Role of family support in the mental health status of physicians

Background: The mental health and well-being of physicians are increasingly recognized as crucial factors not only for the individual physicians themselves but also for the quality of care they provide to patients. This study aimed to assess the role of family support in the mental health status of physicians. Methods: This descriptive study was conducted at the Department of Community Medicine in Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2011 to June 2011. A total of 126 physicians were selected as study subjects as per inclusion and exclusion criteria. A convenience type of non-probability sampling technique was adopted in this study. GHQ- questionnaire was used for the measurement of mental stress. Different statistical methods were used in this study. Statistical package for social science (SPSS) version 17.0 for Windows was used to analyze the data. Results: Among 126 physicians 42 physicians (33.3%) had no evidence of mental stress, 42 physicians (33.3%) had mild mental stress, 29 physicians (23.0%) had moderate mental stress and only 13 physicians (10.3%) had severe mental stress. The study shows that among 32 physicians who didn't get help from family members majority i.e. 29 (90.7%) physicians had mental stress and only 3 (9.4%) physicians had no evidence of mental stress. But 94 physicians got help from family members among which 55 (58.5%) physicians had mental stress and 39 physicians or 41.5% physicians had no evidence of mental stress. Conclusions: Family support plays a significant role in mitigating stress, while marital status, income, and work environment also impact well-being. Addressing these factors can foster a culture of physician well-being and improve patient care.

Assessment of knowledge, awareness and attitudes regarding the re-emerging outbreak of monkeypox among the health professionals in Bangladesh: a web based cross-sectional study

Background: Before the early 70s, Monkeypox (MPX) was simply recognized as a native disregarded disease in western and central Africa. Moreover, monkeypox is a re-emerging disease that becomes a serious life threatening issue all over the world including non-endemic countries. Regarding the evaluation of research based information about monkeypox in Bangladesh, this study has been conducted to assess the existing knowledge among health professionals. Methods: An online-based cross-sectional study was carried out from 20 June 2022 to 10 August 2022 time period where respondents' knowledge about monkeypox was assessed through using a 21-item scale. The chi-square test was used to make the association between socio-demographic variables and knowledge level. Results: Among 223 respondents, only 53% had good knowledge (mean score >14). Respondents age and sex were significantly correlated with the level of knowledge about monkeypox (p<0.006) and (p<0.02) respectively. Around 72.1% of respondents agreed that the world's populations are able to prevent and control monkeypox worldwide and 65% of respondents believed that media coverage of monkeypox may contribute to global prevention. Moreover, 52.4% respondents had negative attitudes toward monkeypox for becoming a world pandemic. Conclusions: The study finding reveals that knowledge about the monkeypox virus was average and training as well as awareness programs are recommended on monkeypox to promote feather knowledge development among health professionals.

The association between different types of cooking fuels and common health problems: north India region

Background: The fuel used for cooking is a major source of indoor air pollution because of inefficient combustion and inadequate ventilation. This study was conducted to see if there is any association between the type of cooking fuel and common health problems in light of inadequate ventilation. Methods: This was a cross-sectional study; 688 subjects were selected randomly from various sectors and the outlying areas of Surajkund. The impact of indoor air pollution on health was assessed by questionnaires, general physical examination, and pulmonary function testing. Results: One of the key findings of the study has been the implication of LPG, touted as a safe, non-polluting fuel with a definite negative impact on health. There was significantly more breathlessness experienced by LPG users as opposed to the users of wood and cow dung. Though the prevalence of fever in both groups was similar, chest pain, burning of eyes, and fatigue were reported by wood and cow dung users much more frequently. The pulmonary function test showed restrictive pathology in cow dung and wood users, whereas obstructive pathology in LPG users. Conclusions: LPG is considered “clean” fuel because it does not produce visible emissions. However, improper burner design, blocking and clogging of the flue vent, and insufficient combustion air result in improper combustion and the emission of aldehydes, CO, hydrocarbons, and other organics. It would be folly to believe that LPG is harmless. Even a harmless material may become harmful if used inappropriately.

Evaluation of serum carbohydrate antigen 19-9 as a diagnostic marker for pancreatic malignancy

Background: Carbohydrate antigen (CA) 19-9 is considered as a tumor marker in biliary-pancreatic malignancy. Though a high level may indicate the presence of a malignant disorder, it may rise even in benign condition. Similarly, the value may be normal even in malignant condition.Methods: An observational comparative study was conducted in the Department of Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from 01 June 2016 to 31 May 2017 to find out the sensitivity and specificity of CA 19-9 as a tumor marker in pancreatic malignancy in our perspective and to find out a cut-off value of CA 19-9 which might prove as a definitive indication of pancreatic malignancy.Results: The study shows when the cut off value of CA 19-9 is 37 U/ml. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) were 77.8%, for all four characteristics respectively. But if the serum CA 19-9 threshold used to diagnose pancreatic cancer was raised to 100 and 120, sensitivity decreased to 72.2% and 66.7% and NPV decreased to 76.2% and 73.9% respectively. However, specificity increased to 88.9% and 94.4% and PPV increased to 86.7% and 92.3% respectively.Conclusions: Serum CA 19-9 level may be considered as an important determinant in the diagnosis of malignant pancreatic diseases and to assess the resectability of the lesions preoperatively, but other adjuncts are necessary in the overall management of pancreatic diseases.

A Comparative Study on Causative Micro-Organisms for Post-Operative Wound Infection between First and Subsequent Cases in Routine Surgical Procedure

Introduction: Infection is the invasion of the body by thepathogenic micro-organisms with consequent local andsystemic effect. For this, a sufficient number of pathogens mustenter the tissues, overcome the patients' resistance andmultiply. The commonest organisms are staphylococcusaureus and gram-negative intestinal bacilli. Streptococcuspyogenes are not infrequent.Objective: The main purpose of this research is to make acomparative study on causative micro-organisms for postoperative wound infection between first and subsequent casesin routine surgical procedure.Method: Incidence of wound infection between first andsubsequent cases in routine surgical procedure was thesubject matter of this study. In this study 228 cases have beenstudied. Of these cases, 76 were the 1st case, 76 were 2ndcase, and 76 were the 3rd case in 76 routine operation days.The study duration was from September 2015 to August 2016.Result: After numerous information and examinationinvestigation; this study revealed that maximum woundinfection was due to Escherichia Coli.Conclusion: The study concludes that Escherichia coli werethe commonest organism isolated from infected wounds whichis the inhabitant of gastrointestinal and biliary tracts.

Urinary incontinence among female patients attending a selected public hospital in Bangladesh

Background:Urinary incontinence is a frequent public health problem with negative social consequences, particularly for women. Women are much more susceptible to urinary incontinence than men. Female susceptibility is the result of anatomical, social, economic and cultural factors. Methods:A crosssectional study was conducted to find out the factors related to urinary incontinence, distribution of types of incontinence among female patients and their health care seeking behavior and socio-demographic characteristics among 121 adult female patients who attended the outpatient department of Gynae and Obstetrics department and Urology department of Dhaka Medical College and Hospital during the period of January to June 2016. Data werecollected through face to face interview.Results:The mean age of the respondents was 43.42 years and the mean monthly income of the respondents was 17409.09 taka. Little above nine-tenths (91.7%) of the respondents were Muslim and the majority of the respondents (47.9%) were living in pacca house. More than seven-tenths (73.6%) of the respondents were married and over 35% of the respondents were illiterate. Among the respondents about 42.1% of them had pressure type of incontinence, followed by mixed incontinence (27.3%). Over 65% had some complication during delivery and little above six-tenths (61.2%) had gynecological problems.Conclusions:Female urinary incontinence is a frequent and a major embarrassing healthcare problem in Bangladesh. Patients who had complications during labor, having multipara, recurrent UTI, gynecological problem such as uterine prolapse, urethral injury, had high percentage of urinary incontinence. Patients with urinary incontinence should be encouraged to seek treatment early as the problem can be treated.

A Comparative Study between Double Tension Band Wiring and Reconstruction Plate and Screws for the Treatment of Displaced Bicondylar Intra-Articular Fractures of the Distal Humerus

Objective: In this study our main goal is to evaluatetheoutcome of double tension band wiring and reconstructionplate and screws for the treatment of displaced bicondylar intraarticular fractures of the distal humerus.Methodology: This perspective and randomized study wasconducted at the National Institute of Traumatology andOrthopaedic Rehabilitation (NITOR), Dhaka from July 2003 to2005. Where out of 24 patients 12 were selected for operativetreatment by reconstruction plate and screws (Group –I), and12 were selected for operative treatment by double tensionband wiring (Group-II) as on random basis.Results: During the study, in group-1 and group-2 most of thepatients belongs to 18-30 age group., 75% patients’ injury inleft limb whereas, 35% had injury in left limb in group-2.33.33% patients with reconstruction Plate and Screw, hadexcellent recovery after treatment where as 25% had excellentrecovery when they had double Tension Band Wiring.Conclusion: From our study we can conclude that, operativetreatment of displaced bicondylar intra-articular fractures of thedistal humerus by reconstruction plate and screws gives amore rigid fixation with better functional outcome than bydouble tension band wiring.

Consequence of neo-adjuvant chemotherapy on morphology of breast carcinoma: A systematic evaluation.

BACKGROUND: Neo‑adjuvant chemotherapy (NAC) in locally advanced breast cancer is the present trend. Following NAC, a considerable alteration of morphology occurs in the tumor. AIMS: To study effects of NAC on morphology of breast carcinoma and to evaluate the pathologic response (PR). MATERIALS AND METHODS: A total of 39 surgically resected mastectomy specimens of patients of invasive locally advanced breast carcinoma who received NAC were evaluated for macroscopic and microscopic (by routine stains and immunohistochemistry) alteration of morphology. RESULTS: Macroscopically well‑defined tumor noted in 25 cases (64.1%) and in the rest (14 cases, 35.9%), only fibrotic areas identified. Microscopic examination identified malignant cells in 29 (74.4%), significant chronic inflammation in 24 (61.5%), hyalinized fibrosed stroma in 25 (64.1%) and necrosis in 11 (28.2%) cases. Immunohistochemistry assisted in differentiating malignant cells from histiocytes. In 15 cases (38.5%), axillary lymph nodes isolated where fibrosis seen in 12 (30.8%) and malignant cell in 8 (20.5%) cases. In 34 cases where the pre‑treatment biopsy were available, complete pathologic response (pCR) and partial pathologic response (pPR) were achieved in 7 (20.6%) and 23 (67.4%) cases respectively. DISCUSSION: Protocol of systematic evaluation of morphological changes is different in cases of a patient treated by NAC. Nature of malignancy was difficult to categorize as morphology of typical breast carcinomas were altered. Sometimes, immunohistochemistry is advantageous as routine H and E stains are not sufficient to isolate malignant cells in fibrotic and necrotic areas. Appropriate morphological evaluation of the mastectomy specimen is absolutely crucial for assessment of PR and subsequent management.

Multiple Pseudoaneurysms of the Brachiocephalic Artery Following Penetrating Arrow Injury in the Neck.

Arrow injury in the neck with subsequent pseudoaneurysm formation of the brachiocephalic artery is an uncommon type of injury in our country. Initially it was a punctured wound in the neck which was simply repaired. About 13 days after the initial injury patient came back to hospital with severe respiratory distress and backache for which emergency tracheostomy was needed. This simple puncture wound subsequently developed haematoma in the neck and two pseudoaneurysms at distal brachiocephalic artery. CT angiogram was very helpful to confirm the diagnosis. Correct referral to tertiary hospital like National Institute Cardiovascular Diseases (NICVD) ,prompt diagnosis, definitive treatment of the injury and subsequent aggressive postoperative management saved the life of this young tailor.

Pharmacogenomics- The Promise of Personalized Medicine.

Introduction: Pharmacogenomics (PGx) is the study of the genetic basis of variability among individuals in response to drugs. It is the newest discipline of medicine and is becoming a very active area of research, with the pharmaceutical industry gaining experience applying it, integrating it into the drug development process, and also learning to better manage the expectations of the medical community. Methodology: A comprehensive review of the literature on the principles, applications, challenges and prospects of pharmacogenomics was performed. Results: Pharmacogenomics tailors therapies to the genetic makeup of an individual and can therefore offer treatments that are more efficacious and have fewer side effects. Despite these benefits, personalized medicine has not been embraced by large pharmaceutical companies. It is expected that the first wave of successful pharmacogenomics products will be used in acute treatments for which current therapies have and severe side effects. These products should also be good candidates for premium pricing. Personalized medicine (PM), based on the genetic makeup of a patient, may result in not only an improved therapeutic response but also a clinically important reduction in adverse drug reactions. The experience to date is mixed, with a few successes but many frustrations. Conclusion: However, for pharmacogenomics to be truly embraced, the benefits of this technology must become more widely accepted in terms of economic, public, regulatory and ethical issues.

Unmet Need for Family Planning among Married Women: Experience from Rural and Urban Communities.

Unmet need for family planning is the key indicator to achieve Millennium Development Goal by the year 2015. Bangladesh Government has a great success in family planning sector but population has almost doubled in recent years. This study was carried out among married women to compare the determinants of unmet need for family planning among rural and urban communities during the period from July 2010 to June 2011. Unmet need for family planning in rural community was found 18(12%) and in urban community it was 38(25.3%). Among rural women unmet need for limiter was 13(8.6%) and spacer was 5(3.4%) while limiter 29(19.4%) and spacer 9(5.9%) found among urban women. Mean age at marriage was found 17.97(SD±2.66) years and mean age at first child birth was 19.91(SD±2.71) years among rural women. Among urban women mean age at marriage was found 20.43(SD±4.08) years and mean age at first child birth was 22.55(SD±4.3) years. Current contraceptive users among rural women was 79(52.7%) while it was 61(40.7%) among urban women. In this study, association between unmet need for family planning and freedom of choice of contraceptives was highly significant (p=0.001). To increase contraceptive prevalence rate and reduction of unplanned pregnancy, more emphasis should be given on unmet need for family planning.

Correlation of Coronary Angiographic Severity with Carotid intima Media Thickness and Flow mediated dilatation of brachial Artery in Patients with Ischemic Heart Disease.

Background: Ischemic Heart Disease which encompasses Acute Coronary Syndrome and Chronic Stable Angina is the most common cause of worldwide mortality and morbidity. Carotid intima media thickness (CIMT) is a non-invasive ultrasonographic technique to image the carotid arteries which measures the thickness of the intima and media of these vessels. It is a marker of atherosclerotic process. Flow mediated dilatation (FMD) is a marker of endothelial function of arteries. Ischemic heart disease can be predicted long before its actual occurrence by observing these two phenomenons. Methods: This cross sectional study done in the Department of Cardiology, Dhaka Medical College Hospital during the period of Oct 2010- Sept 2011.We enrolled 102 patients admitted with IHD by purposive sampling. We assessed FMD of brachial artery, CIMT by vascular duplex. Coronary artery disease severity was assessed by vessel score, stenosis score and extent score from angiography. Results:The mean (±SD) age of the patients was 50.9(±11.3) years. The male- female ratio was 5:1. CIMT has significant negative correlation with FMD (r=-.407, p=<.001). Flow mediated dilatation of brachial artery has weak but significant negative co-relation with vessel score(r=-.609, p=<.001), stenosis score(r=- .493, p=<.001) and extent score (r=-.477, p=<.001). However, carotid intima media thickness has weak but positive correlation with vessel score (r=.447, p=<.001), stenosis score (r=.417, p=<.001) and extent score(r=.412, p=<.001). Conclusion: The present study concludes CIMT has significant negative correlation with flow mediated dilatation of brachial artery. FMD has weak but significant negative co-relation and CIMT has weak but positive correlation with vessel score, stenosis score and extent score of coronary arteries.

Impact of mealey bug (Maconellicoccus hirsutus) infection on biochemical components of hibiscus rosa sinensis.

Mealey bug (Maconellicoccus hirsutus) causes dreadful infection in Hibiscus rosa sinensis.Infections are highly virulent and alters biochemical components of the species. Therefore an attempt has been made to evaluate the alteration of biochemical components in Hibiscus stem at various stages of infection. The results reveal that partial infected stem had shown 78% decrease in its aminoacids whereas highly infected had shown 64% decrease. The results also show that proteins had increased significantly(72%) in highly infected stem and noticeable increase (63%) in partial infected.

Negative PressureWound Therapy (NPWT) in open wound management: A study of 16 Cases in Orthopaedic Department of Faridpur Medical College Hospital.

Wound management is a major concern in open fracture cases. Negative Pressure Wound Therapy (NPWT) is an advanced method for managing open wounds. It is a topical treatment using sub-atmospheric pressure to increase blood flow, remove bacteria and increase growth of granulation tissue in the wound. The study was performed to evaluate the results of NPWT in patients with open fracture in lower extremity. Using Aquarium pump as an NPWT device, 16 patients were prospectly treated for open fractures in their inferior extremity. Mean patients' age range was 21 to 60 yrs. The patients under study either had suffered from trauma, fall or had post operative wound infection. Many of them had wounds with underlying tendon or bone exposure. Necrotic tissues were debrided before applying NPWT. Dressings were changed every 3rd or 4th day and treatments were continued for 07 to 28 days. Exposed tendons and bones were successfully covered with healthy granulation tissue in all cases, depth of the wounds reduced as well as surface areas. In 12 cases coverage of granulation tissue were achieved and further managed by skin grafting, 4 cases with wound infections were closed with secondary suture. No significant complications were noted regarding the treatment. NPWT was found to facilitate the rapid formation of healthy granulation tissue on open wounds in lower extremity and thus to shorten healing time and minimize secondary soft tissue defect coverage procedures.

Risk factors for ischemic heart disorder patients: Outcome of a survey conducted in Dhaka city, Bangladesh

This study was conducted to explore the risk factors of the patients of ischemic heart disorder. Data were collected by questionnaires on the basis of age, sex, body mass index, smoking and presence or absence of other diseases like lung, kidney, thyroid and peripheral vascular diseases, diabetes etc. Data of 150 patients were analyzed statistically. Males were found more vulnerable to ischemic heart disorder than females. This study also indicates that increased body weight, higher body mass index, hypertension, smoking, sedenatary life style and family history of cardiac diseases are influential risk factors for ischemic heart disorder.

Bryant's Traction for Neonatal Femur Fracture Occurred During Birth.

Femoral shaft fracture is an uncommon birth trauma. Bryant's Traction followed by spica cast is an acceptable method of treatment of femoral shaft fracture 0-18 month's age group. Here we treated 30 cases of neonatal femur fracture during birth with only Bryant's Traction of both legs for 3 weeks in hospital. We retrospectively reviewed all neonatal femur fractures occurred during birth admitted in FMCH during a two and half years period. All patients were followed up monthly for 3 months and 6 monthly for 2 years. All fractures healed satisfactorily clinically and radiographically and with no residual deformity, limb length discrepancy or functional impairment. Parents were highly satisfied with the method and its result. It is very simple method and could be safely carried out.

Road Traffic Accidents by 'Nasimon' and 'Karimon'-A Study in Faridpur Medical College Hospital.

Road traffic accidents in Bangladesh have been rapidly increasing with huge mortality through road accidents each year. There are many causes of road accidents in recent years; one important cause is running of locally made improvised three wheelers (flat bed tricycle) in the urban areas and also on the highways, popularly known as 'Nasimon' and 'Karimon'. This prospective study was carried out in Faridpur Medical College Hospital from January through June 2011, to study the accident patients caused by 'Nasimon' and 'Karimon'. Fifty six (12%) patients were of RTA by 'Nasimon' and 'Karimon' out of a total of 468 patients admitted into our hospital during this period. Most patients (41, 73.21%) were male, highest accidents (24, 42.86%) were observed among 21-30 years age group and most victims (33, 58.93%) were belonged to low socioeconomic status. Commonest (31, 55.36%) victims were passengers of 'Nasimon' and 'Karimon' while maximum number of accidents (46, 82.14%) took place in the urban areas and on the highways. Injury pattern of victims were similar to that found in any other road accident patients. These three wheelers 'Nasimon' and 'Karimon' are run in violating of Bangladesh Motor Vehicles Act (1983) as they are totally unfit for plying on the highways. Strict surveillance against these illegal and risky vehicles on the highways and in the urban areas by law enforcing agencies is required as a measure to reduce the burden of road accidents in our country.

Early Risk Assessment In Right Ventricular Infarction By TIMI Risk Score.

Background: Inferior myocardial infarction complicated by right ventricular infarction is associated with a greater risk of in-hospital mortality and cardiovascular related complications. Early risk stratification of patients with right ventricular infarction is crucial for appropriate management and reduction of adverse cardiac events. The development of TIMI risk score has provided a useful tool to quickly and easily stratify patients with right ventricular infarction. We conducted this study to evaluate the prognostic value of TIMI Risk Score analysis in patients with right ventricular infarction. Methods: This observational study was conducted in the department of Cardiology in NICVD, Dhaka, from July 2006 to June 2008. Considering inclusion and exclusion criteria, a total of 60 patients with right ventricular infarction were evaluated. All the patients were evaluated clinically and ECG was done after admission. Patients were categorized into two groups by TIMI risk scoring. Patients with low TIMI risk score(0-3) were in Group-I and patients with high TIMI risk score(4- 14) were in Group-II. Results: The study revealed no statistically significant difference among the patients of two groups (p>0.05) in relation to sex, weight, risk factors and presenting complaints. Analysis revealed statistically significant difference among the patients of two groups (p<0.05) in relation to age, duration of chest pain, clinical parameters, Killip class of heart failure and LVEF. Regarding inhospital outcome, 51.7% patients developed complications during the study period and all the complications were more in group II patients with high TIMI risk score(4-14). Death (18.3%) was the most common complication followed by cardiogenic shock (15.0%), complete heart block(6.6%),cardiac arrest(6.6%),VT(3.3%)and 2nd degree heart block(1.6%). Conclusion: This study indicates that on admission - TIMI risk score analysis can identify patients with right ventricular infarction at higher risk for in-hospital mortality and morbidity.

Impact of Low Hemoglobin on Contrast-Induced Nephropathy After Percutaneous Coronary Intervention.

Background: Contrast-Induced Nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. The aim of this study was to assess whether anaemia is a predictor of contrast induced nephropathy after Percutaneous Coronary Intervention (PCI). Methods: This was a prospective observational study. A total of one hundred patients fulfilling the inclusion and exclusion criteria who underwent (PCI) Percutaneous Transluminal Coronary Angioplasty with stenting, were studied during the study period of two years from January 2008 to December 2009. Patients were divided into two groups : Group-I (n=50), patients with low hemoglobin (male <13-10gm/dl, female < 12-10 gm/dl) and Group-II (n=50), patients with normal hemoglobin (male >13gm/dl, female >12gm/dl). Non-ionic low-osmolar contrast agents was used in all patients.Volume of contrast medium (ml) was recorded. Adequate hydration given intravenously (ml). Prior to procedure serum creatinine, serum electrolytes and Creatinine clearance rate were measured within 24 hrs before PCI and on days 1,2,3 after PCI. If there is renal impairment (CIN) serum creatinine, serum electrolytes and Creatinine clearance rate were measured daily from the 4th day onward after PCI until recovery. Results: The mean serum creatinine level of low hemoglobin group and normal hemoglobin group were 0.9mg/dl and 1mg/dl respectively at base line. The low hemoglobin group experienced a considerable increase in serum creatinine up to 1.5mg/dl at day 3 compared to 1.3 mg/dl in normal hemoglobin group. When the most common definition of contrast induced nephropathy (as an increase in the serum creatinine concentration >0.5 mg/dl from baseline) was used the incidence of CIN was 26% in low hemoglobin group and 8% in the normal hemoglobin group. Conclusion: preprocedural low hemoglobin is an independent determinant of increased incidence of contrast induced nephropathy after percutaneous coronary intervention.