Thoracic epidural versus general anaesthesia for MRM surgeries.

Background: General anaesthesia is still the preferred technique amongst many practitioners for oncologic breast surgeries. However the TEA technique has a lot of advantages over the conventional GA technique. Objective: We attempted to evaluate the two techniques of anaesthesia for MRM surgeries. Materials and method: Sixty ASA I-II patients undergoing MRM were randomly assigned to two study groups of 30 patients each. In the TEA group( group T), an epidural catheter was inserted at T7-T8 level, and 8-10 ml of 0.5% bupivacaine was titrated and administered.GA (group G) was induced with 2mg/kg of propofol and was maintained with Isoflurane ,intermittent inj. Vecuronium and 70% N2O in oxygen. The authors evaluated the adequacy of anesthesia, surgical condition, post anesthetic recovery, post anesthetic analgesia and patients’ satisfaction. Results: The intra operative haemodynamics was comparable in between the two groups. The incidence of nausea and vomiting was significantly lower in the TEA group ( 16.5% in group T and 39.6% in group G , P = 0.02).The mean immediate VAS score was also lower in TEA group ( group T =2.4 , group G =5.8,P = 0.001).Aldrete recovery score was 9/10 in 1st hr in a significant proportion in the TEA group (89.1% in group T v/s 59.4% in group G , P = 0.003).Patient satisfaction was significantly higher. The surgeons were however satisfied with both the methods. Conclusion: Use of thoracic epidural technique as a sole anaesthetic technique for MRM surgeries provides adequate operating conditions, better side effect profile, better pain management and patient satisfaction.

Determinants of Infant And Child Mortality in Bangladesh: Time Trends and Comparisons across South Asia.

In spite of various effective intervention programs, the under-5 child mortality rate (U5MR) is still high in Bangladesh. The present paper focused on the levels, trends and determinants of U5MR in Bangladesh utilizing data from Bangladesh Demographic and Health Survey (BDHS), 2007. Differential pattern in U5MR in Bangladesh was examined using life table technique as a bi-variate analysis and Cox proportional hazard model was used to analyze the determinants of U5MR mortality. Data from BDHS (2007) showed that U5MR during the five years preceding the survey was 65 per 1,000 live births, i.e. one in fifteen children born in Bangladesh died before reaching the fifth birthday. The risk of dying in the first month of life (37 per 1,000) was nearly two and a half times greater than in the subsequent 11 months (15 per 1,000). Deaths in the neonatal period accounted for 57 percent of all under-five deaths. In the Cox proportional hazard model analysis, factors such as the place of residence, parent’s education, father’s working status, sources of drinking water, type of toilet facility, wealth status, watching of television, mother’s age, months of breastfeeding, birth interval had significant influence on infant and child mortality. The most significant predictors of neonatal, post-neonatal, infant and child mortality were residence, parent’s education, type of toilet facility, wealth status, watching TV, months of breastfeeding, and birth interval. Despite the improvement of medical technology, child mortality remained alarmingly high, indicating that demographic, socioeconomic, household and environmental conditions must be improved to substantially reduce child mortality in this population.

Lead Exposure and Intellectual Function: Findings from Primary School Children in Bangladesh.

Backgrounds: About 120 million people around the world are overexposed to lead which is neurotoxic and 99 percent of the most severely affected children are in the developing world including Bangladesh. Methods and Materials: The present cross-sectional ecological study was carried out to explore the impact of lead poisoning on the intelligence level among 84 primary school children of a school of Bangladesh, aged between 8 and 14 years from September 2010 through January 2011. The research instrument was an interviewer questionnaire, questionnaire for IQ test and assessment of blood lead level (inductively-coupled plasma mass spectrometry with collision/reaction cells) of the study subjects after obtaining permission from their parents and the school authority. Results: Data were cross-checked and frequency distribution and association using chi-square test was accomplished. Background information depicted majority (69.1%) of the children aged10-11 years (mean = 10.25 ±1.177 yrs), female (51.2%), parents having primary level of education or below (73.8% in case of father and 77.4% in mother) and from lower socioeconomics (78.6% earned BDT 10,000 or below per month). Among all, majority (56%) were found to be moron, 27.4% in borderline, while 8.3% were imbecile with the same proportion with normal level. By their blood lead level. Majority (70.2%) had blood lead level up to 10 microgram/dl and the rest (29.8%) had more than 10 microgram/ dl. Though no statistically significant association was found between IQ level of the children and their blood lead level (p>0.05), the health problems found among the respondents as abdominal pain (53.57%), impatience (14.29%), nausea (10.71%) and all other problems (loss of concentration to study, ear problem, anorexia and loss of weight) amounting for 21.43% are suggestive of chronic lead poisoning. Conclusion: Further studies in large scale with larger samples including comparative studies of inter-industrial areas have been strongly recommended.

Health Awareness among Geriatric People.

Demographic and epidemiological transitions reveal geriatric problems as burning public health issue. The present cross-sectional study was undertaken to explore the health awareness among geriatric people in Mirpur in Dhaka city from January to April 2008 on purposively selected persons aged 60 years and above. An interviewer administered semi-structured questionnaire was used for data collection. The mean age of the respondents was found to be 66.5 ±7.25 yrs (Range: 60-103 yrs). It was found that perfect knowledge about food, nutrition, health and disease is significantly high among male respondents. The study revealed that 13.3% and 12.8% respondents have perfect knowledge on balanced diet and fiber containing food for regular bowel movement respectively. A large number of respondents (40.6%) were found having no knowledge about osteoporosis preventing foods. It was also found that 38.0% and 22.6% respondents have no knowledge regarding the causes of gingivitis and helminthasis respectively. On the basis of significant findings, it was suggested that more emphasis should be given on health education and awareness among geriatric people in order to ensure physical, mental and socially sound health.

Prevalence of psychiatric ailments among patients with sexually transmitted disease.

A cross-sectional descriptive study conducted on 250 sexually transmitted disease patients was carried out in two teaching institutes and their tertiary hospitals. These subjects constitute a special group of population for psychiatric diagnosis by using Structured Clinical Interview for Diagnostic and Statistical Manual IIIR. The study was done in the dermatology and venereology outpatient department of two tertiary hospitals of Dhaka, between January 1998 and January 1999. The findings show that 34% of total sexually transmitted disease patients had psychiatric disorders. Anxiety disorders (11.2%) were found to be the most common disorder among these psychiatric patients; this was followed by depressive disorder (8.4%), psychoactive substance use disorder (6.8%), sexual dysfunction (6.8%), bipolar mood disorder (0.4%), and schizophrenia (0.4%). Four percent of anxiety disorder was associated with psychoactive substance use disorder and sexual dysfunction. Similarly 3.6% of depressive disorder was found with psychoactive substance use disorder and sexual dysfunction while 1.6% of sexual dysfunction was associated with substance use disorder. Most of the patients in the sexually transmitted disease population recruited in the present study had both anxiety disorder and depressive disorder though majority of them were undetected and untreated. These findings underscore that special attention needs to be given to the mental health component of our health care delivery system.