Evaluation of the Braden Scale Implementation by nurses: A Case Study in a Specialized Hospital in the Dhaka City.

Objective: The aim of this routine to research (R to R) developmental study was to implement the Braden Scale (BS) to identify risks of pressure ulcer (PU) development among hospitalized patients with spinal cord injury admitted in National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Bangladesh. Methods: Roger’s Diffusion of Innovation Theory and PU related literature were used to guide the development of the implementation. The subjects were 10 nurses and 13 doctors who were working at the NITOR. Different strategies were provided for the implementation of the BS including workshops to provide knowledge, persuasion, and decision making to implement the BS for the nurse participants. The outcomes of this study were to determine: (a) nurses’ adoption in terms of the rate of using the BS and the accuracy of using the BS to identify PU risks, (b) nurses’ satisfaction to use the BS, and (c) doctors’ satisfaction on the implication of the BS to identify the risks of PUs in hospitalized adult patients with paraplegia. Data were analyzed by descriptive statistics and percentage of agreement. Results: Weekly proportions of nurses’ adoption in terms of the rate of using the BS ranged from 96% to 100%. The accuracy of using the BS yielded percentage of agreement between 70.6% to 100% for each item of the BS. Nurses’ and doctors’ satisfactions were at very high levels. Mean score of nurses’ satisfaction was 98.5% (SD=1.23) and mean score of doctors’ satisfaction was 89.79% (SD=4.17). Conclusion: Nurses are capable to assess PU risks of paraplegic patients independently by using the BS and may be incorporated to identify PU risks in addition to their work protocol. After identifying the PU risks, effective nursing care should be implemented to the patients in order to prevent the PU formation.

A rare case of disseminated cysticercosis: Case report and literature review.

Cysticercosis is a common tropical disease. One of the uncommon manifestations of cysticercosis and a rare complication is its disseminated form. We report an immunocompetent patient with disseminated cysticercosis who had involvement of the brain, subcutaneous tissues, lungs and skeletal muscles and presented with arthritis. He was otherwise asymptomatic in spite of the extensive involvement of multiple organs. A planned approach to therapy is necessary to prevent complications.

Short Term Urinary Catheterized Patients in Intensive Care Unit (ICU) – A Need to Screen.

Catheter-Associated Urinary Tract Infection (CAUTI) is the second most commonly reported healthcare associated infection, accounting for upto 40% of all nosocomial infections. Silent catheter associated bacteriuria comprises a huge reservoir of resistant organism in hospitals particularly in critical care units. We prospectively studied 100 newly short term catheterized patients in a tertiary care hospital. Samples collected on day three and daily thereafter for semi quantitative urine culture and pus cell count. Antibiotic sensitivity was tested using Kirby-Bauer disc diffusion method. Out of hundred patients, 32 showed growth on fifth day and remaining 68 samples were culture negative up to seventh day. None of the culture positive samples had pus cells. Escherichia coli (35%) was the predominant isolate followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus faecium, Candida spp (15% each) and Coagulase negative Staphylococcus (5%). Among the Gram negative organisms, four strains of Escherichia coli and two strains of Klebsiella pneumonia were Extended Spectrum Beta Lactamases (ESBL) producers and 33.3% were Multidrug resistant Pseudomonas aeruginosa. Multidrug resistant pathogens in an asymptomatic short term catheterized patient are a major reservoir in hospitals. This emphasizes the importance of periodic surveillance for nosocomial infections in hospital and the periodic screening will also help us to frame antibiotic policy in a new tertiary care hospital.

Prevalence of diabetes and impaired fasting glucose in urban population of Bangladesh.

We investigated the prevalence of type 2 diabetes (T2DM) and impaired fasting glycemia (IFG) and their risk factors in the urban population of Bangladesh. The study was carried out in Dhaka City Corporation with a population of 99,12,908 in 20,89,336 households distributed in 95 wards. Using a multistage cluster sampling, we investigated 5265 eligible participants of 20 age years and above for height, weight, waist-girth, hip-girth, blood pressure and fasting blood glucose. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. We used WHO diagnostic criteria of 1999. The overall prevalence of T2DM was 11.2% and IFG was 5.9%. The age-standardized prevalence of T2DM (95% CI) was 10.5% (9.37-11.13) and IFG was 5.2% (4.51-5.84). Compared with the slum dwellers, the non-slum dwellers had significantly higher prevalence of both T2DM (7.4 vs. 13.4%, p<0.001) and IFG (4.1 vs. 7.4%, p<0.001). Logistic regression analysis showed that family history of diabetes, higher family income, sedentary lifestyle and higher quartiles of age, BMI and WHR were significantly related to diabetes. The prevalence of diabetes in the urban population has increased alarmingly in recent years. Older age, obesity, higher income, family history of diabetes and reduced physical activity were proved to be the significant risk factors for diabetes and IFG.

Waist-to-height ratio is a better obesity index than body mass index and waist-to-hip ratio for predicting diabetes, hypertension and lipidemia.

Body mass index (BMI, kg/m.sq) and waist-to-hip ratio (WHR) are widely used as obesity indices for diabetes and cardiovascular risks. Lower adult height was related to diabetes and stroke. Waist-girth was proved important for visceral obesity. Incorporating waist-girth and height as waist-to-height ratio (WHtR), we reported earlier--"Waist-to-height ratio is an important predictor of hypertension and diabetes". We readdressed this index in a larger sample with two-sample OGTT and lipid profiles. In a cluster sampling of 16,818 rural inhabitants, considering age > or = 20 y, 5713 subjects were found eligible. Of them, 4923 (M/F=2321/2602) volunteered for height, weight, blood pressure, waist-girth and hip-girth. Fasting venous blood (5 ml) was drawn for plasma glucose, total cholesterol (T-chol), Triglycerides (TG) and high-density lipoprotien (HDL-c). Overall, 1565 participants were undertaken for OGTT. The mean (SD) values of BMI, WHR and WHtR for subjects with diabetes and hypertension were significantly higher in either sex. The level significance was highest for WHtR. The prevalence of diabetes and hypertension increased significantly with higher quintiles of BMI, WHR and WHtR (chi sq values were largest in WHtR for both events). Partial correlation coefficients, controlling for age and sex, showed that BMI, WHR and WHtR significantly correlated with systolic and diastolic BP, FBG, T-chol and TG. In the entire correlation matrix, the 'r' values were the highest for WHtR. Taking diabetes and hypertension as dependent variables, logistic regression also showed the highest odds ratio in higher WHtR than BMI and WHR. We conclude that WHtR was proved again a valuable obesity index for predicting diabetes, hypertension and lipidemia.

Prevalence of hypertension in Bangladesh: effect of socioeconomic risk factor on difference between rural and urban community.

Several studies reported that migrant Bangladeshis had greater risk for hypertension, diabetes and coronary heart disease compared with the Europeans and other migrant South Asians. So far, there has been no such study among the native population. This paper reports the hypertension prevalence and related risks among native Bangladeshis. A total of 2,361 subjects over 20 years of age were investigated. Overall prevalence rates of systolic and diastolic hypertension in the study population were 14.4 and 9.1 percent respectively. The prevalence of systolic hypertension was significantly higher in rural than in urban participants (P < 0.001). Compared with the poor the rich class had significantly higher prevalence of both systolic (P = 0.002) and diastolic (P = 0.041) hypertension. With increase of age, body mass index (BMI) and blood glucose level were significantly related to hypertension (P < 0.0001); whereas the trend for increasing waist-to-hip ratio (WHR), adjusting for social class, was not significant. Regression analysis showed that age, BMI, rural area and rich class were the strong predictors for hypertension. This study explored that hypertension prevalence in the native Bangladeshis is almost comparable to that of other Asian populations and South Asian migrants.

Blood pressure and glycemic status in relation to body mass index in a rural population of Bangladesh.

A cluster sampling of five villages in Dohar thana were selected for screening of hypertension and diabetes in relation to age structure and body habitus. All the subjects over 15 years of age were enlisted for investigation. The response rate was more than 70%. Height, weight, blood pressure (BP) and capillary blood glucose (fasting and 2-hPG) were measured. Diagnostic criteria of international standard were used for hypertension and diabetes. Out of 1005 participants 106 subjects (10.5%) had systolic blood pressure (sBP) more than 140 mmHg and 9% of them had diastolic blood pressure (dBP) more than 90 mmHg. The prevalence of non-insulin-dependent diabetes mellitus (NIDDM) was 2.1% and impaired glucose tolerance (IGT) was 13.3%. The mean body mass index (BMI) of men was 20.39 (SD = 2.91) and that of women was 20.11 (SD = 2.92), having no significant difference between them. Increased age (> or = 50 yr), high BMI (> or = 23.0) and hyperglycemia (2-hPG > 7.8 mmol/L) were the risk factors for both systolic (sBP > 140 mmHg) and diastolic (dBP > 90 mmHg) hypertension. Likewise, increased age, high BMI and hypertension showed significant association with glucose intolerance. Moreover, significant correlations were observed between age and BP (sBP, r = 0.328 p < 0.001; dBP, r = 0.187 p < 0.001) BMI and BP (sBP, r = 0.193 p < 0.001; dBP, r = 0.192 p < 0.001) and 2-hPG and BP (sBP, r = 0.188 p < 0.001; dBP, r = 0.134 p < 0.001).