Bangladesh Medical Research Council Bulletin (Vol 46, No 03 2020)

Abstract

Background: SARS-CoV-2 a highly contagious virus causing the current global pandemic of COVID-19 is transmitted mainly through close physical contact and airborne transmission of respiratory droplets, and associated with significant morbidity and mortality.

Objective: The study was carried out aiming to assess knowledge, attitude and practices (KAP) of university level (medical and nonmedical) students towards COVID-19.

Methods: This online cross-sectional KAP study was carried out on andprivate university and medical college students. The questionnaire used consisted of two main sections: demographic and knowledge, attitude and practices (KAP) towards COVID-19 transmission and prevention. Demographic variables included gender, age, religion, marital status, type of education. KAP section consisted of 14questions for assessment of knowledge regarding clinical symptoms, transmission route, vaccine, prevention and control of COVID-19. The link of the online questionnaire was shared with students of three government and one private medical colleges and 8 universities of which 5 government and 3 private through their faculties with an invitation to participating in the study.

Results: A total of 399 students participated in the study, 61.9% were non-medical and 38.1% were medical students; males accounted for 62.7% of the respondents. Knowledge and practice scores were significantly higher in females than in males (p< 0.05). KAP scores were significantly higher among medical students compared to non-medical students (p< 0.05). Though about 52.1% of total students had good knowledge, less than 25% had favourable attitude but 48.6% had good practices towards preventive measures of COVID-19

Conclusion: There is need for more awareness campaign focusing the students to cover their knowledge gaps, motivation for appropriate practices and further improvement of attitude and practices towards prevention of COVID-19 transmission.

Keywords: COVID-19, KAP, Medical and non-medical students, SARS-COV-2.

Abstract

Background: Coronavirus pandemic has become the leading cause of disability and death throughout the world. Nurses have a pivotal role in managing the COVID-19 Patients across the globe including Bangladesh.

Objective: The study was aimed to assess the level of nurses’ knowledge, attitude and practice with regard to readiness for providing nursing care for COVID-19 patients at COVID-19 dedicated hospitals in Dhaka.

Method: This is a cross-sectional descriptive study. Data were collected from July, to September, 2020 using a self-administered questionnaire. A total of 384 nurses were selected from four corona dedicated hospitals in Dhaka. Nurses’ readiness was measured by using paper and pencil questionnaire. Personal and professional characteristics knowledge, attitudes and practice related to COVID-19 questionnaires were used. Data were analysed using descriptive statistics, independent t-test, one way ANOVA and Pearson’s Product-Moment Correlation-Coefficient.

Results: Findings showed that nurses had moderate level of knowledge (M = 34.34.15, SD = 2.98), attitude (M = 27.58, SD = 3.45) and practice (M = 13.12, SD = 1.78) respectively. A significant negative correlation found between knowledge and attitude (r = -.178, p = .000). However, no significant relationship was to be found between attitude and practice and knowledge and practice regarding nurses’ readiness to provide nursing care to COVID-19 patients. Statistical analysis showed that nurses working at Kurmitola General Hospital (F = 9.47, p = .000) had better practice than those of other hospitals. Senior staff nurses did better practice (F = 21.765, p = .000) than those of other nurses.

Conclusion: Nurses achieved moderate level of knowledge, attitude and practice. There was negative correlation between knowledge and attitude of nurses. In-service education programme can be developed and conducted to increase knowledge, attitude and practice regarding nurses readiness for caring of COVID-19 patients.

Keywords: COVID-19 patient, Nursing care, Nurses readiness, Frontline health care workers

Abstract

Background: Chronic obstructive pulmonary disease (COPD) represents an important public health challenge. It is a major cause of chronic morbidity and mortality throughout the world. Arterial hypertension (AH) is considered one of the principal COPD-associated comorbidities.

Objective: The study was aimed to assess the role of angiotensinogen (AGT) gene polymorphism in occurrence of AH in patients with COPD.

Methods: The study was conducted among 96 patients of them, Group 1 (25 individuals with COPD), Group 2 (23 individuals with AH), Group 3 (28 individuals with COPD and AH). The control group consisted of the 20 healthy subjects. I/D genotypes of AGT were determined by polymerase chain reaction amplification. Plasma AGT activity was determined photometrically by a commercially available kit.

Results: The results of the study have not demonstrated any significant impact of alleles of AGT genes on occurrence of such disease as COPD, AH and combinations thereof. However, analysis of odds ratio has demonstrated the presence of a trend towards a protective role of the M allele of the AGT gene concerning occurrence of COPD, AH and their combinations (OR=0.90, OR=0.71 and OR=0.56, respectively). At the same time, the presence of the T allele of the AGT gene may increase the risk for occurrence of the above mentioned disease (OR=1.11, OR=1.4 and OR=1.79, respectively).

Conclusion: The study suggests that the presence of Т allele of the AGT gene at position 235 of the peptide chain both in homozygous and heterozygous state may increase the risk for AH in patients with COPD.

Keywords: Chronic obstructive pulmonary disease, Arterial hypertension, Angiotensinogen gene, Polymerase chain reaction.

Abstract

Background: Bangladesh got its glorious victory of independence in 1971 from Pakistan after nine months of the liberation war. After 47 years, freedom fighters are in geriatric age. The study aimed to assess the ability to perform daily living activities among the Freedom fighters of Bangladesh.

Methods: It was a cross-sectional study and a mixed-method qualitative and quantitative. It was conducted from December 2017 to May 2018. A total of 153 freedom fighters who actively participated in the Liberation War were randomly selected from eight Bangladesh divisions. The Sami-structure questionnaire was collected in quantitative data. Qualitative data was collected by key informant interviews (K.I.I.) Physical functional status was determined by Activity of Daily Living Scales (A.D.L.s) and Instrumental Activity of Daily Living Scales (IADLs). Freedom fighters who actively participated in the Liberation War and gladly participated were included in the study.

Results: Among the 153 respondents, 92.8% were Muslim and mean age 68.50±5.808 years. Their monthly family income was a minimum of 6000 BDT and a maximum of 500000 BDT, and92.2% received the freedom fighter allowance. Most of them lived with their family members and about half of them took care of themselves. Activities of the daily living scale showed that two-third of them had difficulties in one or more activities. The Instrumental Activities of daily living scale revealed that most of them had problems in one or more instrumental activities.

Conclusion: This study revealed that the ability to perform daily living activities was so difficult for Freedom fighters at their old ages. Further large-scale studies involving all living freedom fighters could show a more complex scenario.

Keywords: Freedom fighters, Bangladesh, Daily Activity, ADLS, IADLS

Abstract

Background: Hematological malignancy and its treatment produce multiple symptoms that significantly distress patients and impair function. Symptoms caused by treatment may delay treatment or lead to premature treatment termination and residual treatment-related symptoms often complicate post treatment rehabilitation. When treatment is no longer possible, symptom control becomes the focus of cancer care.

Objectives: The study was aimed to determine the symptom burden of the haematological malignancy patients.

Methods: A cross sectional study was conducted from July 2015 to June 2016 among the haematological malignancy patients. A total of 316 hematological malignancy adult (age ≥18 years) patients were purposively selected from haematology department of two tertiary level of hospitals in Dhaka city. Face to face interviews were taken from the diagnosed haematological malignancy patients admitted in the hospital and attending outdoor using questionnaire based on symptom distress scale (SDS).

Results: Mean age was 39 years and most of the patients suffering from Acute Leukemia 162 (51.3%). Mean monthly family income was around 22235 taka and 120 (37.9%) patients were unemployed. Patients with haematological malignancy had a considerable physical and psychological symptom burden which ranged from 94.3% for fatigue to 8.5% for difficulty in concentration. Physical symptoms such as fatigue 127 (40.2%), change in appetite 86 (27.2%), pain1 81 (25.6%), insomnia44 (13.9%) caused severe distress and psychological symptoms include change in appearance 37 (11.7%) and outlook 33 (10.4%) were sever distressing. Significant association (p&lt;0.001) was to be found between occupation and symptom distress where 82 (68.4%) unemployed and 51 (66.3%) housewife had moderate/sever symptom distress. Respondents who managed their treatment expenditure by loan and asset sell 11 (84.6%) had significant(p=0.004) moderate/sever distress. Patients having less than one month of diagnosis 47(72.3%) and admitted in inpatient 114 (66.6%) had significant higher moderate/sever symptom distress(p=0.03) and (p&lt;0.001) respectively.

Conclusion: Patients with haematological malignancy were likely to have multiple symptoms and comprehensive symptom assessment was suggested throughout. The introduction of supportive or palliative care services during times of increased symptom burden may assist haematologists and other careers in the management of their patient’s distress and quality of life.

Keywords: Haematological malignancy, Symptom burden, Symptom distress, Symptom distress stress

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a global health burden having systemic and extrapulmonary manifestations. Among them cardiovascular changes are the major comorbidity associated with COPD, responsible for significant morbidity and mortality. Echocardiography is one of the simplest and noninvasive tools in assessing these changes.

Objective:To evaluate the echocardiographic changes in COPD patients.

Methods:A cross sectional observational study was carried out in Department of Cardiology and Department of Respiratory Medicine, Dhaka Medical College Hospital from July, 2018 to June, 2019. Total 98 COPD patients were included in the study. They underwent spirometry in Department of Respiratory Medicine and echocardiography in Department of Cardiology. Data was collected from the patients and recorded in a structured report form.

Results:Significant echocardiographic abnormalities were present in 51.02% patients. Most common echocardiographic change was pulmonary hypertension (43.9%). Other echocardiographic findings were dilated RA & RV (36.7%), RVH (35.7%), LV diastolic dysfunction (30.6%) and RV systolic dysfunction (9.2%). Echocardiographic signs of pulmonary hypertension, dilated RA & RV, RVH, RV systolic dysfunction and LV diastolic dysfunction were correlated with the severity of the disease. Though echocardiographic change of pulmonary hypertension was uncommon in COPD stage 1 & 2, but it was very common in stage 3(45.71%) & stage 4(92.86%).

Conclusion:Our study showed that echocardiographic changes were very common among the COPD GOLD stage 3 & 4 patients. Though these changes were infrequent among mild COPD patients but their severity increased with increasing stage of COPD.

Keywords: COPD, Echocardiography, Pulmonary hypertension, Cor pulmonale.

Abstract

Background: Hematological malignancy and its treatment produce multiple symptoms that significantly distress patients and impair function. Symptoms caused by treatment may delay treatment or lead to premature treatment termination and residual treatment-related symptoms often complicate post treatment rehabilitation. When treatment is no longer possible, symptom control becomes the focus of cancer care.

Objectives:The study was aimed to determine the symptom burden of the haematological malignancy patients.

Methods: A cross sectional study was conducted from July 2015 to June 2016 among the haematological malignancy patients. A total of 316 hematological malignancy adult (age ≥18 years) patients were purposively selected from haematology department of two tertiary level of hospitals in Dhaka city. Face to face interviews were taken from the diagnosed haematological malignancy patients admitted in the hospital and attending outdoor using questionnaire based on symptom distress scale (SDS).

Results:Mean age was 39 years and most of the patients suffering from Acute Leukemia 162 (51.3%). Mean monthly family income was around 22235 taka and 120 (37.9%) patients were unemployed. Patients with haematological malignancy had a considerable physical and psychological symptom burden which ranged from 94.3% for fatigue to 8.5% for difficulty in concentration. Physical symptoms such as fatigue 127 (40.2%), change in appetite 86 (27.2%), pain1 81 (25.6%), insomnia44 (13.9%) caused severe distress and psychological symptoms include change in appearance 37 (11.7%) and outlook 33 (10.4%) were sever distressing. Significant association (p&lt;0.001) was to be found between occupation and symptom distress where 82 (68.4%) unemployed and 51 (66.3%) housewife had moderate/sever symptom distress. Respondents who managed their treatment expenditure by loan and asset sell 11 (84.6%) had significant(p=0.004) moderate/sever distress. Patients having less than one month of diagnosis 47(72.3%) and admitted in inpatient 114 (66.6%) had significant higher moderate/sever symptom distress(p=0.03) and (p&lt;0.001) respectively.

Conclusion: Patients with haematological malignancy were likely to have multiple symptoms and comprehensive symptom assessment was suggested throughout. The introduction of supportive or palliative care services during times of increased symptom burden may assist haematologists and other careers in the management of their patient’s distress and quality of life.

Keywords: Haematological malignancy, Symptom burden, Symptom distress, Symptom distress stress

Abstract

Background: Occupational noise is considered as a global problem with social and physiological impacts, causing noise-induced hearing loss (NIHL). High levels of occupational noise is a problem in all regions of the world. Road traffic produces high noise levels that can cause damage to the traffic police hearing. Hence, occupational hearing loss is a well-known outcome of noise exposure at work.

Objectives: The study aimed to measure the noise exposure level at different traffic points and determine the occurrence rate and severity of hearing loss among the traffic police of Dhaka Metropolitan City.

Method: This cross-sectional study was conducted during 2017-2019 in 28 selected traffic points of Dhaka Metropolitan City under four traffic zone (East, West, North, and South) and among 100 traffic police who were working there and met the inclusion and exclusion criteria. Noise exposure level was measured from all selected traffic points with a digital sound level meter. Data were collected by face to face interview with a pretested semi-structured questionnaire followed by an otoscopic examination, tuning fork tests, and a baseline audiogram. To see the association, Chi-square tests or Pearson’s correlation coefficient (r) tests were performed.

Results: This study revealed that the average noise exposure level at East, West, North, and South zones are respectively 125.6 dB, 112.9 dB, 121.3 dB, and 119.4 dB. At every point, the noise exposure level was more than the acceptable limit set by the Occupational Safety and Health Administration (OSHA). In the audiometry report of 100 traffic police, 64% had sensorineural hearing loss. Of them 85% had mild, 9% had moderate and 6% with severe hearing loss. Notch in 4 kHz in an audiogram was present in the right ear of 46% of respondents and left ear of 52% respondents. It was observed that hearing loss was significantly associated with increasing age and job duration.

Conclusion: Traffic police of Dhaka Metropolitan City is in constant risk of noise induced hearing loss as the ambient noise of this city is very high. Regular assessment and hearing screening is recommended for all the traffic police who are exposed to noise.

Keywords:Noise exposure, Noise-induced hearing loss, Traffic police, Audiogram.

Abstract

Background: Teamwork is one of the most fundamental factors in rehabilitation medicine. Although isolated physicians and therapists are working with rehabilitation services in Bangladesh, there is limited data for understanding the effects of a team effort.

Objective: To evaluate the effect of rehabilitation team meeting on the patients’ disability in the Department of Physical Medicine and Rehabilitation (PMR) in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka.

Methods: This was a randomized controlled trial conducted in the Department of Physical Medicine and Rehabilitation (PMR) in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from September 2018 to October 2019. Two hundred and thirty nine patients attending the PMR department for comprehensive management of disability (such as disability in mobility, speech, self-care, sphincter control etc.) were purposively selected for the study. Patients were randomly allocated by lottery in two groups- group A (received Rehabilitation Team Meeting service) and group B (received conventional Rehabilitation treatment). The meeting comprised physiotherapist, occupational therapist, rehabilitation nurse, speech and language therapists, social worker, nutritionist, psychologists under the team leader guidance by physiatrist. Respondents of both groups were assessed to see the effects of treatment at 6^th weeks, 12^th weeks and 24^th weeks. Among 239 patients, 77 patients in group A and 71 patients in group B had completed 24^th week follow up. Outcomes were measured by FIM (Functional independence Measure) scores.

Results: The mean age of the patients in group A and B were 42.2 (±17.5) years and 45.7 (±14.6) years respectively. In both groups, majority of the patents were male and came from urban areas. Main cause of disability was stroke while others had traumatic brain injury, spinal cord injury, spinal cord compression, rheumatoid disease and others. At baseline and after 6^th week of treatment, there were no significant statistical differences between the two groups (p>0.05) regarding FIM scores. In 12^th week, FIM significantly increased in group A (p=0.009) compared to group B which persisted till 24^th week (p<0.001).

Conclusion: Rehabilitation team meeting significantly reduce disability of the patient. It needs to work continuously to build up the rehabilitation team to improve physical rehabilitation in Bangladesh to ensure total care of the disabled.

Keywords: Rehabilitation, Team meeting, Functional independence measure (FIM), Physical medicine.

Abstract

Background: Infective vertebral lesions usually involve the vertebral column, including the bone, intervertebral disk and paravertebral soft tissues. Variable imaging characteristics in conjunction with clinical findings can facilitate early diagnosis and treatment. MRI is a powerful imaging tool that can be help to evaluate spinal pathology specially infection. Typical MRI findings of infective vertebral disease are vertebral endplate destruction, bone marrow and intervertebral disc signal intensity changes and para vertebral soft tissue involvement.

Objective: This study was aimed to assess whether the MRI can different the in differentiate the invective vertebral lesions from benign or malignant Tumors.

Methods: This cross-sectional study was conducted on a total of 52 clinically suspected patients of infective vertebral lesions to establish diagnostic accuracy of MRI. The validity of MRI diagnosis for infective vertebral lesion was compared against CT-guided fine needle aspiration cytological (FNAC) diagnosis.

Results: The sensitivity, specificity, positive and negative predictive values (PPVs and NPVs) and finally diagnostic accuracy of MRI were calculated by comparing the MRI diagnoses with those of fine needle aspiration cytological diagnosis of vertebral lesions. Finally the sensitivity, specificity, PPV and NPV of MRI diagnosis for infective vertebral lesion were 95.6%, 85.7%, 97.7% and 75.0% respectively. The overall diagnostic accuracy was 94.2%.

Conclusion: Finding of this study suggested that MRI should be considered as the imaging modality of choice for patients with suspected infective vertebral lesions.

Keywords: Magnetic reasoning imaging, Vertebral infection, Fine needle aspiration cytology, Predictive value.

Abstract

Bangladesh has been implementing the digital health services to promote and protect public health, including telehealth, video-consultation, reporting even through data collection from the remote rural areas, monitoring, surveillance, human resource development including continued professional development etc since long before the COVID-19 pandemic.¹

The National Telehealth services is known as ‘ShasthyoBatayon16263’ that was inaugurated by thehonorable Minister, Ministry of Health and Family Welfare (MoHFW)on April 2016. The objectives are to provide low cost, efficient and timely delivery of general health care servicesin 24/7 by medical doctors and linking with existing health system for effectively responding the needs of citizen in Bangladesh. ‘Shasthyo Batayon’ has been financed bythe MoHFW through Directorate General of Health Services (DGHS) andimplemented by Synesis IT, a private provider of eHealth services and pioneer in digital health servicesin Bangladesh. It is a collaborative partnership and integrated withinoperational plan for sustainable citizen’s digital health services. The guidelines for telemedicine treatment protocol, advice/counseling, referral services and Standard Operating Procedures (SOP) were developed and approved for ‘Shasthyo Batayon’ (SB)by DGHS, Government. To avail ‘Shasthyo Batayon’ services, anyone can call to 16263 from any phone and access

Abstract

Bangladesh has achieved a remarkable progress in controlling communicable diseases, but still facing pressure in public health problems especially controlling the emerging or re-emerging diseases. Increase in dengue cases introduce threats to public health. Most of the cases of dengue virus infection remain asymptomatic; but it can cause a wide spectrum of clinical manifestations from mild illness to spontaneous recovery and also haemorrhagic dengue fever (DF) and/or dengue shock syndrome (DSS).¹ There are four serotypes of dengue virus (DEN1-4) with 25-40% heterogeneity.² Infection with one serotype confers lifelong immunity against that particular serotype but subsequent infection by another serotype often creates fatal outcomes if remains untreated.¹

Since 1970, liver injury due to dengue infection has been described and it’s not uncommon. Dengue hemorrhagic fever (DHF) is associated with hepatomegaly in 30% of patients, and its magnitude has no relationship with the severity of the disease. On the other hand, 90% of people with dengue infection presented with an increase in aminotransferases, with levels of aspartate aminotransferase (AST) higher than those of alanine aminotransferase (ALT). Acute liver failure is a severe complicating factor in dengue infection, predisposing to life-threatening hemorrhage, disseminated intravascular coagulation and encephalopathy.³

Dear Editor,

“Consent” means that the patient accepts, through an unequivocal act of will, to assume certain obligations.¹ Before providing care or treatment to a patient, the dentist must obtain the individual’s free and informed consent. This requirement is based on two principles: personal inviolability and free will.

Types of consent include implied consent and expressed consent. Expressed consent is inform either verbal or written. Consent as understood in specific context may differ from its everyday meaning.² Rowe described implied consent as: ‘by being in the chair at the dental surgery with mouths open a patient implies that they are there for dental treatment’ and continued ‘in the past a dentist would undertake treatment as he or she saw fit, which the patient would accept without argument.³

Contemporary medical ethics and bioethics began after the World War II as a result of contemptible issues in medical research and medical interventions.⁴ The Nuremberg Code of 1948 laid out the principle that “voluntary consent of the human subject is absolutely essential”.⁵