Community Based Rehabilitation for Accessibility of Disable Person in a Low and Middle-income Country like Bangladesh.

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Ethical issues and dilemmas in spinal cord injury rehabilitation in the developing world: a mixed-method study.

STUDY DESIGN: Mixed-method study (small group discussions and online literature search). OBJECTIVES: Identify the ethical issues and dilemmas faced by rehabilitation professionals involved in the service delivery to the persons with spinal cord injury (SCI) in the low income and lower-middle-income countries (LIC/LMIC) located in Asia. SETTING: Small group discussions in three biomedical conferences in Dhaka, Bangladesh and Kualalampur, Malaysia. METHODS: Three small group discussions (30-45 min each) were held during three international conferences in 2019. The conferences brought together experts in the fields of neurology, rehabilitation, neurorehabilitation, and bioethics. A summary of SCI practice points and dilemmas were documented including goals of care, duties of rehabilitation professionals, health care worker-patient relationships, roles, and expectations of family members at different care settings. RESULTS: There is a paucity of literature on this topic. The application of the principles of contemporary bioethics in the pluralistic societies of LIC/LMIC can be challenging. The ethical dilemmas faced by rehabilitation professionals working in LIC/LMIC are diverse and different from those reported from the Western and developed countries. Ethical issues and dilemmas identified were understanding patient autonomy in decision making, lack of insurance for SCI rehabilitation, financial challenges, challenges of providing emerging technology in SCI rehabilitation and SCI rehabilitation during disasters. CONCLUSIONS: We have summarized the possible ethical issues and dilemmas which rehabilitation professionals in LIC/LMIC may encounter during delivery of SCI rehabilitation services. We hope it generates a discussion on an often-neglected aspect of SCI care in the LIC/LMIC and helps identify the complexities of ethical dilemmas unique to persons with SCI living in a developing country.

Effect of dexamethasone on brain oedema following acute ischemic stroke.

A randomized clinical trial was conducted to asses the effects of dexamethasone on brain oedema following acute ischemic stroke in the departments of Medicine of different hospitals from July, 2003 to December, 2006. A total of 60 patients were included in the study. They were divided into two groups keeping the similarity regarding the age, sex and severity of the stroke between two groups. There were 30 patients in experimental group and 30 in control group. The level of consciousness was compared by Glasgow Coma Scale (GCS) on 3rd, 7th and 10th day of intervention and improvement was found in both the groups, but the improvement of level of consciousness was statistically significant in Dexamethasone treated group. The volume of hypodense area did not differ significantly in two groups in CT scans before and after treatment (p=0.74). The study results demonstrate that Dexamethasone improves the level of consciousness in acute ischemic stroke associated with brain oedema but did not reduce volume of hypodense area.

Effects of therapeutic modalities on patients with post stroke shoulder pain.

A randomized clinical trial was conducted to find out the effects of physical modalities transcutaneous electrical nerve stimulation (TENS) and ultrasonic therapy (UST) on the patients with post stroke shoulder pain in the Department of Physical Medicine & Rehabilitation & Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from 1st July 2006 to 31st December 2006. In that period a total of 750 stroke patients attended the stroke clinic of the Department of Neurology, BSMMU, of which 150(20%) patients presented with post stroke shoulder pain. Among the patients with post stroke shoulder pain, 45(6%) patients were included in the study. The aim of the study was to find out the improvement with proper and timely physical therapy and to study the comparative efficacy of TENS or UST therapy on shoulder pain in stroke patients. Results of this study showed that most of the patients were elderly and maximum number of patients (86.66%) was diagnosed as adhesive capsulitis. In each group, pain reduction and increase of muscle strength was same, TENS showed better improvement of muscle strength. There was complete recovery of tenderness by both TENS and UST. Significant improvement was observed after treatment in each group except in active internal rotation in UST group. But in comparison between two groups, Group A (TENS) showed statistically significant better improvement in all planes of pain free range of motion than Group B except active abduction which was better improved in group B (UST) and in case of passive abduction, passive external rotation and passive extension, TENS had better effect than UST. It may be concluded that TENS and UST both are effective but TENS may be safer and superior to ultrasonic therapy (UST) in the treatment of the patients with post stroke shoulder pain.

Effects of isometric quadriceps muscle strengthening exercise on chronic osteoarthritis of the knee.

A total of 64 patients of osteoarthritis of the knee joints were studied to observe the effects of isometric quadriceps muscle strengthening exercise plus non-steroidal anti-inflammatory drugs (NSAIDs) on osteoarthritis of knee joints. Another 75 patients were treated with NSAIDs as control. They were assessed by visual analogue scale, OMAC scale and range of motion of the knee joints and followed-up weekly for six weeks. Improvement was found in both groups (p = 0.001) after treatment. In comparison, more improvement was found in the exercise group after four weeks (p = 009). Then improvement was gradually increased day by day and finally there was highly significant improvement (p = 0.001). This study suggests that isometric quadriceps muscle strengthening exercise has its beneficial role to reduce symptoms in osteoarthritis knee.

Informed consent: knowledge, attitude and practice of the researchers in a postgraduate institute of Bangladesh.

A prospective experimental study was conducted in a postgraduate institute in Dhaka, Bangladesh, from April '05 to September '05. A total of 214 doctors of a postgraduate medical institute were included in the study who was involved in research works. A written questionnaire was given to the respondents to assess their knowledge, attitude and practice about informed consent (IC). The data was analyzed statistically. Chi-Square test was done to see the level of significance. Regarding knowledge of IC, we found maximum participants were more or less knowledgeable about it. The attitude of the respondents was also in favour of taking IC. In practice, most of them had taken informed consent that was verbal (39.3%) and written (47.6%). But some of the researcher (13.1%) had not taken any informed consent. By the present study, it may be concluded that the researchers of the concerned institute were aware of IC.

Effects of deep heat therapy on the patients with chronic low back pain.

A randomized clinical trial was conducted in the Department of Physical Medicine & Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from 1st April 2006 to 31st March 2007. A total of 102 patients of Chronic LBP were included in the study. Out of them, 42 (41.2%) were male and 60 (58.8%) were female and male: female ratio was 1:1.43. The mean age of the patients was 42.22+/-8.07 years. They were divided randomly into two groups by the way of lottery for the clinical trial. Group A was treated with short wave diathermy (SWD) and non steroidal anti inflammatory drugs (NSAID) and Group B was treated with placebo SWD and NSAID. After treatment the result was compared and student's 't' test was done to see the level of significance. There was significant improvement after treatment in both the group (P=0). In comparison between two groups, it was found that there was no significant improvement in pre-treatment, after 1st week and after 2nd week. Improvement was found in Group A than Group B after 3rd week (P=0.05). And the improvement was gradually increased in Group A in comparison to Group B. Finally, it was found that there was significant improvement in Group A than Group B after 6th week (P=0). From the present study, it may be concluded that both the treatment (NSAID and SWD) is effective for the treatment of Chronic LBP. But the patient may be more benefited if SWD is used as an adjunct to NSAID.

Effects of activity modification on the patients with osteoarthritis of the knee.

A prospective randomized clinical trial was conducted on 162 patients of osteoarthritis of knee were included in the study. The patients were divided into two groups- Group A and Group B. The Group A was treated with shortwave diathermy, exercise, naproxen and activity modification and the Group B was treated with shortwave diathermy, exercise and naproxen. Improvement was found more in Group A than Group B after 4th week (95% CI was -2.59 to 6.56). Then it was found that the improvement was gradually increased in Group A than Group B and finally, it was found that there was highly significant improvement in Group A than Group B after 6th week (95% CI was -3.45 to -0.70). This study suggests that activity modification play an important role for the treatment of the patients with osteoarthritis of knee.

Endometriosis association research center.

Endometriosis, the presence of endometrial tissue outside the uterus, is a progressive, estrogen-dependent disease and occurs nearly exclusively in menstruating women of reproductive age. Pain syndrome, however, represents the major clinical problem of this disease, manifested as dysmenorrhea, pelvic pain, lower abdominal pain, and dyspareunia. About 32 literatures are reviewed in recent advancement for diagnosis of endometriosis. The magnifications of its managements are understood. In outdoor, the management is only depending on clinical findings and on some non invasive procedures without any definitive diagnosis. So, research activities should be done on the basis of recent advancement of endometriosis.

Arthrographic distension of the shoulder joint in the management of frozen shoulder.

The study was an open randomized controlled trial to compare the outcome at 8 weeks with two different modalities in the treatment of 'Frozen shoulder'. Clinical cases with painful limitation of movement of shoulder were randomized to receive physical therapies alone versus physical therapies and shoulder arthrography with intra-articular steroid in a sequential randomization process. Cases suspected of having a concomitant illness and has potential to cause secondary frozen shoulder were excluded, such as, history of trauma to shoulder over the last 6 months, symptomatic clinical cervical degenerative diseases, and causes in and around the shoulder (infective and non-infective). Physical Therapies provided to all patients were therapeutic exercises, transcutaneous electrical nerve stimulation (TENS) and infra-red radiation (IRR). Outcome measures were improvement of pain on a Visual Analogue Scale (VAS) score and range of motion measured by Goniometer at 8 weeks. Patients were followed weekly for 8 weeks and outcome parameters were recorded on every evaluation. The baseline range of motion in the two groups was comparable. At 8 weeks a statistically significant difference in outcome were observed in the two groups. The chi-square means difference of improvement in range of motion for abduction was p <0.00 and for external rotation was p <0. 00. The pain reduction on VAS score was not significant in the two groups (p <0. 40). In the present small series, the distension arthrography with intra-articular (IA) steroid plus physical therapy was superior over physical therapy alone in the functional improvement of the frozen shoulder. Further studies with larger sample size are required to confirm the observations.

Effects of cervical traction and exercise therapy in cervical spondylosis.

A randomised clinical trial was conducted in the Department of Physical Medicine, Chittagong Medical College Hospital from July, 2001 to June, 2002. The objectives of the study were to find out the effects of cervical traction (CT) and exercise on the patients with chronic cervical spondylosis. A total of 199 patients with cervical spondylosis were included in the clinical trial. One hundred patients were treated with cervical traction plus exercise and 99 patients were treated with non-steroidal anti-inflammatory drug (NSAID). Posture correction advice was given to all patients. The patients were treated for 6 weeks. There was a marked improvement in both the groups after treatment (P<0.001). But there was nearly significant difference regarding improvement in treatment with CT plus exercise than with NSAID (P = 0.06). The results indicate that the improvement of the patients with chronic cervical spondylosis was more in CT plus exercise than analgesics. So, CT & neck muscle strengthening exercise may have some more beneficial effects than NSAIDs on chronic cervical spondylosis.

Platelet support for cardiopulmonary bypass surgery.

After we discontinued the use of fresh blood for cardiopulmonary bypass surgery, we routinely provided platelet concentrates for the patients. To ascertain if this was necessary, patients paired for procedure and age were given either 4 units of platelets (Group I) or no platelets (Group II). Platelet counts were obtained preoperatively; hourly during bypass; immediately, 1/2 hour, and 3 to 4 hours after bypass; and daily for 7 postoperative days. In the 60 patients evaluated, a significant difference between mean platelet counts could not be demonstrated at any time. Total blood use and the total time required for postbypass hemostasis was not significantly different between the two groups. The degree of thrombocytopenia could not be correlated by bypass time. Platelet concentrates or fresh blood are not needed prophylactically for cardiopulmonary bypass surgery, and their usage should be reserved for the occasional patient who manifests thrombocytopenia as well as hemorrhagic complications.