Assessment of Quality of Life of Chronic Kidney Disease Patients Receiving Hemodialysis with Kidney Disease Quality of Life™-36 Scale.

Chronic kidney disease and the methods of its treatment play an important part in shaping the Quality of Life QOL of patients receiving dialysis. KDQOL™-36 is the most widely used instrument to evaluate health related quality of life of chronic kidney disease patients. The aim of the study was the subjective assessment of the quality of life (QOL) of patients treated with hemodialysis and also to understand the distribution of component scores of the scale with distribution of responses to individual items of the scale among the selected sample. This cross sectional study was conducted among randomly selected 151 patients of chronic kidney disease receiving hemodialysis with pre-dialysis proper education at Inpatient Department in National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh during the period of June 2018 to December 2018. The instrument to measure the QOL was Kidney Disease and Quality of Life Bangla version 36 (KDQOL™-36). Recruited patients were interviewed with questionnaire technique to collect data with the scale which is a structured questionnaire comprised of four subscales. Mean scores ±SD of the domain of the physical and mental component summary, burden of kidney disease, symptoms and problems of kidney disease and effects of kidney disease subscales were 29.3±16.03, 16.93±13.0, 81.09±13.14 and 61.67±13.84 respectively. The mean ±SD of the combined score for all the four domains was 47.24±11.52. The rate of those with impaired QOL (mean score <66.7) was 96.7%. The most bothersome domain was burden of the kidney disease domain, where the mean scores of all the items were below 66.7. The study provides information that regular pre-dialysis attendance helps to provide the patient with proper education and thereby achieve better QOL among patients of chronic kidney disease receiving hemodialysis. By using the KDQOL™-36 scale this study finds that the domain of symptom of the kidney disease appeared to have least effect on the quality of life as the mean scores ranged higher from other subscales and in most cases the scores were above 66.7.

Plasma Neutrophil Gelatinase Associated Lipocalin (pNGAL) Level to Identify AKI Early in Patients Undergoing Cardiac Valve Surgery.

Cardiac valve surgery is considered one of the most frequent surgical procedures in which AKI is a common & serious complication. Although serum creatinine is routinely used as a marker of renal function, it poorly reflects the immediate post operative period renal function. Within minutes to few hours after a renal insult, plasma neutrophil gelatinase associated lipocalin (pNGAL) is released. The aim of this study was to assess the superiority of pNGAL over serum creatinine in detecting AKI in early post operative period. This prospective observational study was carried out in the Department of Nephrology of National Institute of Kidney Diseases & Urology in collaboration with National Institute of Cardiovascular Diseases (NICVD) & Dhaka Shisu Hospital (DSH) from January 2015 to December 2016. Total 120 patients were selected from inpatient ward of cardiovascular surgery department. According to inclusion & exclusion criteria total 80 patients were included who was undergone cardiac valve surgery. Serum samples for pNGAL were collected from study population 6 hours after completion of surgery & stored at -80°C, serum samples were also collected for serum creatinine day before surgery, in 1st post operative day (POD1) & 2nd post operative day (POD2). Total 79 patients undergoing cardiac surgery, who met the inclusion & exclusion criteria, were consecutively included. There were 44 male (55.69%) and 35 female (40.31%) ranged from 15-60 years, with mean age of 36 years. pNGAL level in the blood of AKI patients (244.19±59.61ng/ml) 6 hours after completion of surgery was significantly higher from the non AKI patients (171.73±68.63ng/ml). A positive significant correlation was found between pNGAL 6 hours after completion of surgery & serum creatinine at POD1, POD2. This study demonstrated that level of pNGAL concentration 6 hours after completion of cardiac valve surgery increased before the rise of serum creatinine level & can thus AKI can be detected earlier by pNGAL.

Epidemiology of stroke: findings from a community-based survey in rural Bangladesh.

OBJECTIVES: This study was designed to determine the epidemiology of stroke in a rural population of Bangladesh. STUDY DESIGN: In a cross-sectional study, we surveyed stroke patients. METHODS: The survey was conducted in a rural community of Bangladesh from January 2016 to June 2016. All community members 15 years and older in a surveillance system were included in this study. The Questionnaire for Verifying Stroke-Free Status was used to screen stroke cases at household level which were again examined by the neurologist for confirmatory diagnosis. RESULTS: The prevalence of stroke was 1.96 (95% confidence interval [CI] 1.69-2.26) per 1000 population. The highest prevalence was 9.65 (95% CI 7.42-12.33) per 1000 population, identified among patients aged 65-79 years. Males had higher prevalence (2.38 per 1000 population) than females (1.55 per 1000 population). Of the 24% of patients who had radiological examination (magnetic resonance imaging and computed tomography scan) reports, 17.2% of stroke cases were ischemic, 4.8% were intracerebral, and about 1.1% were subarachnoid. The ratio of infarction to hemorrhage was 2.91. Approximately 67% of patients were diagnosed as hypertensive, and 37% of patients had elevated blood glucose level. While 15% of patients were found to be overweight or obese, 45% of patients had raised blood cholesterol level. More than 10% of patients reported that they had heart disease before the occurrence of stroke. About 40% of patients had the history of tobacco consumption. CONCLUSIONS: The prevalence of stroke is higher among elderly and male populations. A significant proportion of patients presented with hypertension and/or diabetes.

Surgical Outcome of Intradural Spinal Tumors.

Results of 63 surgically treated intradural spinal tumors between the period of October 2003 and December 2014 at Bangabandhu Sheikh Mujib Medical University (BSMMU) and in our private settings, Dhaka, were analyzed retrospectively. There were 33 males, 30 females with an average age of 52.4 years (13-70 years) and followed up for at least a year. The preoperative symptom with duration, tumors location and intradural space occupancy and the histopathological diagnosis were analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade. The tumors were located as, thoracic (n=32, 50.79%), lumbar (n=16, 25.39%), cervical (n=05, 07.93%), and junctional (n=10, 15.87%, CervicoThoracic-01, Thoracolumbar-09). The histopathological diagnosis included schwannoma (n=30, 47.7%), meningiomas (n=14, 22.3%), neurofibroma, arachnoid cyst and myxopapillary ependymoma (n=03, 04.76%) each and paraganglioma (n=01, 01.59%). Among the intramedullary tumors, ependymoma (n=03, 04.76%), astrocytoma and epidermoid cyst (n=02, 03.17%), haemangioblastoma, paraganglioma and cavernous haemangioma (n=01, 01.59%) each. The VAS score was reduced in all cases from 8.0±1.2 to 1.2±0.8 (p<0.003) and the Nurick's grade was improved in all cases from 3.0±1.3 to 1.0±0.0 (p<0.005). The preoperative neurological deficit improved within 8 postoperative weeks in most cases and within 1 postoperative year in all cases. Complications included cerebrospinal fluid leakage, parasthesia and further neurological deterioration (Astrocytoma) (n=02, 03.17%) and dependant bedsore and recurrence (Ependymoma) (n=01, 01.59%). Aggressive surgical excision potentially minimizes neurologic morbidity and improved outcome except intramedullary tumors where initial treatment consists of maximum safe surgical resection or biopsy.

Comparative Study of Adenosine Deaminase and Other Conventional Diagnostic Parameters in Diagnosis of Tuberculous Pleural Effusion.

Though pulmonary tuberculosis is the common presentation of Mycobacterium tuberculosis infection, extra-pulmonary tuberculosis is also a growing problem worldwide. Tuberculous pleural effusion is the second frequent form of extra-pulmonary presentation after tuberculous lymphadenitis and if untreated up to 65% of patients with tubercular pleural effusions will eventually develop active TB. Traditional diagnostic methods are very useful for the diagnosis of pulmonary TB but have a low yield when applied to pleural fluid. So,the aim of this study was to evaluate the diagnostic value of ADA level in plural fluid and other conventional methods for diagnosis of tubercular plural effusion. This was a cross sectional study. This study was carried out in 64 Patients suffering from plural effusion and were consecutively selected and divided into two groups: tuberculous (n=40) and non tuberculous (n=24), depending upon etiology. Details clinical history, physical examination, routine and other relevant investigations including ADA estimation was measured. The mean value of ADA in the tuberculous group was 64.11 ± 19.50 U/L which was significantly higher (p<0.05). Cut off value of ADA was ≥ 40 U/L with 97% sensitivity and 93%specificity. In this study, sensitivity, specificity, PPV and NPV of ADA level in pleural effusion were more significant than other conventional parameters.

Comparison of Serum CA72-4 and CEA Levels in Patient with Endoscopically Suspected Gastric Carcinoma.

Several serum tumour markers have been described for gastric cancer. Preoperative level of tumor marker helps to predict the diagnosis of gastric carcinoma. CA72-4 as a serum tumour marker for gastric cancer is evaluated, and compared its utility in this regard with that of carcinoembryonic antigen (CEA). Analysis of gastric carcinoma by serum levels of CEA and CA72-4 and their correlation with histopathology help the clinician to develop his management strategies for gastric carcinoma. A prospective observational study was carried out in the Department of Clinical Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with Department of Surgery BSMMU, DMCH, Delta Hospital Limited, Dhaka, during the period of October 2010 to September 2011. Serum CA72-4 and CEA were analyzed in 71 endoscopically suspected patients for gastric carcinoma. Among them 58 cases were diagnosed as malignant gastric disease and 13 cases were nonmalignant gastric disease. Sensitivity of CA 72-4 and CEA were 48.3% and 31% respectively and specificity were 92.3% and 76.9% respectively. In poorly differentiated carcinoma, positivity for CA72-4 and CEA were 55.6% and 36.1% respectively. Because of the high positivity of CA72-4 in poorly differentiated carcinoma, CA72-4 is reliable tumour marker in advanced cases. As the sensitivity of CA72-4 was more than that of CEA in diagnosis of gastric cancer, CA72-4 can be used in conjunction with other diagnostic tests like endoscopy that would be more helpful for the patients.

Management of adult Still's disease-an update.

Adult Still's disease (ASD) is not uncommon disease. It is recognized as multi-systemic inflammatory disease of unknown aetiology. There is no significant racial and geographical distribution of the disease. In most of the cases-onset of disease course occur before the age of 35. Its main feature is the combination of symptoms, such as fever higher than 39°C, cutaneous rash during fever peak, polyarthritis, lymphadenopathy, raised white blood cell count, abnormalities of liver metabolism, raised serum ferritin etc. None of these signs is significant to establish the diagnosis. Some diagnostic criteria have been developed for diagnosis of ASD. Among them Yamaguchi criteria is superior to others in respect of its sensitivity and specificity. Some bacterial and viral infections, other rheumatic diseases, malignancy and drug hypersensitivity can also mimic ASD. The aim of treatment of ASD is to limit the intensity of the symptoms and to control disease evolution. Various types of drugs including biological agents are now promising to treat ASD.

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.

Misuse of drugs in acute diarrhoea in under-five children.

This was a community based, thirty cluster survey, carried out in Chittagong metropolitan area of Bangladesh, aimed to determine the extent of misuse of drugs in acute diarrhoea among under-five children. Data were collected from 360 mothers whose under-five children had suffered from acute diarrhoea during the preceding two weeks of interview. Data were pertained to type and duration of diarrhoea and treatment received. There were 339(94.2%) cases of acute watery diarrhoea and 21 (5.8%) cases of dysentery i.e. blood in stool. The mean duration of the diarrhoeal episode was 3.17 +/- 1.69 days (95% CI, 2.99-3.34). Three hundred twenty eight (91.1%) cases received treatment. There was a total of 401 consultations, out of which 328(81.8%) had first, 69(17.2%) had second and 4(1.0%) had third consultations. The first and second treatment were provided predominantly by care-providers (43.3%) and physicians (5.5%) respectively. Only 82(26.7%) cases of acute watery diarrhoea received WHO recommended treatment and only 5(23.8%) cases of dysentery received appropriate antibiotics. The rest 241(73.5%) cases received inappropriate treatment either antibiotic or drugs other than WHO recommendation. The average number of drugs prescribed per patient was 1.5 during the episode. The commonly prescribed drugs were metronidazole (38.6%) and antibiotics (17.3%). Those who consulted health professionals were at 5.7 times higher risk of receiving drugs. The mean duration of the episode of acute watery diarrhoea was increased significantly when drug is used in the treatment. It is concluded that there was high prevalence of misuse of drugs in the treatment of acute diarrhoea among under-five children which calls for intervention to improve the prescribing pattern as per WHO recommendation.

PIP: This study determines the extent of drug misuse in acute diarrhea among under-five children in Chittagong, Bangladesh. Data were collected from 360 mothers whose under-five children suffered acute diarrhea 2 weeks prior to interview. Information gathered pertained to the type and duration of diarrhea and the treatment received. The were 339 cases of acute watery diarrhea and 21 cases of dysentery (i.e., bloody stools). The mean duration of the diarrheal episode lasted 3.17 +or- 1.69 days. From the total cases, only 328 received treatment. Moreover, only 82 cases of acute watery diarrhea received WHO recommended treatment and only 5 from the total number of cases received appropriate antibiotic treatment, while the 241 cases received inappropriate medication. The commonly prescribed drugs were metronidazole and antibiotics. Unfortunately, those who consulted health professionals were at 5.7 times higher risk of receiving the drugs and even experienced longer episodes of acute diarrhea. Results suggest that there is a significant misuse of antidiarrheal drugs among under-five children.

Effect of health warning on the use of breast milk substitutes by lactating mothers.

This cross-sectional study was carried out with the objectives to determine the awareness, readability and understandability of health warning and its effect on the use of breast milk substitutes(BMS) by lactating mothers. A total of 400 mothers who had infant of less than 5 months of age & able to read the bangla newspaper were interviewed at urban EPI centres. The mothers were requested to locate and read the health warning on BMS container. The BMS were used by 189(47.25%) mothers but only 137(34.3%) mothers knew the health warning. The mean time taken by mothers to locate the health warning in the BMS container was 40.4 +/- 40.9 seconds(95% CI 35-45). The health warning in the container could not be located by 97(24.2%) mothers and another 51(12.2%) located it with difficulty. There were 263(65.8%) mothers who were able to read the health warning easily and the rest either read with difficulty (10.0%) or unable to read(24.24%). More than one third of the mothers did not understand the meaning of health warning. Even after the education on health warning during the course of interview, 170(42.5%) mothers responded in favour of using BMS. The low level of awareness and poor understanding of the meaning of health warning by the lactating mothers might be the cause of a high rate of BMS use which calls for strengthening of information, education and communication (IEC) activities.