Socio-Demographic, Clinical and Diabetes Status of Foot Ulcer Patients

Background: Foot ulcers are considered as a serious complication, especially for patients with diabetes. People with diabetes and people with peripheral vascular disease are more likely to develop foot ulcers. If an infection occurs in an ulcer and is not treated in the proper way, it can develop into cellulitis, osteomyelitis, or gangrene that may require some part of the toe, foot, or lower leg to be amputated. The aim of this study was to find the socio-demographic, clinical, and diabetes status of foot ulcer patients. Material & Methods: This prospective observational study was conducted in the Department of Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, during the period from March 2012 to August 2012. In total 100 patients with foot ulcers in the different surgical units of the mentioned hospital were enrolled in this study as study subjects. Data from the study regarding age, sex, occupation, smoking habit, and socio-demographic condition were recorded in the prescribed questionnaire. The purposive sampling technique was used for this study. All data were processed, analyzed, and disseminated using MS Excel and SPSS version 23 programs as necessary. Results: In this study, the male-female ratio of the participants was 2:1. The maximum number of patients (42%) were from the age of 51-60 years and the highest number of patients were housewives (28%), followed by farmers (22%). Among the total male patients, 87.88% were smokers. Low HDL was found in 51% of patients and 68% of patients had been suffering from diabetes mellitus,18% from Buerger’s disease and 6% from atherosclerosis, and 8% from malignant foot ulcer. Most of the diabetic patients (95.59%) were hyperglycemic on admission and 55.88% had diabetes for 6-10 years. On admission, 3 patients (4.41%) had controlled blood sugar and 65 patients (95.59%) had uncontrolled blood sugar. Conclusion: The frequency of foot ulcers among the male population was higher than that in females. Concerning occupation of the patients, housewives and farmers were the most prevalent. Smokers were most affected groups among the study population. Pre-diagnosed diabetes mellitus for a long period was one of the major clinical issues in most of the patients. Uncontrolled blood sugar was also seen in majority of the patients regarding clinical background.

Assessment of Bacteriological Pattern and Antimicrobial Susceptibility in Deep Neck Space Abscess

Background: Deep neck abscess is a common clinical entity in developing countries like ours. Despite the widespread use of antibiotics, deep neck infections do not disappear and remain one of the most difficult emergencies encountered in daily clinical practice. The extent and severity of the illness could become life-threatening. Therefore, coping with deep neck abscess remain a challenge to otolaryngologists. This study aimed to analyze the bacteriological pattern and antimicrobial susceptibility in deep neck space abscesses. Material & Methods: It was a cross-sectional observational study. 50 patients with deep neck space abscesses fulfilling the inclusion and exclusion criteria admitted to the department of ENT & Head Neck Surgery, Rangpur Medical College Hospital, Rangpur, from 1st July 2017 to 30th December 2017 were enrolled in this study. Pus from deep neck space abscess was collected by either aspiration or incision and drainage with proper aseptic measure and sent by sterile test tube to microbiology department immediately. Data were collected by detailed history taking and clinical examination & investigations with informed written consent and analyzed by SPSS (version 20). Results: In this study most commonly involved deep neck spaces were Submandibular (38%), Peritonsillar (32%), Retropharyngeal (14%), and parapharyngeal (8%) spaces. Streptococcus viridans was the most prominent organism 14 (28%) followed by Klebsiella pneumonia 9(18%) and Staph. aureus 4 (8%). The most effective antibiotic was Ceftriaxone 34(79%) followed by Cefuroxime 30 (70%) and Erythromycin 23(54%). Aerobic organisms were highly sensitive to Cefuroxime (83%) and Ceftriaxone (83%) followed by Erythromycin (48%). Anaerobic organisms were sensitive to Clindamycin (100%), Metronidazole (100%), and Erythromycin (100%) followed by Ceftriaxone (75%). Conclusion: The most frequently isolated organism in deep neck space abscesses were Streptococcus viridans and Staphylococcus aureus and sensitivity results showed the majority of isolates are susceptible to Ceftriaxone and Cefuroxime

A Comparative Study of Nebulized 3% Hypertonic Saline Versus Nebulized Adrenaline in The Treatment of Acute Bronchiolitis

Background: Acute bronchiolitis is the most common lower respiratory tract infection in young infants and young children. The respiratory syncytial virus is the commonest cause of bronchiolitis. Recently the role of nebulized 3% saline has come into focus. Nebulized adrenaline has also been suggested as another treatment option, its primary role being the reduction of mucosal edema, which is an important part of the disease pathology in bronchiolitis. Objective: To see the effects of nebulized adrenaline in comparison to nebulized 3% hypertonic saline in the treatment of acute bronchiolitis. Material & Methods:This was a randomized controlled trial, carried out in the Department of Pediatrics, Bangladesh Shishu Hospital and Institute from October 2017 to March 2020. A total of 90 children from 1 month to 2 years of age of either sex who were diagnosed and admitted with acute bronchiolitis were enrolled. After enrollment, they were randomly assigned to either 3% nebulized hypertonic saline (group A=45) or to the nebulized adrenaline-1:1000 group (group B=45). Monitoring was done by respiratory distress assessment instrument (RDAI) score at 12 hours interval for 1st 24 hours and then 24 hourly till the patient was ready for discharge. The efficacy was determined by assessing clinical severity score/RDAI score and length of hospital stay. Data were analyzed using SPSS version-23.Results:The mean age was found 6.34±3.89 months in group A and 6.06±3.55 months in group B. The majority of patients were males in both groups. All patients had a cough, breathing difficulty, Ronchi, and chest indrawing in both groups. Changes in heart rate were 5.68±6.61/min in group A and 2.86±5.87/min in group B, which was significantly decreasing in group A than in group B. Mean clinical severity scores at 12 hours and at 24 hours were statistically significant (p<0.05). However, mean clinical severity scores at baseline, at 48 hours, at 72 hours, and at 96 hours were not statistically significant. The mean duration of oxygen therapy was found 15.00±5.36 hours in group A and 24.63±11.64 hours in group B. Which indicates that the duration of oxygen therapy was significantly higher in group B than in group A. Majority of the patients of group A and group B were discharged within 72 hours 39(86.7%) and 28(62.2%) respectively, which was statistically significant.Conclusions:Nebulization with 3% hypertonic saline significantly reduced clinical severity score and length of hospital stay in case of acute bronchiolitis in comparison to nebulized adrenaline.

Primary Closure of Common Bile Duct: Our Experience

Objective: To assess the outcome of primary closure ofCommon Bile Duct (CBD) after open and laparoscopiccholedocholithotomy.Method: This descriptive observational study was conducted ina private hospital in Chattogram, Bangladesh from February2016 to June 2019. All the patients who underwent open orlaparoscopic choledocholithotomy during the study period wereincluded. Ultrasonographic findings of CBD and its stone,wound infection, operation time, bile leak, biliary peritonitis,hospital stay all were observed.Results: A total of 35 patients were found from clinical recordshaving male to female ratio of 1:1.9. Most of the patients werein 41- 50 years age group. Mean operating time was 135minutes in laparoscopic type and 80 minutes in open type.Overall wound infections were in 5 patients (14.28%) and allwere in open group. Bile leak were in 4 patients (11.42%).Post-operative transient jaundice in 5 patients (14.20%). Biliaryperitonitis in 3 patients (8.57%).Retained single stone in one, pelvic abscess and abortion inone. Mean hospital stay were 5days in open type and 2 days inlaparoscopic type.Conclusion: Primary closure of common bile duct aftercholedocholithotomy is relatively safe and not associated withthat much of complications.

Study of binary and ternary solid dispersion of ibuprofen for the enhancement of oral bioavailability.

To develop a novel ibuprofen loaded solid dispersion system (SDs) with enhanced dissolution rate, binary and ternary solid dispersion were prepared by co-precipitation method using poloxamer-407 only and mixture of poloxamer-407 with a second polymer such as HPMC 6cps, HPC, Kollicoat IR, Kollidon VA 64 respectively. In case of binary SDs, poloxamer 407 was used in three concentrations: 33%, 50% and 66.67% wt/wt of total SDs. In case of ternary SDs, poloxamer 407 was used at 15%, 25% 35% wt/wt of the total SDs content while maintaining the concentration of the second polymer at fixed amount (1gm). In vitro dissolution study was conducted in phosphate buffer of pH 6.8 for 1h. Release property of ibuprofen from two different SDs was investigated. And in case of both the systems, enhanced release property was found where the release was compared with pure ibuprofen powder. Enhanced release of ibuprofen from the optimized SDs was characterized in light of cumulative percent release, % release after 5 min of dissolution and release rate of the drug from different SDs. When the amount of carriers increased with a decrease in drug content, the release of ibuprofen was elevated. And it was found that almost two fold increase in the release of ibuprofen while 66.67% poloxamer was used.

Spot urinary protein/osmolality ratio as a predictor for proteinuria of nephrotic range.

A prospective study was carried out on 50 patients (age 1-15 years) with nephrotic range of proteinuria to determine the correlation of 24-hour urinary total protein with spot urinary protein/creatinine ratio and urinary protein/osmolality ratio. Another 50 patients having no proteinuria grouped as control. Twenty-four hours urine and spot urine were collected from each child and were analyzed for total volume, total protein, creatinine and osmolality level. The average 24-hour urinary total proteins in nephritic patient were 2148.6 +/- 808.7 mg and the spot urinary protein/creatinine and spot urinary protein/osmolality were 3.2332 +/- 0.4293 mg/mg and 3.2418 +/- 0.4393 mg/mOsm respectively. There was a strong positive correlation of the 24-hour urinary total protein with spot urinary protein/creatinine and protein/osmolality ratios (r=0.9846 and 0.9870, p= <0.001). But in control group, these ratios did not show any correlation with 24-hour urinary total protein. These results suggest that in pediatric patients with nephrotic range of proteinuria, the spot urinary protein/osmolality ratio can predict the 24-hour urinary total protein excretion like that of spot urinary protein/creatinine ratios.