Background: Tetanus is a vaccine preventable serious disease that can affect people of all age group with a high mortality. Although tetanus incidence is significantly reduced due to nationwide vaccination coverage, it is not uncommon in our country. Aims & Objectives: To determine of the socio-demographic profile, nature of injury, incubation period and outcome of the tetanus patients who were admitted in the Infectious Diseases Hospital, Dhaka during the study period. Materials and Methods: This cross sectional observational study was done in the Infectious diseases hospital, Dhaka during the period of February 2017 to January 2018. The data, were collected, compiled and analyzed. Results: Out of 149 patients, neonates were 13(8.7%) in number. Most of the cases were in middle aged group. Malefemale ratio about 4.5:1. Majority of the patients (134, 89.9%) had no history of immunization but one patient was immunized within five years. Mean incubation period tetanus was 8.45 days with ±5.56 SD. Death occurs in 41(27.5%) patients and all of them had no history of immunization. Death rate of patients having early incubation period was significantly higher (p=0.003). Death rate in neonatal tetanus (53.84%) also significantly higher than that of non-neonatal tetanus (25%) (p= 0.026). Conclusion: Tetanus is not uncommon in Bangladesh, especially in neonates and adult male and mortality rate is high. Short incubation period predicts were outcome. J Bangladesh Coll Phys Surg 2021; 39(3): 160-166
Background: Emergency department is one of the most important parts of a hospital which is the point of major public health interest. Objective: The purpose of the present study was to find out the existing facilities of emergency department, to assess the satisfaction of patients and health care providers on emergency services. Method: This cross-sectional study was carried out at emergency department of Mugda Medical College, Dhaka, Bangladesh from January 2017 to June 2017 for a period of six (06) months. Research instruments were semi structured questionnaire. Existing facilities at emergency department were assessed by check list which was adopted from Table of Equipment (TOE) by Directorate General of Health Service (DGHS) and satisfaction level was categorized as good and bad. Face to face interview was taken from emergency patients and health care providers attending in emergency unit. Result: A total of 75 samples of respondents were selected purposively. Most of the respondents (30.0%) were in 26 to 35 years age group. According to their education level, 24(48.0%) were illiterate. Most of the respondents (76.0%) were attended to emergency unit by walking; however 48(96.0%) respondents attended by health care providers immediately. Half of the patients (50.0%) buy drugs from local dispensary and investigation in hospital was also done by half of the patients. After reaching at emergency, maximum patients 25(50.0%) waited for 1 to 5 minutes for receiving medical attention and mean waiting time was 10.14 minutes. Overall satisfactory level at emergency unit was good 23(46.0%) and bad 27(54.0%) (p<0.0001). Conclusion: Numbers of potential barriers influence the patients’ satisfaction. Periodic patient satisfaction survey should be institutionalized to provide feedback for continuous quality improvement. Journal of Current and Advance Medical Research 2019;6(1):53-58
Background: Acute promyelocytic leukaemia (APL) is curable with carefully selected treatment protocol. Reduction of early fatal haemorrhage in initial phase of induction with cost effective combination of chemotherapeutic agents is considered to be the main challenge for successful outcome in APL. Objective: The study was conducted to see the effectiveness of the use of all-trans retinoic acid (ATRA) followed by single agent Arsenic tri oxide (ATO) in the induction phase of the management of APL. Methodology: This is an observational study and was conducted from October 2012 to September 2013, in department of Haematology and BMT of Dhaka Medical College Hospital, Dhaka, Bangladesh. Total 17 patients with PML/RARA positive APL were enrolled and all patients were treated with sequential use of ATRA in a dose of 45mg/m2 for initial 2-3 weeks up to differentiation and then ATO in a dose of 0.15mg/kg daily was used in induction up to 60 days after taking informed written consent. Outcome was drawn after consolidation of therapy. Results: The morphologic complete remission rate was 88.2%. Remission failure was in observed in 2 cases (11.8%) that died at day 12 and day 51 due to differentiation syndrome and arrhythmia respectively. No death observed within first 10 days of treatment initiation. Complications observed during management were weight gain (11, 64.7%), hyper leucocytosis (10, 58.8%), ATRA syndrome (9, 52.9%), headache (6, 35.3%), tachycardia (5, 29.4%), hypomagnesaemia (3, 17.7%) and supra ventricular tachycardia (1, 5.8%). Conclusion: Initial use of ATRA up to differentiation of promyelocytes before use of single agent ATO induction and consolidation can be a cost-effective alternative against newly diagnosed APL in reduction of early haemorrhagic death.
Background: Haematological malignancy and its treatment produce multiple symptoms that significantly distress patients and impair function. Symptoms caused by treatment may delay treatment or lead to premature treatment termination and residual treatment-related symptoms often complicate post treatment rehabilitation. When treatment is no longer possible, symptom control becomes the focus of cancer care. Objectives: The study was aimed to determine the symptom burden of the haematological malignancy patients. Methods: A cross sectional study was conducted from July 2015 to June 2016 among the haematological malignancy patients. A total of 316 haematological malignancy adult (age ≥18 years) patients were purposively selected from haematology department of two tertiary level of hospitals in Dhaka city. Face to face interviews were taken from the diagnosed haematological malignancy patients admitted in the hospital and attending outdoor using questionnaire based on symptom distress scale (SDS). Results: Mean age was 39 years and most of the patients suffering from Acute Leukemia 162(51.3%). Mean monthly family income was around 22235 taka and 120(37.9%) patients were unemployed. Patients with haematological malignancy had a considerable physical and psychological symptom burden which ranged from 94.3% for fatigue to 8.5% for difficulty in concentration. Physical symptoms such as fatigue 127 (40.2%), change in appetite 86 (27.2%), pain1 81 (25.6%), insomnia44 (13.9%) caused severedistress and psychological symptoms include change in appearance 37 (11.7%) and outlook 33 (10.4%) were sever distressing. Significant association (p<0.001) was to be found between occupation and symptom distress where 82 (68.4%) unemployed and 51 (66.3%) housewife had moderate/sever symptom distress. Respondents who managed their treatment expenditure by loan and asset sell 11 (84.6%) had significant(p=0.004) moderate/sever distress. Patients having less than one month of diagnosis 47(72.3%) and admitted in inpatient 114 (66.6%) had significant higher moderate/sever symptom distress(p=0.03) and (p<0.001) respectively. Conclusion: Patients with haematological malignancy were likely to have multiple symptoms and comprehensive symptom assessment was suggested throughout. The introduction of supportiveor palliative care services during times of increased symptom burden may assist haematologists and other careers in the management of their patient’s distress and quality of life. Bangladesh Med Res Counc Bull 2020; 46(3): 196-203
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