can be done through the same parotidectomy incision. The role of irradiation in cN- necks is not clear but some studies recommend its usage for curative intent and argue that it adds less morbidity than the elective neck dissection. Although the management of the neck in cN+ patients is widely agreed, controversy still exists about the need for elective neck dissection in cN- patients and the levels which should be dissected.</p>
Aim Endoscopy services across United Kingdom were affected significantly since March 2020 due to Covid-19 pandemic. Services were reduced and were more selective. We aim to compare the impact on duration between referral to colonoscopy and the detection rate of pathology between February (pre- Covid) and August (Covid impacted) 2020. Method Data was analysed from a prospectively maintained database of patients referred for colonoscopy to Royal Alexandra Hospital, Scotland. Patients underwent colonoscopy in month of February and August 2020 were included. Bowel screening patients were excluded. Positive findings included diverticulosis, colitis, polyp and adenocarcinoma. P value of < 0.05 was considered significant. Results Total number of patients included was 97 (55 in February, 42 in August). Median age was 61 and 69 years, respectively. Mean duration from referral to colonoscopy were 4 weeks in February and 7 weeks in August. qFIT test were found raised in 50.9% in February and 57.1% in August with positive findings of 47.3% in February and 66.7% in August. 46.4% in February and 16.7% in August had raised qFIT but normal findings (p < 0.05). Two high grade dysplasia polyps and two adenocarcinomas were identified in February, none found in August. Conclusions Covid-19 pandemic has disrupted the endoscopic services prolonging the duration from referral to colonoscopy. qFIT test is more heavily relied to prioritise urgent colonoscopies resulting in more positive findings on colonoscopy. Cancer detection rate has reduced which is a consistent finding as the UK national endoscopy study. Massive efforts are needed to restore endoscopy services.
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