TDHRC - Publications

Violence against physicians working in public tertiary care hospital of Bangladesh: a facility-based cross-sectional study

Summary of the research:

Introduction: Violence against physicians in the workplace is a prevalent global issue, and Bangladesh is no exception. Such violence significantly disrupts healthcare delivery and the attainment of universal health coverage. This study aimed to comprehensively evaluate the prevalence, nature and associated risk factors of workplace violence (WPV) against physicians in Bangladesh.

Description: This descriptive cross-sectional study was conducted at a public tertiary care hospital involving 441 physicians with a minimum tenure of 6 months. Data were gathered through a structured self-reported questionnaire, and statistical analyses were performed by using SPSS V.25.

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Optimizing survival in Russell’s viper bite cases in low-resource setting: two case reports

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Introduction: Snakebite envenomation poses a significant health risk, particularly in low-resource settings where access to proper treatment is limited.

Description: This study reports two cases of Russell's viper bites in rural Bangladesh, involving 48 and 35-year-old Bangladesh males, respectively, and highlights the difficulties in providing adequate medical care and in treating any complications that may arise. Both cases involved delayed access to healthcare, initial visit to traditional healers, and the development of severe complications such as coagulopathy, renal failure. After the intervention both cases survived which is scarce in low resource settings.

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The 2023 Dengue Outbreak in Bangladesh: Exploring the Epidemiology in Hospitalized Patients.

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Introduction: For the past two decades, Bangladesh has faced recurrent dengue outbreaks, with the most recent occurring in 2023. We investigated the socioeconomic, clinical, and laboratory aspects of patients diagnosed with dengue during this outbreak. This observational study was conducted from July to September 2023 at Dhaka Medical College Hospital and Chittagong Medical College Hospital, and included 450 confirmed cases of dengue. Sociodemographic information was collected via face-to-face interviews, clinical examinations, and laboratory testing, which was done within 24 hours of admission. Dengue severity was classified according to the 2009 WHO dengue guidelines. Notably, 17% of patients experienced severe dengue, and 89% of those with nonsevere cases exhibited at least one warning sign. Most patients were young adults (mean age, 33 years), with a nearly equal male-to-female ratio. Common clinical presentations included fever (95%), myalgia (62%), and headache (58%), whereas warning signs such as vomiting (54%) and abdominal pain (39%) were prevalent. Plasma leakage indicators, including ascites, pleural effusion, and edema, were found predominantly in severe cases. Laboratory findings revealed leukopenia, thrombocytopenia, and elevated hepatic enzymes (alanine aminotransferase and aspartate aminotransferase) in nearly half the patients. An elevated hematocrit level was associated with severe dengue. We report that a substantial number of patients developed severe dengue during the epidemic in 2023, and provide detailed clinical–epidemiological profiles of the patients, offering valuable insight into management of dengue cases.

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Predictors of poor neurodevelopmental outcomes in neonates with clinically observed seizures: A prospective observational study in a tertiary care hos

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Introduction: Neonatal seizures can lead to long-term neurodevelopmental problems. This study aims to identify predictors of poor developmental outcomes in neonates with seizures to aid in early intervention and referral for follow-up and rehabilitation. This observational study was conducted in the Department of Neonatology and Institute of Paediatric Neurodisorder, Bangabandhu Sheikh Mujib Medical University. Among 75 study cases of neonatal seizure, 23 died, and 46 were follow-ups at 6 and 9 months after discharge. EEGs were performed on every patient with a comprehensive neurological examination and developmental evaluation using Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III). Three-fourths of neonates were born at term (76.1 %), and over half were male (56.5 %). The majority were appropriate for gestational age (79.7 %) and had an average birth weight of 2607 ± 696 g (±SD). Over half of the neonates (52.2 %) had adverse neurodevelopmental outcomes, with global developmental delay being the most common. Recurrent seizures, the number of anticonvulsants needed to control seizures, and abnormal Electroencephalograms were identified as independent predictors of adverse neurodevelopmental outcomes. The study highlights the need for early referral for follow-up and rehabilitation of neonates with seizures having abnormal electroencephalograms, recurrent seizures and requiring more anticonvulsants to control seizures.

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Comparison Of Clinical And Laboratory Profile Of Pediatric And Adult Dengue Patients During 2019 Dengue Epidemic In Bangladesh

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Introduction: Introduction: Bangladesh has experienced a large scale epidemic of dengue in 2019 affecting both children and adults. The objective of the present study was to compare e the clinical and laboratory parameters of pediatric and adult dengue cases during this epidemic

Description: Results: The average age of the pediatric and adult cases was 6.6 (SD 4.7) and 30 (SD 11.5) years, respectively and almost 60% were male. Around 10% of the pediatric and 16.7% of the adult patients developed severe dengue. Fever (89%), nausea/vomiting (56%), diarrhea (18%), headache (28%) and retro-orbital pain (18%) were the most common conventional clinical presentation. Abdominal pain (29%), persistent vomiting (7.6%) and mucosal bleeding (14%) were most commonly presented warning signs. Evidence of clinical fluid accumulation and dengue shock syndrome were present in almost 5.9 and 6.4% of patients respectively. Thrombocytopenia and leukopenia were present in 32 and 28% of the patients while raised serum ALT and/or AST was present in 23% and 39% patients

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Comparison Of Clinical And Laboratory Profile Of Pediatric And Adult Dengue Patients During 2019 Dengue Epidemic In Bangladesh

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Description: Methods: The retrospective study comprises data of 739 confirmed pediatric cases collected from the Dhaka Sishu Hospital and 486 adult confirmed dengue cases from the Dhaka Medical College Hospital. The study period was between June to September 2019. Clinical and laboratory information were retrieved along with sociodemographic data.

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Capacity Building And Fungal Surveillance Among Critically Ill Patients: A Multicenter Cross-Sectional Survey

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Introduction: Background: Invasive fungal infections are a growing problem in critically ill patients and are associated with increased morbidity and mortality. It can causes candidemia, disseminated candidiasis with deep organ involvement and chronic disseminated candidiasis. Along with the traditional candida species, rare pathogenic fungi are also emerging. Timely diagnosis and proper treatment are of paramount importance for a favorable outcome. The aim of the study is to determine the contemporary epidemiology, management, and outcome of invasive fungal infections in critically ill patients admitted in ICU

Description: Patients and Methods: This prospective surveillance study will be performed in three ICU departments at Dhaka Medical College Hospital, Sir Salimullah Medical College Mitford Hospital and Mugda Medical College Hospital from January 1 to December 31, 2018. All patients above 18 years of age in whom fungal infection or colonization will be confirmed by specimen culture will be included in the study. Before starting the study ethical permission will be taken from ethical review committee of the 3 centers. Informed consents will be obtained from the patients or surrogate decision makers. For each of the cases, demographic and clinical data (age, gender, comorbidities, risk factors, clinical presentations, severity of illness on ICU admission, organ dysfunctions on enrollment, length of stay, concomitant bacterial infections and antibiotic therapy, antifungal prophylaxis and treatment) will be collected. Severity on admission will be defined by the APACHE II score and organ dysfunction will be computed by the Sequential Organ Failure Assessment (SOFA) score. Microbiological data (e.g., etiological agents, fungal colonization antifungal susceptibility) will be noted then. All biological samples will be cultured on Sabouraud’s dextrose agar (SDA)

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Pattern Of Gut Microbiota In NAFLD Patients In Bangladesh: A Pilot Study

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Introduction: In addition to the well-known underlying pathophysiology of nonalcoholic fatty liver disease (NAFLD), dysbiosis of the gut microbiota is a relatively newer concept. A lack of evidence considering human subjects is evident in our country. Therefore, finding the pattern of gut microbiota in NAFLD patients is the objective of the study. This cross-sectional study will be conducted at the Department of Medicine and Department of Hepatology, Dhaka Medical College Hospital (DMCH), for a period of six months. Formal ethical permission will be sought from the proper authority. Biopsy-proven NAFLD cases will be included. The severity will be defined by the NAFLD activity score (NAS)

Description: To identify gut dysbiosis, a metagenomic approach will be followed. In this process, the microbial community will be profiled by denaturing gradient gel electrophoresis and examined by 454 pyrosequencing of the 16S ribosomal RNA V3 region from a stool sample. For the convenience of the study, a total of 30 cases will be included in this study. A written informed consent form will be ensured before participation as well as for the biopsy procedure. The ethical measures will be taken in accordance with the current Declaration of Helsinki. Data analysis will be performed following completion and verification of the data, and the statistical software SPSS will be used during data analysis. It is expected that the result will prove the change in the composition of the gut microbiota in NAFLD patients and establish the relation of gut dysbiosis with the severity of NAFLD. Moreover, it will help clinicians and policymakers establish guidelines to prevent the increasing number of NAFLD cases in our country.

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Assessment Of Inhaler Using Technique Among Adult Asthma Patients In Bangladesh: A Facility-Based Cross-Sectional Study

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Introduction: Background: Inhaler using technique has influences on disease control in patients with bronchial asthma. The objective of this study was to assess the inhaler using technique and factors associated with correct technique among adult asthma patients in northern Bangladesh.

Description: Methods: A total 357 asthma patients were recruited from medicine outpatient department of Rajshahi Medical College Hospital (RMCH) from November 2020 to January 2021. All patients were stable and using either metered dose inhaler (MDI) with or without spacer or dry powder inhaler (DPI). Demographic and disease details were collected by direct interviewing of the patients and inhaler using technique were also observed. A preformed checklist was used for marking the activities of the patients. Inhaler using technique was defined as incorrect if there was one or more critical error observed during using the prescribed inhaler. Logistic regression model was used to determine the predictors of incorrect inhaler using technique.

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The Deadly Trio Of Hypertension, Diabetes Mellitus And Non-Alcoholic Fatty Liver Disease (NAFLD) Among Bangladeshi Adults: A Cross-Sectional Study

Summary of the research:

Introduction: Diabetes mellitus and hypertension are two deadly noncommunicable diseases that affect almost billions of people worldwide. The connection between type 2 diabetes (T2DM) and hypertension is well established. However, a number of diabetic patients with or without hypertension develop nonalcoholic fatty liver disease (NAFLD) followed by cirrhosis silently. Even until the development of complications, patients cannot even understand the disease. Based on the scientific gap, the study is designed to assess the concurrent presence of diabetes, hypertension and NAFLD

Description: Bangladeshi adults. This cross-sectional study will be conducted at the Department of Endocrinology and Department of Medicine in Dhaka Medical College Hospital (DMCH) for a six-month period from October 2022 to March 2023. All diabetic patients visiting the outpatient departments will be prospectively screened for hypertension. Both newly diagnosed hypertension and patients already on antihypertensive medications will be included. The dual presence of the disease (DM and HTN) in patients aged over 18 years will be the prime criteria and will be assessed by ultrasonography to detect the presence of NAFLD along with severity grading. A total of 340 subjects will be examined. Informed written consent will be obtained from each patient after full explanation of the purpose and nature of all procedures that will be used. Collected data will be analysed using SPSS software version 25.0. Data will be expressed as the mean ± SD, median [IQR], or frequencies (percentage), when appropriate.

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Association Of Screentime And Subjective Sleep Quality With Hypertension- A Facility-Based Case-Control Study

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Introduction: Scientific studies have indicated that screen time and subjective sleep quality might play a role in blood pressure elevation. However, the association of these two factors with the emergence of hypertension is still unknown. Therefore, this study aimed to assess the relationship of the screentime and subjective sleep quality with the development of hypertension. The case‒control study will be conducted in the Hypertension and Research Center, Rangpur, for a period of six months. Participants attending the study center for blood pressure check-up and hypertension

Description: screening will be approached for this study. A total of 160 patients will be included according to the selection criteria in the two groups: 80 cases and 80 controls. Newly diagnosed hypertension patients according to American Heart Association guidelines will be included as cases, and age- and sex-matched apparently healthy participants will be included as controls. A semi structured questionnaire will be developed containing sociodemographic information, information regarding subjective sleep quality and screentime. Subjective sleep quality will be assessed by the Bengali validated Pittsburg Sleep Quality Index. Screentime will be assessed by the total duration of screen exposure in a day, including background exposure and direct exposure. Face-to-face interviews will be conducted for data collection. The collected data will be checked for errors and stored anonymously. Data analysis will be conducted by using IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. Ethical clearance will be sought from Bangladesh Medical and Research Council. The study will be conducted according to the Declaration of Helsinki.

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Systemic Lupus Erythematosus In The Light Of The COVID 19 Pandemic: Infection, Vaccination, And Impact On Disease Management’’

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Introduction: As the world witnessed the coronavirus disease 2019 (COVID-19) pandemic, there is a growing need to assess its impact in patients with autoimmune rheumatic diseases, such as systemic lupus erythematosus (SLE). As patients with chronic diseases are prone to more severe COVID-19 and unfavorable outcomes, the use of systemic glucocorticoids and immunosuppressants and underlying organ damage from SLE are potential susceptibility factors. Thus, the pandemic poses multiple issues concerning COVID-19 among SLE patients, management and patients’ attitudes toward COVID-19. As there are very limited data regarding the impact of COVID-19 on SLE patients, the objective of the study is to evaluate the prevalence and severity of COVID-19 among SLE patients, the efficacy of COVID-19 vaccination, the impact on the management of SLE

Description: Bangladesh. This cross-sectional observational study will be conducted at the Rheumatology clinic and Research Center (SLE Clinic) in the Department of Medicine of Dhaka Medical College Hospital (DMCH), Bangladesh. The total study period will be six-months from September 2022 to February 2023. The study protocol will be approved by the Ethical Review Committee (ERC) of Bangladesh Medical Research Council (BMRC) and will follow the regulation of Declaration of Helsinki. Adult (>18 years of age) patients who are already registered at the SLE clinic of DMCH and also who will be coming for treatment of recent diagnosis, will be taken as study participants. Registered patients coming for follow-ups will be approached for direct interviews, and the rest of the patients will be contacted through telephone interviews. Verbal (through telephone) and written informed consent will be obtained from each of the participants as appropriate. Sociodemographic, clinical, and vaccination data will be collected by using a question-based case record form (CRF). The CRF is designe

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Risk Stratification Using The 2021 IDF-DAR Risk Calculator And Fasting Experience Of Bangladeshi Subjects With Type 2 Diabetes In Ramadan: The DAR-BAN

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Introduction: Aims: To risk-stratify patients with type 2 diabetes mellitus (T2DM) according to the International Diabetes Federation- Diabetes and Ramadan International Alliance (IDF-DAR) 2021 guidelines and to observe their responsiveness to risk-category-based recommendations and fasting experience.

Description: Methods: This observational study, conducted in the peri-Ramadan period of 2022, evaluated subjects with T2DM and categorized them using the 14-item IDF-DAR 2021 risk stratification tool. Recommendations for fasting according to the risk categories were made, their intention to fast was recorded, and follow-up data, including hypo- and hyperglycemic events in the month, were collected within one month of the end of Ramadan.

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Health Seeking Behavior Among Hypertensive Patients In North-Eastern Region Of Bangladesh: A Cross-Sectional Analytic Study

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Introduction: Hypertension is one of leading causes of disability and deaths worldwide. Despite the life-threatening implications of uncontrolled blood pressure, both suspected and confirmed hypertensive patients seek care from both formal and informal health providers in low- and middle-income countries. This study aimed to assess quantitatively about the health seeking behavior and associated factors among registered hypertensive patients in the North-Eastern region of Bangladesh.

Description: Results: Mean age of the hypertensive patients was 52 ±11 (SD) years. Majority of them were aged between 51 to 60 years (33%), female (55%), came from rural areas (57%), and belonged to middle socio-economic class (68%). One fourth of the patients (27%) have chosen informal health care providers for their first consultation. Fear of stroke (244, 45%), Headache (170, 36%) and neck pain (81, 17%) were the three most common compelling causes of their visit. Age (aOR 0.96, 95% CI 0.94 – 0.98), male sex (aOR: 1.81, 95% CI 1.05 – 3.10), living in semi-urban (aOR 4.69, 95% CI 1.46 – 15.12) and/or rural area (aOR 1.72, 95% CI 1.03 – 2.88), farmers as occupation (aOR: 3.18, 95%CI: 1.29 – 7.85) and belonging to lower social economic class (aOR 4.15, 95% CI 1.64 – 10.47) were predictors of visiting informal providers of hypertensive patient.

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