Childbirth experience of mothers attending selected secondary hospital

Background: Childbirth experience is an important event in every woman抯 life but there is lack of current research in this area in Bangladesh. For improving quality of care for pregnant women during childbirth, clinical care modalities should be designed to improve the experience of care by the mothers. The aim of the study was to assess the childbirth experience in regards to respectful maternity care, effective communication, companionship during childbirth and continuity of care. Methods: A cross-sectional study was conducted between January to December 2020 among 98 mothers during facility-based childbirth in one model district hospital and one existing district hospital situated in northern part of the country. Results: Mean age of the respondents was 23.2 years (+SD 5.0). Majority completed secondary education (53.1%), and their average monthly family income was 12081.63 taka (+SD 5469.08). Childbirth experience was not associated with socio-demographic status and educational background (P>0.05). This study presents data on physical abuse prevalence and consent refusal rates among respondents, stratified by age groups, educational levels, and monthly family income. Despite variations observed across demographics, statistical analysis, including chi-square tests with continuity correction, revealed no significant differences (P<0.05) in these outcomes based on demographic factors. Conclusions: More than half of the mothers experienced non consented care and around one fourth of mothers being physically abused during childbirth.

Oleogels Of Olive Oil And Soybean Oil For Topical Drug Delivery: A Comparative Analysis

Objective: The objective of the present investigation was to develop olive and soybean oil-based oleogels with Span 40 and/or Tween 80 (as gelator and/or surfactant) and determine the critical gelator concentration (CGC), characterise and compare the rheological, thermal properties and drug release profile of the gels formed for topical delivery. Methods: Olive and soybean oil-based Span 40 and Span 40/Tween 80 oleogel formulations were prepared by solid fiber mechanism and subjected to organoleptic evaluation, FT-IR spectroscopy, thermal analysis, rheological study, kinetic modeling of gelation and drug release. Results: The critical gelator (Span 40) concentration was found to be lower for olive oil (12% w/v) and depend on the type of oil. Tween 80 reduced CGC of soybean oleogels only. Soybean oil-based oleogel containing 18% w/v Span 40 was found to form more flexible, less viscous and thermally less stable formulation with better release of paracetamol as evident from lower melt flow index, Tg value, lower β and higher α value compared to olive oil-based oleogel with 12% w/v Span 40 (CGC). Surfactant addition can be assumed to modify the microarchitecture of the oleogels to a great extent to produce more flexible and thermally stable gels with even better drug release profile. Span-Tween based soybean oleogel formed a gel-matrix whereas matrix in olive oil-based oleogels containing Span only became slightly flexible to release the drug in zero-order fashion on the addition of surfactant cogelator. Conclusion: Nature of oil exerts profound influence on the rheological, thermal and release profile of oleogels containing Span 40 as gelator and/or Tween 80 as surfactant cogelator.

Management of Hepatitis C Virus Infection - New Era Has Been Started.

Hepatitis C virus is a major cause of chronic hepatitis and is responsible for majority of liver transplantation worldwide. It has got no vaccine for prevention. Interferon containing regimen was the only management options for treatment of Hepatitis C virus till last year. Due to side effect profile and treatment cost this treatment options was not reachable for general population. Besides, response rate was not so satisfactory (Genotype 1, 40-50%, Genotype 2 & 3, 70-80%). New oral antivirals were introduced in 2014 which has got little side effect profile as well as good treatment response rate (80-95%). These new drugs with their different combination regimens along with indications, contraindications and treatment monitoring of Hepatitis C virus are discussed briefly in this review.

Management of Inferior Vena Cava Injury in a Non Specialized Tertiary Hospital-a Case Report.

Abdominal vascular injury are among the most challenging and lethal injuries in the traumatized patients. Inferior vena cava (IVC) is the most frequently injured vein during the blunt or penetrating trauma. Ligation of IVC, venorrhaphy, venoplasty, end to end anastomosis, endovascular stenting or graft interposition should be considered in selected cases. However most of the procedures require special setting and surgical team. Relatively simple procedure e.g. venorrhaphy produces narrowing of lumen in many cases. Ligation of IVC may result in thrombosis and embolism thus increases morbidity of patients. Here, in the present case the authors report a patient with IVC injury repaired by venoplasty (cavaplasty) with great saphenous vein patch in a non specialized tertiary hospital and it can be performed by a team led by general surgeon.

Respiratory Health Problems Among the Ceramic Workers in Dhaka,.

Ceramic factory workers are potentially at risk to develop occupational respiratory diseases due to chronic inhalation of dust particles generated in the ceramic factory. A cross-sectional descriptive study was carried out to assess the respiratory and other health problems among the workers of Mirpur Ceramic Works Limited, Dhaka, Bangladesh during the period of April to June, 2011. Among 200 participants, 132 (66%) were males and 68 (34%) were females. Less than one-third of the workers were habituated to use personal protective equipments (PPE), while more than two-third were not habituated. Nearly half (45.5%) of the workers were suffering from at least one respiratory problem and of them 86.8% (P = 0.001) had problems after joining the factory. Of the respiratory sufferers 27% had chronic bronchitis, 20% bronchial asthma, 1% pulmonary tuberculosis, and 0.5% had silicosis. A significant numbers (60.5%) of workers were suffering from other health problems along with or without respiratory problems, in terms of musculoskeletal pain, back pain, headache, dermatitis, anaemia and fever. The prevalence of respiratory problems was significantly higher among non-users of PPE than PPE users (P = 0.006), and it was found to be higher with the increased of job duration. The study showed the notable higher prevalence of respiratory problems among the workers exposed to ceramic dust, although the other potential environmental confounding factors could not be ruled out in the analysis. Obligatory use of PPE by all workers and health education to increase awareness among the workers might have role to reduce the prevalence.

Anthropometric Status between Tribal and Non Tribal School Children.

A descriptive cross sectional study named "Anthropometric status between tribal and non tribal school children" was conducted on Guimara primary school, Matiranga, Kharagrachari and Thana primary school, Sitakund, Chittagong to assess the difference in nutritional status between tribal and non tribal school children aged 6 to 10 years in terms of selected indicators. The indicators were height for age Z score, weight for height Z score, and weight for age Z score. Data were collected by interview from mother of the child through semi-structured questionnaire and measuring height and weight of 128 children. Among them 63 were selected from tribal community and 65 from non tribal area. The study revealed that 9.2% non tribal and 7.9% tribal children were severely stunted, 12.3% non tribal and 1.6% tribal were moderately wasted and 9.2% non tribal and 1.6% tribal children were moderately underweight. In relation to sex among tribal children 12.9% tribal boys and 3.1% tribal girls were severely stunted, only 3.2% tribal boys were both moderately wasted and underweight. In case of non tribal children 17.9% boys and 2.7% girls were severely stunted, 17.9% boys and 8.1% girls were moderately wasted and 17.9% boys and 2.7% girls were moderately underweight. According to the age group of 6 to 7 years it was found that, only 4.2% non tribal children were severely stunted and 29.2% were moderately stunted where as 12% tribal children were moderately stunted. In both case of moderately wasting and underweight non tribal were 8.5% more than tribal children and among 8 to 10 years age group it was 12.2% and 7.3% more respectively and in case of severely stunted tribal children were 1% more than non tribal. Improper dietary practice was also found among the two group of study population. Information and health education should be provided to the parents of the children by community participation regarding proper use of sanitary latrine, provision of safe drinking water and proper dietary practice.

Management of Inflammation in Chronic Obstructive Pulmonary Disease-Update.

Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory condition, the earliest manifestation of which is airway obstruction which is only partially reversible and the treatment rationales are provided accordingly. Research has shown that COPD-inflammation involves multiple inflammatory cells and mediators and the underlying pathology differs from asthma inflammation.For these reasons, therapeutic agents that are effective in asthma patients may not be optimal in COPD patients. COPD exacerbations are intensified inflammatory events compared with stable COPD. The clinical and systemic consequences believed to result from the chronic inflammation observed in COPD, suggest that inflammation intensity is a key factor in COPD and exacerbation severity and frequency. Although inhaled corticosteroids are commonly used and are essential in asthma management, their efficacy in COPD is limited, with only a modest effect at reducing exacerbations. The importance of inflammation in COPD needs to be better understood by clinicians, and the differences in inflammation in COPD versus asthma should be considered carefully to optimize the use of anti-inflammatory agents. Current COPD management focuses predominantly on symptom relief by optimizing bronchodilatation. The role of phosphodiesterase type 4 inhibitors (PDE4), statins, angiotensin converting enzyme inhibitors, theophylline and tumor necrosis factor inhibitors in COPD management will be reviewed. Targeting COPD inflammation with the goal of reducing exacerbations is a major focus of current clinical practice & outcome research.

Quality of Care: View of Patient Satisfaction with Physiotherapy in Government and Private Settings in Dhaka, Bangladesh.

Patients' satisfaction plays an important role to attract patients for health services. It has not been closely monitored in physiotherapy; limited studies exist in this area of allied health services. The objective of the study was to determine the level of satisfaction of patients at the government and private hospitals in Dhaka and to compare between two facilities. This descriptive type of cross-sectional study was carried out with patients who sought physiotherapy care at the outdoor of Physical Medicine Department of the Dhaka Medical College Hospital (DMCH) and the Centre for Rehabilitation of Paralyzed (CRP), Mirpur, Dhaka. In total, 150 patients - 75 from each setting were interviewed. Appropriate research instruments comprising a structured and semi-structured questionnaire developed by the American Physical Therapy Association (APTA) were administered by interviewers to collect data. To find out any association among the socio-demographic characteristics, chi-squire test was applied, and the level of satisfaction was measured in percentages to compare between the two settings (government and private). Patients attendance differ because different socio-demographic characteristics and location of physical health problem in two hospital. Location of the hospital, privacy of patients, behaviour of staff members, physical qualities of hospitals (cleanliness, light, ventilation, etc.) had more than 10% variation in the level of satisfaction between the two settings. So, patient satisfaction with physiotherapy is higher in private setting than that in government setting in Dhaka.

Stapled Haemorrhoidopexy Compared with Conventional Haemorrhoidectomy--A Systematic Review.

Haemorrhoids are one of the most common anorectal disorders. Conventional haemorrhoidectomy (CH) is the most commonly practiced surgical technique. Stapled haemorrhoidopexy (SH) [procedure for prolapsed haemorrhoids (PPH)] is newly developed method for the surgical management of Haemorrhoids. This review looks at the surgical management of prolapsed haemorrhoids in light of this recent development and suggests a treatment approach based on this current evidence. A Medline, Pubmed and Cochrane data base search was performed using key words "haemorrhoid" or 'hemorrhoid' and staple. Relevant papers e.g. randomized controlled trials, review and metaanalyses from different parts of the world were collected. Data were analyzed and compiled. Though early small RCTs (stapled haemorrhoidopexy comparing with traditional excisional surgery) have shown stapled haemorrhoidopexy is less painful and it is associated with quicker recovery but recent large meta-analyses and long term follow up have shown SH is associated with a higher long term risk of haemorrhoid recurrence and symptoms of prolapse.

Pattern of Tobacco Consumption among the Diabetic Patients.

Diabetes Mellitus (DM) is a public health challenge all over the world. Recent evidence suggests that there is a positive association between smoking and the risk of diabetes. This descriptive cross-sectional study was conducted from March to June 2008 at BIRDEM Hospital, Shahbagh, Dhaka to find out pattern of tobacco consumption among diabetic patients. Age of the respondents was >15 years. With purposive sampling total 255 respondents were selected. Data was collected through face-to-face interview with structured questionnaire. Out of 255 respondents, 51.4% consumed deferent type of tobacco. Smoker was 63.36% and smokeless tobacco user was 52.67%. The highest (45.80%) had habit of smoking, 36.64% had habit of smokeless tobacco and 17.56% had habit both types of tobacco consumption. The highest smoking and smokeless tobacco consumption found within 50-60 years age group. Total 60.80% male had smoking habit and 32.82% female were smokeless tobacco consumer but no female was smoker. Twenty nine percent tobacco consumers were primarily educated, 16.08% service holders were tobacco consumer and 13.75% service holders were smoker. Among respondents lung diseases and heart diseases were common (78.54.0% and 49.36%). Respondents who consumed tobacco were suffered (74.36%) more complication than non-tobacco consumer (25.64%). So an effective awareness program is required to discourage the consumption of tobacco to protect diabetic patients.

Cytomegalovirus oesophagitis in a patient with Non-Hodgkin's lymphoma.

Cytomegalovirus (CMV) infection is frequent in immunocompromised patients, especially in AIDS, organ transplantation and rarely in Hodgkin's disease and Non-Hodgkin's lymphoma (NHL). We present a case of NHL with CMV oesophagitis, which has rarely been documented in literature. Apart from fungal and herpes simplex infections, as the common differential diagnosis for oesophagitis in patients of lymphoma, CMV should be considered an important etiologic agent. Early diagnosis and prompt treatment of CMV oesophagitis with gancyclovir can avert significant morbidity and avoid unacceptable treatment delays.

Activity and toxicity of 2-CDA in Langerhans cell histiocytosis: a single institutional experience.

BACKGROUND: Langerhans cell histiocytosis (LCH) is a rare disorder characterized by clonal proliferation of immature and abnormal bone marrow derived langerhans cells. Treatment is usually multimodal. Potent anti-monocyte as well as immunomodulatory activity of 2-CDA and its proven efficacy in many lymphoproliferative disorders has made 2-CDA a rational choice in treatment of LCH. AIM: To evaluate the efficacy and toxicity profile of 2-CDA in children with relapsed or refractory LCH. SETTING AND DESIGN: This is a pilot study and we present the initial data of the first seven patients treated at our institution. MATERIALS AND METHODS: Seven patients of relapsed and refractory LCH were enrolled from July 2000 to June 2004. The cohort of seven patients included six males and one female with a median age at initiation of cladribine was 2.25 years (range, 1.67 to 7.0 years). Three patients had received one prior chemotherapy regimen while the rest were heavily pretreated. Cladribine was administered over two hours IV daily for five days and repeated every four weeks. RESULTS: After a median of six courses of cladribine (range, 2 to 9), two (33%) patients achieved PR and two (33%) patients have SD on imaging but are clinically better. None experienced grade 3 or 4 hematologic toxicity. At a median follow-up of 19 months (range, 8 to 52 months), five patients remain alive and one patient has died. CONCLUSION: Our study shows that single agent 2-CDA is active and well-tolerated in children with relapsed or refractory LCH.

Metachronous gastric diffuse large B-cell lymphoma and adenocarcinoma.

The development of gastric carcinoma in a patient with gastric lymphoma is rare. Helicobacter pylori is a common etiologic agent for both these conditions. We report a 38-year-old lady who was initially diagnosed to have gastric lymphoma and developed early gastric carcinoma on follow up. She was operated on for the carcinoma and is in complete remission since.

Successful complete regression of isolated intramedullary spinal cord metastases from epithelial ovarian carcinoma with chemotherapy and radiotherapy.

Advances in the management of ovarian cancer by use of aggressive surgery and effective platinum-based chemotherapy have prolonged survival; this may have resulted in an alteration of the metastatic pattern of the disease and spread to unusual sites (e.g, CNS) has become more common. Also, with the availability of more sensitive imaging techniques, these tumors are being diagnosed with increasing frequency. Intramedullary spinal cord metastasis is rare. We report one such case treated successfully with chemotherapy and radiotherapy with long-term survival.

Primitive neuroectodermal tumor (PNET) as second malignancy after treatment of Hodgkin's disease.

Hodgkin's disease survivors are at an increased risk of developing second malignant neoplasms including secondary bone tumors. Common secondary bone tumors are osteogenic sarcoma and fibrosarcoma. Secondary primitive neuroectodermal tumor is extremely rare in this group. We present below, a rare case of secondary PNET in an 8-year-old child with Hodgkin's disease which developed unusually early outside the radiation portal and discuss potential factors responsible for its causation.

Brain metastasis--evidence based management.

Advances in cancer management have resulted in a significant increase in median survival of number of diseases. Consequently we are seeing more patients living long enough to develop symptomatic brain metastases. The management of such patients will be discussed here. The most important definitive investigation is contrast enhanced MRI scan of brain. Management consists of supportive care and disease directed treatment. Surgical resection remains the gold standard for the treatment of solitary brain metastases. Whole brain radiotherapy is considered standard treatment for all patients with brain metastases. The role of chemotherapy was limited in the past. Recently several new agents have been identified as potentially useful. Preliminary results indicate that drugs like temozolomide and topotecan have antitumor activity against the brain metastases as well as the primary systemic malignancies. The goal of multimodality treatment for brain metastases is to palliate local symptoms and prevent consequences of neurological involvement.