Attributes of Childhood Cancer among the Patients Attending Specialized Hospitals in Bangladesh.

Background: Childhood cancer is an emerging health problem worldwide. It is the second common cause of child death. Epidemiological and clinical attributes of childhood cancer are not properly documented in Bangladesh. This study was designed to reveal the attributes of childhood cancer among the patients attended specialized hospitals in Dhaka city. Objective: To determine the epidemiological and clinical attributes of childhood cancer. Materials and Methods: The cross-sectional study was conducted among 99 under 18 years old children suffering from cancer, who were included considering specific selection criteria. Data were collected by face to face interview using a semi-structured questionnaire with the help of a semi-structured questionnaire and checklist. Data were analyzed by using SPSS software. Results: Of all the children, majority (40.4%) was in age group of 6-10 years and their mean (±SD) age was 7.48 (±3.70) years. Male to female ratio was 1.9:1.6 and majority (48.5%) was in middle income group. Major part (42.4%) of the children was from sub-urban followed by 30.3% rural and 27.2% from urban communities. Major types of childhood cancer comprised acute lymphoblastic leukaemia (37.4%), retinoblastoma (14.1%), neuroblastoma (10.1%), and Wilm’stumour (10.1%). Less common cancers included non-Hodgekin’s lymphoma (7.1%), Hodgekin’s lymphoma (5.1%), osteosercoma (5.1%), nasopharyngeal carcinoma (4.0%), germ cell tumour (3.0%), acute myeloid leukaemia (3.0%) and Ewing’s tumour (1.0%). Majority (35.1%) of acute lymphoblastic leukaemia patients were from urban while most (85.7%) of retinoblastoma patients from sub-urban, 50.0% of neuroblastoma cases from rural, and 40.0% of Wilm’s tumour from sub-urban communities, this geographical variation of childhood cancer was statistically significant [χ2(33)=56.46, p=0.01]. In poor and middle income group, most of the children (91.8%) were detected in stage II while among the higher income group, most (88.9%) of the cancer were detected in stage-I and this variation was statistically significant [χ2(9)=16.77, p=0.05]. Family history was strongly related with childhood cancer [χ2(20)=32.81, p=0.04]. Conclusion: Cancer was more prevalent among male children with poor socio-economic condition residing in sub-urban communities. The study recommends specific measures to detect childhood cancer and related risk factors at early stage to prevention and control.

Evaluation of attributes to hyperbilirubinaemia in neonates in a tertiary care hospital in the Dhaka city.

Objective: The study was aimed to evaluate the attributes related to hyperbilirubinaemia among neonates. Materials and methods: A total number of 120 neonates with hyperbilirubinemia included in the study. Data were collected using hospital records and by face-to-face interview of mother of those neonates using a predesigned questionnaire. Data were expressed as mean±SD and number (percent) as appropriate. Both descriptive and inferential statistics were considered in data analysis. Statistical analyses were performed using SPSS Software. Result: Of the total neonates, 57% were baby boys. In age group of 2nd to 7th days were 59.2% of neonates. According to the birth weight, neonates distribution was 38.3% in very low (<2000g), 42.5% low (2001-2500g) and 19.2% normal (>2500g) birth weight group. ABO incompatibility was found in 14.2% and Rh 8.3% cases of hyperbilirubinaemia. Birth trauma was found in 7.5% and congenital anomalies 3.3% neonates. Pre-maturity (gestational age <37 wks) was found in 73.3% cases. Normal vaginal delivery was performed in 59.2% of cases. Exclusive breast feeding was given by 43.33% mothers. Of the mothers 93.4% were housewives. Thirty percent (30%) of mothers were adolescents (<20 years) and 27.5% young adults (20 to 25 years). Of the 120 mothers 56.7% had primary level education. Low birth weight (<2000g to 2500g) neonates had significantly higher (p<0.005) serum bilirubin than the normal birth weight counterpart. Among the neonates of the mothers with GDM, 9.2% had serum bilirubin level above 20mg/dl and the distribution showed significant association (p<0.005). Conclusions: It is concluded that low birth weight and prematurity remained to the major causes of neonatal hyperbilirubinemia in neonates. Other common causes, particularly ABO and Rh incompatibility, are also present which could be avoided by meticulous clinical practice and burden of neonatal morbidity and mortality related to hyperbilirubinemia can be reduced.

Cost and outcome of caesarean section in a public and private hospital in Dhaka city.

Introduction: Caesarean section (CS) is one of the most common surgical interventions to ensure safe delivery and outcome. Cost of CS is comparatively higher in private hospitals but it is not verified that this higher cost could influence the better outcome in private over a public hospital. Objectives: To compare cost and outcome of caesarean section between a public and private hospital. Materials and Methods: This cross-sectional comparative study was carried out among 130 clients of CS from Dhaka Medical College Hospital (DMCH) and Holly Family Red Crescent Hospital (HFRCH). Data were collected by face-to-face interview and reviewing medical documents. Cost of CS was estimated in terms of direct and indirect cost of CS incurred by the women while outcome was assessed by finding the health condition of the mother and newborn. Result: Majority of the women had CS as per doctor's advice. Majority (61.5%) had different kind of problems after CS including lower abdominal pain (86.0% in HFRCH and 69.2% in DMCH) and fever (10.7% in HFRCH and 17.3% in DMCH). Average cost of CS was significantly higher in HFRCH (Tk.36852.90±8396.38) than in DMCH (Tk.7344.23± 5081.67) [t(128), p<0.01]. Both direct and indirect cost of CS were significantly lower in DMCH than in HFRCH [t(128), p<0.01]. Outcome of CS was significantly better to mothers in DMCH than of HFRCH [?2 (7.9)=0.048, p<.05]. Conclusion: Cost of CS was higher in private hospital while outcome was better in public hospital. Effective measures are recommended for reduction of cost of CS to make it cost-effective.

Stress among Parents of Children with Mental Retardation.

Mental retardation is one of the most prevalent developmental disabilities of the children globally. Family is the main source of support for those disable children in any society. Parents experience enormous physical and mental stress to tackle the mentally retarded children. This present comparative cross-sectional study tried to compare difference of mental and physical stress between the parents of children with mental retardation and the parents of children with no mental retardation. It included 220 parents, 110 of whom had children with mental retardation and another 110 parents of children with no mental retardation. To assess stress, A Quick Stress Assessment Test (QSAT) (Vaz, 1995) was used, which comprised two parts: physical and mental, former with 19 items and latter with 21 items. Data were collected with a self-administered questionnaire and analyzed by using SPSS software. To check differences of stress scores and gender differences of stress,‘t’ test and ‘?2’ tests were applied as required. The study revealed that the parents of children with mental retardation (PCMR) shared significantly greater stress score (34.27) than the parents of children with no mental retardation (PCNR) (21.66), [t(218)= 2.63, p=0.001]. Mental stress score was significantly higher among PCMR (33.57) than the PCNR (26.46) [t(218)= 3.87; p=0.002] while physical stress score was insignificantly higher among PCMR (20.43) than the PCNR (18.66). Majority of the parents with mentally retarded children (71.4% mothers and 67.5% fathers) had higher mental stress than physical stress [?2 (1)=22 43, p=0.024]. Mothers had significantly higher mental stress score than the fathers of mentally retarded children [‘t’(109), p=0.025]. Special measures like early diagnosis, prompt treatment and counseling for mental and physical stress of the parents along with provision of need based rehabilitation services for the mentally retarded children at different levels to reduce the stress burden of their parents.

Arsenic in Eggs and Excreta of Laying Hens in Bangladesh: A Preliminary Study

The aim of this study was to detect arsenic concentrations in feed, well-water for drinking, eggs, and excreta of laying hens in arsenic-prone areas of Bangladesh and to assess the effect of arsenic-containing feed and well-water on the accumulation of arsenic in eggs and excreta of the same subject. One egg from each laying hen (n=248) and its excreta, feed, and well-water for drinking were collected. Total arsenic concentrations were determined by atomic absorption spectrophotometer, coupled with hydride generator. Effects of arsenic-containing feed and drinking-water on the accumulation of arsenic in eggs and excreta were analyzed by multivariate regression model, using Stata software. Mean arsenic concentrations in drinkingwater, feed (dry weight [DW]), egg (wet weight [WW]), and excreta (DW) of hens were 77.3, 176.6, 19.2, and 1,439.9 ppb respectively. Significant (p<0.01) positive correlations were found between the arsenic contents in eggs and drinking-water (r=0.602), drinking-water and excreta (r=0.716), feed and excreta (r=0.402) as well as between the arsenic content in eggs and the age of the layer (r=0.243). On an average, 55% and 82% of the total variation in arsenic contents of eggs and excreta respectively could be attributed to the variation in the geographic area, age, feed type, and arsenic contents of drinking-water and feed. For each week’s increase in age of hens, arsenic content in eggs increased by 0.94%. For every 1% elevation of arsenic in drinking-water, arsenic in eggs and excreta increased by 0.41% and 0.44% respectively whereas for a 1% rise of arsenic in feed, arsenic in eggs and excreta increased by 0.40% and 0.52% respectively. These results provide evidence that, although high arsenic level prevails in well-water for drinking in Bangladesh, the arsenic shows low biological transmission capability from body to eggs and, thus, the value was below the maximum tolerable limit for humans. However, arsenic in drinking-water and/or feed makes a significant contribution to the arsenic accumulations in eggs and excreta of laying hens.

Reproductive health profile of married women: experience from a rural community of Bangladesh.

Design: The study was a community based cross sectional study. Objective: The study was conducted to find out the reproductive health profile of rural married women of a selected rural community in Dhamrai Upazila of Dhaka district. Materials and Methods: The study was conducted among 204 married women of reproductive age included considering specific selection criteria. Data were collected by face-to-face interview using a semi-structured questionnaire. Maintaining quality control check data were processed and analyzed by using SPSS software. Results: The study revealed that majority of the women were either illiterate (34.1%) or had primary education (33.3%) with mean age of 31+8.65 years. Most of them (88.2%) were house wives and major segment (52.9%) had poor monthly family income (Tk.5000-10000). Among all, 63.7% were married within 11-17 years of age and 69.8% gave birth of first child during adolescence (16- 18 years). Major part (60.29%) of the women didn't use any contraceptive and only 38.55% utilized antenatal care. Average number of children was 2.73+1.52 and most of the delivery (81.6%) was conducted at home by untrained birth attendants (57.0%). Adverse pregnancy outcome included abortion, menstruation regulation, still birth, complications to new born and mothers. Reproductive health problems faced by the women included menstrual problem, physical assault, leucorrhea, mental torment, sexual annoyance, puerperal infection, pregnancy related complications, urinary tract infection & pelvic inflammatory disease. Most (81.43%) of the illiterate women didn't utilize ante-natal care while majority (60.0%) having higher secondary school certificate (HSC) had =3 ante-natal visits and this variation was statistically significant [?2(12)=26.35, p<0.05]. Majority (71.21%) of the illiterate women didn't use any contraceptive method while most of them having HSC used either condom or oral contraceptive and this discrepancy was statistically significant [?2(12)=27.86, p<0.05]. Majority (67.1%) of the illiterate women were delivered by untrained birth attendants whereas all women having HSC were delivered by doctor (40.0%), nurse (20.0%) and traditional birth attendant (40.0%), this difference was statistically significant [?2(12)=24.57, p<0.05]. Conclusion: Reproductive health profile was worse among the illiterate, less aware and low income rural women. The study recommends formulation and implementation of effective strategies to improve reproductive health status of the rural women.

Camptomelic dysplasia with sex reversal.

Camptomelic dysplasia is a disorder of the newborn characterized by congenital bowing and angulation of long bones together with other skeletal and extraskeletal defects. The affected newborn had dysmorphic features with bowing of the legs and bilateral talipes equinovarus. Radiology showed marked anterior bowing of both tibia with disproportionately short fibula, anterolateral bowing of the femurs and wide pelvic outlet with small iliac wings. She had sex reversal with normal female genitalia and 46, XY karyotype. Camptomelic dysplasia is generally considered to be a lethal skeletal dysplasia and most patients die in the neonatal period due to severe respiratory distress. Survivors may have learning difficulties, developmental delay, conductive hearing loss, myopia and recurrent chest infections. Because of its high associated mortality, prenatal diagnosis of camptomelic dysplasia is mandatory. The birth of a child with skeletal dysplasia is an emotionally difficult experience for parents.

Tulip liposuction in plastic surgery.

Tulip liposuction is a recent modification of the classical Mayo liposuction, which is done by suction apparatus consisting of large cannula, non collapsible wide bore tubing and a big suction device. Tulip liposuction is an entirely hand operated device comprising of special syringes, designed to fit snugly to thinner metallic cannula, with proximal ends shaped like a Tulip hence the Tulip liposuction. This modification has many advantages over the Mayo type. This paper presents the experience 110 cases of liposuction in Bangladesh. The study was carried out at different hospitals in Dhaka from December 1997 to February 2001. One hundred ten patients underwent this procedure. Of them hundred and one were carried out for cosmetic reasons. The other nine for extraction of lipomas. The age range was 21 to 49 years. Twenty four were males and eighty six were females. Sixty seven patients received spinal anesthesia and thirty nine patients received general anaesthesia. Only four cases were done under local anaesthesia. Hyaluronidase, adrenaline and normal saline were injected in the subcutaneous fat. A small stab incision was made and then fat was aspirated. No stitches were required. Complications were minimal and insignificant.