Multicenter Cohort Study to Evaluate the Relationship between Radiological Findings and Disability in Moderate and Severe Head Injury Patients.

This was a multicenter cohort study to evaluate the relationship between radiological findings and disability in moderate and severe head injury patients. The study places were the Neurosurgery department of Sylhet M A G Osmani Medical College Hospital, Sylhet Women's Medical College Hospital (SWMCH) and King Faisal Hospital (KFH), Taif, KSA. Sample size was 104 and the study period was 36 months (July 2021 to December 2022). On the basis of radiological findings the participants were divided into three arms. The different arms were diffused traumatic brain injury (arm-1), focal traumatic brain injury (arm-2) and both (diffused and traumatic) types traumatic brain injury (arm-3). Outcome was assessed by modified Rankin Score (mRS). Mean age was significantly higher in female. Overall mean age was 40.28 year. Highest number was in the below 20-year age group followed by the 41-50-year age group. Lowest number of participants was in the above 60-year group. Improved group was significantly higher than 'not improved' and the 'died' group (p<0.00001). Improved participants were significantly higher in the arm-1 and arm-2. Mortality was significantly higher (p<0.00001) in the arm-3 group.

Assessing the Effectiveness of Clinical Skills Laboratory and Traditional Lecture in Teaching Basic Life Support and Performance Evaluation According to Different Domains of Revised Bloom's Taxonomy.

Sudden cardiac arrest out-side hospital is serious global concern. If non-medical people are taught to initiate the basic life support (BLS) training with cardiopulmonary resuscitation (CPR) then the mortality could be reduced significantly. This was a non-randomized controlled study to evaluate clinical skills laboratory (CSL) as teaching tool for basic life support (BLS) training in comparison to traditional lecture. Sample size was 68 and performed in Sylhet Women's Medical College from July 2022 to September 2022. All the participants were third year nursing students. They were enrolled in to two groups. Group-A were taught BLS by clinical skills laboratory (CSL) and Group-B were taught by traditional lecture (TL). At the end of the teaching all of them were tested by a vetted multiple choice question (MCQ) set. The questions were set according the 5 levels of revised Blood's taxonomy. Mean score of Group-A (CSL) were higher the TL group (p=0.0003). Among the revised Bloom's taxonomy understand, apply and evaluate domains were significantly better taught (p<0.05) by CSL. The sensitivity of CSL was 0.559 in comparison to TL for BLS training. In the modern medical education teaching and assessment should be focused on the higher levels of learning taxonomy. Introducing CSL in medical education could boost up the psychomotor and cognition both in the medical education.

Relationship between Cholesterol Level and Spontaneous Intracerebral Hemorrhage: A Case-Control Study in Bangladesh.

Spontaneous intracerebral hemorrhage is one of the leading causes of mortality and morbidity. Genetic factors play an important role in this disease. Among the non-genetic causes cholesterol level is one of the risk factors. The aim of the study was to evaluate the association between ICH (Intracerebral hemorrhage) and cholesterol level as well as to find out the risk of total cholesterol (TC), Triglyceride (TG), High-density lipoprotein (HDL) and Low-density lipoprotein (LDL) for the disease. This was a case-control retrospective study with 60 cases and 60 controls. The study place was in the Neurosurgery department of Sylhet Women's Medical College Hospital and the study period was 2 years (from January 2020 to December 2021). The mean age ±SD of the cases was 57.08±9.47 years and the highest number of participants was in the 51-60 year group. Commonest location of ICH was deep (67.0%) followed by intraventricular hemorrhage (IVH) (28.3%) and lobar (5.0%). The means of TC (p=0.0004), TG (p=0.00013) and LDL (p<0.00001) were significantly lower than those of control group. The mean of HDL (36.48) of cases was significantly (p=0.00003) higher than the mean HDL (28.9) of controls. TC participants had 52.0% less risk to develop ICH. Raised TG had 46.0% and raised LDL had 52.0% lower risk of ICH.

Myers-Briggs Type Indicator Personality Types of Female Intern Doctors and Their Specialty Preference.

The Myers-Briggs Type Indicator (MBTI) personality types were established in 1940s. Career planning of doctors were found related to the MBTI personality. There are 16 subtypes of MBTI based on 4 dichotomies. Relationship between MBTI and career choice has been changed gradually in last few decades. Extroverted doctors are supposed to select surgery and introverted are prone to choose medicine according to MBTI study. This was a cross-sectional study on the female interns of Sylhet Women's Medical College Hospital, Bangladesh from September 2021 to November 2021, to evaluate their MBTI personality type and the career planning of these individual subtypes. Commonest subtypes of participants ISTP (Introverted, Sensing, Thinking, Perceiving) (14.13%) and ESTP (Extraverted, Observant, Thinking and Prospecting) (14.13%). Other common MBTI personality subtypes were ISTJ (Introversion, Sensing, Thinking and Judgment) (9.78%), ISFP (Introverted, Sensing, Feeling, Perceiving) (8.69%), ESFJ (Extraverted, Sensing, Feeling and Judging) (6.52%), ENTP (Extraverted, Intuitive, Thinking and Perceiving) (5.43%), INFJ (Introverted, Intuitive, Feeling and Judging) (5.43%), INTJ (Introverted, Intuitive, Thinking and Judging) (5.43%) and ISFJ (Introverted, Sensing, Feeling and Judging) (5.43%). Introverted (57.7%) participants were more than extroverted (42.3%) participants. Percentage of general surgery and OBG were higher in the extroverted group and the percentage of medicine was more in the introverted group but the differences were not statistically significant (p>0.05). The career planning of ENFJ, ENFP, ESTP and ISTJ subtypes of participants of this study had similarity of those of MBTI database.

Case-Control Study to Evaluate Zinc Deficiency as a Risk Factor for Oxygen Requirement in Patients with COVID-19.

Zinc is one of the important trace elements of blood. It helps in maturation of immune system in our body. In the past studies originate the relationship between viral disease and serum zinc deficiency. This was a multicenter case-control study to measure the serum zinc level of COVID-19 patients with different respiratory supports and to evaluate the Odds Ratio (OR) and Relative risk (RR) of zinc deficiency for oxygen requirement for COVID-19 patients. Study places were COVID-19 unit of three tertiary hospitals of Sylhet, a Northern district of Bangladesh. There were 30 controls and 90 cases in this study. The mean zinc level of cases (53-38mcg/dl) was significantly (p=0.000072) lower than the level of controls (73-23mcg/dl). The mean zinc level of the COVID-19 patients required oxygen (49-33mcg/dl) was significantly (p=0.0054) lower than the patients were not treated by oxygen therapy (64-51mcg/dl). The RR of getting affected by COVID-19 was 1-91 for the low zinc level people. Among the COVID-19 affected participants the lower zinc level people had a RR of 1-93 to receive oxygen supplementation. Lower zinc level people are more likely to be affected by COVID-19 in comparison to the normal zinc level people. Among the COVID-19 patients the lower zinc level people had nearly double (RR 1-93) risk of becoming hypoxic and eventually prone for oxygen support.

Evaluating the Respiratory Support Pattern and Relationship with Initial Oxygen Saturation of the COVID Isolation Unit Patients in Sylhet.

COVID-19 is the devastating pandemic of the century predominantly fatal due to its respiratory failure nature. Severe and critical patients need oxygen supplementation in different forms. This cross-sectional study was conducted in four tertiary hospitals of Sylhet, Bangladesh from November 2020 to March 2021. All the patients admitted in the COVID-19 isolation units and fulfill the selection criterion were enrolled in this study. The primary objective of this study was to evaluate different types of respiratory supports and its relationship with initial oxygen saturation (SpO2). Total 481 patients were enrolled. There was a male predominance (65.00%) in the participants. Highest number of participants was from 61-70 years age group. Number of ventilated patients were significantly high (p<0.001) in the COVID-19 patient group. The initial SpO2 and hospital staying period of COVID-19 positive and negative group did not show any significant difference but these two parameters showed significant difference among died and survived group (p<0.001). Nearly one fourth patients (24.94%) of total patients were treated in ICU with high flow nasal cannula (HFNC), non-invasive ventilation (NIV) and mechanical ventilation. Among the ICU admitted patients nearly one-fourth (24.16%) patients were treated with mechanical ventilation. Mortality rate was 62.00% for ventilated patients, 70.60% for NIV patients and 15.80% for the HFNC patients.

Cross-Sectional Analytic Study to Compare the Efficacy Between of Clinical Skill Learning (CSL) and Multimedia Lecture as Teaching Tool in Case of Endotracheal Intubation.

Clinical skill lab (CSL) is a part of simulation-based medical education (SBME) which now a days becomes an integral part of modern medical education. This cross-sectional analytic study was performed at Sylhet Women's Medical College, Sylhet, Bangladesh to assess the difference between CSL and traditional multimedia (MM) presentation in case of endotracheal intubation from January 2021 to February 2021. Total 78 first year nursing students were enrolled in study. Both groups were tested by same pre-tested multiple-choice questions. These 10 questions were set according to modified bloom's taxonomy domains. There was no significant difference in the mean scores of both groups. Male of CSL group had scored significantly better than the female of the same group. The top and bottom domains of modified bloom's taxonomy were significantly better taught in CSL group, whereas the others were better in the multimedia group.

Measuring Sensitivity, Specificity and Accuracy of HRCT of Chest and Comparison with Biomarkers in COVID-19 Suspected Patients: A Cross Sectional Study.

COVID-19 is a declared pandemic by World Health Organization. The diagnostic tests are not of high specificity and sensitivity, so far. Pro-inflammatory biomarkers and High Resolution Computed Tomography (HRCT) of chest are the common investigations performed to evaluate the diagnosis and prognosis of COVID-19. The objective of this study was to estimate the sensitivity, specificity and accuracy of HRCT and to find out the relationship between the biomarkers and HRCT findings. This was a cross-sectional descriptive study carried out in the COVID-19 suspected isolation unit of a tertiary hospital from July 2020 to November of 2020. Data were collected from electronic medical record (EMR). Relationship test were done by t-test and one-way-ANOVA test. Total 123 cases were enrolled after matching with selection criterion. Mean age of male was 62.5 years and female 57.7 years. Highest frequency of participants was observed in the 60-69 year age group. According to HRCT% findings 4 groups were made. They are below 25%, 25%-50%, 51%-75% and 76%-100%. The distribution of case among these groups was 15%, 44%, 35% and 6% respectively. The relationship between biomarkers (NLR, D-dimer, Ferritin and CRP) and HRCT% was found significant (p<0.05). In HRCT 92.5% lesion were peripherally placed and 99.2% cases were affected by both lungs. The sensitivity and specificity of HRCT were found 46% and 72.6% respectively with 62% accuracy. Raised biomarkers are significantly related to the more lung involvement in case of COVID-19 suspected pneumonia patients. These biomarkers will be helpful as diagnostic and prognostic markers for this disease. HRCT percentage can play an important role as diagnostic and prognostic tool in case of COVID-19 suspected cases.

Cross-sectional Study on Assessment of First-pass Success of Video Laryngoscope Intubation in General Anesthesia Patients.

Traditional Direct laryngoscope (DL) has been used by anesthesiologist during intubation for general anesthesia patients for more than a century. Video laryngoscope (VL) helps in better visualization of laryngeal orifice during intubation and reduces intubation time. This was a cross sectional study conducted in two Asian Hospitals Queen Elizabeth II hospital of Kotakinabalu, Malaysia and King Faisal Hospital Taif of Saudi Arabia to assess the first-pass success of video laryngoscope and to compare with direct laryngoscope from July 2015 to December 2017. Random lottery technique was applied for sampling. Participants of both groups (VL and DL) were enrolled by simple lottery method. Total 146 patients were enrolled with a set inclusion criterion. Mallampati class, mouth opening, thyromental distance and mobility of atlantooccipital junction were set as predictors of first-pass success. The first-pass success was 98.7% in mallampati II patients and 92.8% in mallampati III patients. Average success rate was 95.75%. The mean success rate of VL and DL was compared and was found VL had a significantly better first-pass success rate than DL (p<0.05).

Systematic review on current antiviral therapy in COVID-19 pandemic.

INTRODUCTION: Currently, there are several attempts to find an effective antiviral drugs against the COVID-19. Although majority of the COVID-19 patients have mild to moderate clinical events, up to 5-10% may have severe, life threatening events that urgently require effective drugs. The purpose of this systematic review is to evaluate the effectiveness of antiviral therapies in the treatment of COVID-19. METHODS: An extensive search was performed in PubMed, EMBASE, Cochrane Library for randomised controlled trials (RCTs), prospective case series studies that evaluated therapies COVID-19. The outcomes searched for were mortality, recovery rate, length of hospital stay and clinical improvement from January to May 15, 2020. Independent reviewers searched, identified, screened, and related studies were included. RESULTS: Total of five RCTs on 439 patients and seventeen case series involving 1656 patients were found in the specified review period that reported the use of Lopinavir, Ritonavir, Remdesivir. Oseltamivir, Ribavirin in patients with COVID-19; but none of which showed efficacy of antiviral therapy. Such current findings impede researchers from recommending an appropriate and effective antiviral therapy against COVID-19, making it a serious concern for the global community. DISCUSSION: In the present pandemic and any future epidemics, all the related authorities should pursue many more RCTs, cohort and case series for a prospective outcome in the management and treatment guidelines.

Systematic Review on Apolipoprotein E: A Strong Genetic Cause of Hemorrhagic Stroke.

Stroke is one of the commonest causes of mortality among the world. Hemorrhagic stroke accounts nearly 15% of all the strokes. Different risk factors have been identified, of them hypertension, anti-coagulation therapy and previous history of ischemic strokes are significant. Regarding the genetic causes of intracerebral hemorrhage (ICH) monogenic causes play a small role. It was found that Apolipoprotein E (APOE) gene has a strong association with ICH. This is a 299 amino acids long protein located in chromosome 19. APOE has three alleles, they are epsilon 2, 3 and 4. Total 10 meta-analysis were reviewed in this article which involved 52,705 participants. When looking for the association, ∈2 and ∈4 showed positive and ∈3 showed negative association with ICH. Association of ∈4 (OR mean 1.77) was stronger than that of ∈2 (OR mean 1.71).

Clinical Features and Location of Intracranial Edema in Posterior Reversible Encephalopathy Syndrome (PRES) Patients.

This is an observational analytic study on clinical features and location of intracranial edema in case of posterior reversible encephalopathy syndrome (PRES). Place of study was Square Hospitals Ltd. Dhaka, Bangladesh. Study period was 1 year (from January 2010 to January 2011). Number of total cases was 5. Mean age of patients was 21 years. Common clinical features were headache, seizure and visual disturbance. Mean time of developing clinical feature(s) was 4.6 days after NVD or LUCS. Intracranial edema was common in occipital, frontal and parietal lobes.

Systematic Review on Repurposing Use of Favipiravir Against SARS-CoV-2.

The sudden outbreak of a novel coronavirus in 2019 in Wuhan, China, that rapidly provoked a global concern, marked as the third attack of corona virus in the human society that affected the global healthcare system as well as the global economy. Until and unless an effective vaccine is discovered against the virus, the pharmacological intervention by different antivirals is in the run for remedy. The aim of this systematic review was to evaluate the role of favipiravir along with its safety and efficacy for the patients who are suffering from severe acute respiratory distress syndrome due to CoronaVirus-2 (SARS-CoV-2) as re-purposeful use. We searched PubMed, EMBASE for randomized controlled trials (RCTs), cilicaltrial.com for registered on going trails to evaluate the pros and cons of using favipiravir in COVID-19. After vigorous searching, screening and sorting of 314 articles for completed and published scientific evidences in electronic database, there were only 2 completed and published randomized control trials (RCT) and 17 ongoing or unpublished trials found until June 2020. The main outcome measures were viral clearance, clinical improvement and adverse events reported and published on 147 patients infected with SARS-CoV2. The 2 completed RCTs showed significantly better treatment effects on disease progression, viral clearance, improved the latency to relief for pyrexia and cough on favipiravir treated patients. Adverse effects caused Favipiravir are mild and manageable. Although 9 more RCTs and cohort studies are supposed to be completed by this time that may unveil some evidence for use of anti-RNA-viral drug favipiravir against influenza or Ebola to re-purposing against COVID-19 as adopted in different treatment guidelines.

Use of Remdesivir in the Management of COVID-19: A Systematic Review on Current Evidences.

The rapid progression of corona virus disease in 2019 (COVID-19) pandemic has become an unprecedented global concern. This systemic review aimed at evaluating the available evidence on efficacy, safety to identify any promising role for compassionate use of remdesivir in patient suffered for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) as re-purposeful use. We searched PubMed, EMBASE, Cochrane Library for randomized controlled trials (RCTs), prospective case series studies and case reports that evaluated use of remdesivir in COVID-19. The outcomes were mortality, recovery rate, length of hospital stay and clinical outcome. Though the drug remdesivir (RDV) is not approved by the FDA, still the "Emergency Use Authorization" (EUA) for compassionate use in severe cases is endorsed. After vigorous searching, screening and sorting of completed and published scientific evidences in electronic database, there were only 2 randomized control trial (RCT), 2 uncontrolled trials found until April 2020. We also included 3 published case reports to analyze the validity use of RDV because of the scarcity of evidence based reports. Remdesivir was thought to be one of the promising options for treating the patients of COVID-19 based on few laboratory experiments and reports from some compassionate use and case reports. The safety and efficacy of this drug in COVID-19 cases require high-quality evidence from well-designed and adequately-powered clinical trials with proper sample size for precise decision.

Role of oral clonidine on intraopereative haemodynamic stability for craniotomies of intracranial space occupying lesion.

This was an analytical comparative study. Aim of this study was to observe the effect of oral clonidine on intra operative haemodynamic stability in intracranial space occupying lesion (ICSOL) patients who underwent craniotomy. Total 60 patients were distributed into case and control group. Number of cases was 30 in each study group of this study. Mean age of experimental and control were significantly close to each other. Baseline weight, pulse, systolic blood pressure, diastolic blood pressure and mean pressure also showed a significant similarity between each group. Variable of each group was collected during different events of craniotomy. All variable of pulse, systolic blood pressure, diastolic blood pressure and mean pressure were tabulated by line chart and fluctuation of variable was measured by significance test. The fluctuation of mean pressure was respectively 11.6%, 11.2%, 12.4%, 11.4%, 14.2%, 15.6%, 10% and 9.4% in different events of craniotomy in hemodynamically unstable group and it was respectively 11.1%, 10.9%, 10.4%, 9.9%, 9.2%, 9.4%, 8.6% and 8.7% in hemodynamically stable group. 'P' value was less than 0.05. It was observed that fluctuation of haemodynamic parameters were significantly less in experimental group where oral clonidine was used as premedication.