Physical activity levels in Bangladeshi adults: results from STEPS survey 2010.

OBJECTIVES: Physical inactivity is an established risk factor for non-communicable diseases (NCD) and identified as the major public health concern worldwide. However, nationally representative and internationally comparable data on physical activity (PA) are lacking in Bangladesh. The objective of this paper was to determine nationally representative prevalence of PA levels among Bangladeshi adults. STUDY DESIGN: Cross-sectional survey. METHODS: Data, on PA for this paper, were analysed from the NCD risk factors survey 2010 in Bangladesh. A standardized approach known as STEPS (STEPSwise approach to Surveillance for NCD risk factors) was followed for this survey. A total of 9275 adults (aged ≥ 25 years) were interviewed. Data on PA were processed and analysed according to Global Physical Activity Questionnaire (GPAQ) version 2 analysis framework. RESULTS: Of total 9275 respondents 4312 were men and 4963 women with a mean age of 42.4 (±13.5) years. Median MET-minutes of total PA in a typical week was double in rural areas (3360) than urban (1680) areas. The overall country wide prevalence of low PA was 34.5% (95% confidence interval, 33.5-35.5), urban 37.7% (36.3-39.1) and rural 31.6% (30.3-32.9). Women in general were more inactive (women, 53.6% [52.2-55.0], men 15.4% [14.9-17.1]). The main contributions to total PA were from work (urban 47.0%, rural 61.0%), and active commuting (38.0%, 30.0%) domains. Leisure-time PA represented only a small proportion (15.0%, 9.0%). CONCLUSIONS: Insufficient physical activity is highly prevalent among the Bangladeshi adult population. Promoting overall PA at leisure-time and commuting considering country context can be feasible options with special attention to the women.

Acute poisoning in southern part of Bangladesh--the case load is decreasing.

This retrospective study was carried out in the Medicine Department of Khulna Medical College, the biggest tertiary hospital in the southern part of Bangladesh to observe the trends of poisoning in southern part of Bangladesh over four years including age and sex variation, mode of poisoning, type of poison used and outcome of poisoning. The hospital medical records of all patients, aged 10 years and above with history of acute poisoning from January, 2003 to December, 2006 were enrolled. Patients were categorized into four age group including Group (Gr.) I, Gr. II, Gr. III & Gr. IV having age range of 10-20, 21-30, 31-40 & >40 respectively. Underlying causes of poisoning were also observed totally and individually in different mode with male, female ratio and the percentage. Death cases according to mode of poisoning with demographic alignment were also observed. Statistical analysis were done using epi-info version 3.5.1 and measures were presented as proportion and percentage. Among 1903 cases, 1012 (53.1%) were male and 891 (46.8%) female with a ratio of 1.4: 1. The year wise total number of cases were progressively decreased from 627 (2003) to 353 (2006). Most commonly found toxic agent was Organo-Phosphate compound (526; 27.64%) with a very little sexual variation & this trend remained same in all study years. Poisoning with unknown substance was the second leading cause (16.03%) followed by Copper-sulphate (14.03%), Sedative (13.35%), Snakebite (12.93%) etc. Incidence of unknown poisoning, sedatives, snake-bite and corrosives were found to be gradually decreased over the study years. Male were found mostly affected in majority type of poisoning except Copper-sulphate, kerosene, puffer fish, paracetamol and other drugs category. Age group II (710; 37.3%) was the most vulnerable group with male (57.89%) preponderance followed by group I (643; 33.7%), III (329; 17.2%) and IV (221; 11.6%) respectively. Highest 1308 (68.7%) cases were suicidal in mode followed by 304 (15.9%) accidental and 291 (15.2%) homicidal. Out of 1903, 140 (7.3%) patients died. Death rate was highest in OPC poisoning (52.1%) followed by unknown substance (13.5%), snakebite and copper-sulphate (11.4%) etc. In an agro-based country like Bangladesh, it's very difficult to reduce the poisoning cases and mortality. Prospectively designed multi-centered studies are needed to reflect the epidemiological properties of poisonings throughout Bangladesh, and would be very valuable for the determination of preventive measures.

Puffer fish poisoning in Bangladesh: clinical and toxicological results from large outbreaks in 2008.

Poisoning after eating puffer fish containing highly lethal tetrodotoxin (TTX) is widespread in Asia. In 2008, naïve inland populations in Bangladesh were exposed to cheap puffer fish sold on markets. In three outbreaks, 141 patients with history of puffer fish consumption were hospitalized. Symptoms of poisoning included perioral paraesthesia, tingling over the entire body, nausea and vomiting, dizziness, headache, abdominal pain and muscular paralysis of the limbs. Seventeen patients (12%) died from rapidly developing respiratory arrest. Blood and urine samples from 38 patients were analyzed using a TTX-specific enzyme-linked immunoassay (ELISA). Medium to high TTX levels were detected (1.7-13.7 ng/ml) in the blood of 27 patients. TTX was below detection level (< 1.6 ng/ml) in 11 blood samples but the toxin was detected in urine. Ten patients had blood levels above 9 ng/ml and developed paralysis; seven of these died. The remaining patients recovered with supportive treatment. High concentrations of TTX and its analogues 4-epiTTX and 4,9-anhydroTTX were also found in cooked puffer fish by post-column liquid chromatography-fluorescence detection. To prevent future instances of puffer fish poisoning of this magnitude, measures should be implemented to increase awareness, to control markets and to establish toxicological testing. To improve the management of this and other poisoning in Bangladesh, facilities for life-saving assisted ventilation and related training of healthcare personnel are urgently needed at all levels of the health system.

Isolated appendicular tuberculosis (TB) presented as peritonitis.

Tuberculosis is very common entity in both developing and under developed countries. Each year 3 million people worldwide died of the disease. Among extra pulmonary TB, alimentary system accounts for about 3.0% cases. The Commonest presentation of alimentary tuberculosis is Ileo-caecal disease, but isolated appendicular involvement is very rarely seen. Although some cases have been reported from our neighboring countries, there is still no such report from Bangladesh. We are here for the first time reporting a case of isolated appendicular tuberculosis which presented to us with peritonitis.

Feeding practice in acute stroke patients in a tertiary care hospital.

BACKGROUND: Feeding is a basic component of care and it is the most common and difficult management issue for stroke patients. Objective of this study was to know the practice of feeding (oral & nasogastric tube feeding), different types of food used and their caloric value in stroke patients. MATERIALS & METHODS: This direct observational study was done from June 2010 to November 2010, in different medicine wards of Dhaka Medical College Hospital, and included 100 acute stroke patients confirmed by CT scan or MRI of brain and duration of hospital stay for at least 24 hours. RESULTS: Out of 100 cases, 22% took their feeding orally and 78% cases through nasogastric tube. Artificial milk powder 66% cases (NG tube vs. Orally, 58% vs. 8%), juice 18% (NG tube 13% vs. orally 5%), horlicks & juice & soup 10% (NG tube vs. Orally, 7% vs. 3%), khichury 2% orally, bread & egg & shuji 4% cases orally. In 100 cases studied, none of them fulfilled the calorie requirement up to the standard level according to the guideline of Nutrition & Food Science Institute, of Dhaka University, Bangladesh. CONCLUSION: Though this study was small scale but the magnitude of under nutrition among stroke patients revealed is alarming and needs urgent attention.

Puffer fish (Tetrodotoxin) poisoning: an analysis and outcome of six cases.

On 24 July 2005, six members of a single family were admitted to the Medicine and Pediatrics Department of Khulna Medical College Hospital, Khulna, Bangladesh, with a history of ingestion of puffer fish. All patients developed toxic manifestations. The cases were clinically analysed with successful outcomes.

Tetrodotoxin poisoning: a clinical analysis, role of neostigmine and short-term outcome of 53 cases.

INTRODUCTION: Puffer fish (tetrodotoxin) poisoning is now a common form of poisoning throughout coastal countries, but its diagnosis and management are still unclear. In this paper, we aim to share our experience and to find out the toxic manifestations, lag period between ingestion of fish and development of symptoms, the short-term clinical outcome, and value of neostigmine in its management. METHODS: The study was carried out in the Department of Medicine and Paediatrics, Khulna Medical College Hospital, Khulna, Bangladesh, from May 1, 2001 to May 1, 2006. A total of 53 patients were admitted with the history of puffer fish ingestion. All the cases were clinically analysed from admission to discharge, for the following variables: Onset of symptoms in minutes after the ingestion of fish, toxic manifestations that developed after ingestion, relation of clinical outcome with approximate amount of fish ingested, and the role of neostigmine. RESULTS: All patients developed toxic manifestation. Important symptoms were perioral paraesthesia (38), weakness of all limbs (33), paraesthesia all over the body (34), headache (25), and difficulty in respiration. Eight patients died, probably due to respiratory muscle paralysis, of which five patients died immediately after admission. We used neostigmine in those patients who developed respiratory failure. 13 patients improved significantly (p-value is less than 0.5), while only three patients died. CONCLUSION: Because of the availability and affordability of puffer fish, the occurrence of tetrodotoxin poisoning throughout coastal countries is very likely. Therefore, health personnel should have enough knowledge regarding its toxic manifestations and management.

National drug policy of Bangladesh: some pitfalls in implementation.

Drug development, manufacturing and marketing have become one of the most important sectors throughout the world for various reasons. Realizing its importance, the World Health Organization (WHO) has stressed the need of a formulated drug policy in every country of the world. Bangladesh responded very early to this. Experiences over the decades have shown that the said policy could not fulfill in toto the declared objectives. Our aim is to describe some of the lacunae for which total implementation of drug policy is still struggling. For this purpose, we meticulously analysed our Drugs Control Ordinance 1982 (with an amendment brought in 1994) and upcoming National Drug Policy. We mainly focussed on three factors pointed out by WHO, which are crucial of a drug policy, which include price limitation, quality and rational use. We found great variations in price which need to be controlled. Regarding quality, safety and efficacy, we have to be more cautious. Rational use of drugs is also an area to be focussed on. Every physician should prescribe proper drug with due indication and in rational way. This pitfall of implementation might happen in many countries of the world and it needs a global discussion so that the future policy makers can mitigate the demand of the nation.

Paralytic complications of puffer fish (tetrodotoxin) poisoning.

INTRODUCTION: Puffer fish is available in Bangladesh and is occasionally eaten by some people. Ignorance regarding its proper cooking process may lead to serious health hazards, including fatality. METHODS: An unusual catastrophic event happened recently in Khulna, Bangladesh that drew nationwide attention. Eight families were affected. RESULTS: Thirty-seven patients were admitted with a history of consumption of puffer fish. Peri-oral paraesthesia (24), weakness of both lower limbs (22), paraesthesia all over the body (18), headache (15), difficulty in respiration (14), nausea and vomiting (8), blurring of vision (7), and vertigo (6) were common clinical presentations. Twenty-two patients developed ascending paralysis of limbs and involved the respiratory muscles in 17 patients. Eight patients died due to respiratory failure while the rest improved. CONCLUSION: Health personnel should have sufficient knowledge regarding the clinical manifestations, complications and management of puffer fish poisoning. During its preparation, organs that contain the highest level of tetrodotoxin should be removed. Since there is no specific treatment, people should be made aware of the potential risk of eating puffer fish, about the warning symptoms and signs of puffer fish poisoning, and when to seek medical help.

Deaths in visceral leishmaniasis (Kala-azar) during treatment.

Twenty-seven out of five hundred and fifty three patients hospitalized for visceral leishmaniasis (Kala-azar) died during treatment with sodium antimony gluconate. Data from these patients were evaluated to find out the cause of death. Eight patients had associated diseases such as pulmonary tuberculosis (3), severe malnutrition (1), acute gastroenteritis (1), spleenic infarction (1), acute renal failure (1) and atrial septal defect (1) which could be attributed to death. Twelve patients developed spontaneous haemorrhages from nose, gums and gastrointestinal tract and died, despite of adequate supportive measures. Seven other patients who were improving slowly with antimony therapy died unexpectedly. Though, cause of death could be explained in some patients with associated disease conditions, it could not be explained in others as significant clinical manifestations, haematological, biochemical and electrocardiographic alterations were not evident prior to death. Our impression is that mortality in Kala-azar patients during standard antimonial therapy is more related to the drug rather than the disease process.