Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66184
Synthia Farhana, Hemonta Podder, G. Ghosh, K. Tarafder, M. Mortuza, G. Acherjya
A proper and complete history is very important to reach the ultimate diagnosis and complete evaluation of a patient. Otherwise, the typical presentation can also be sometimes missed which leads to delay or even miss the actual diagnosis of a patient. However, we hereby present a case of a HIV (Human Immunodeficiency) patient where an incomplete history put the physician into a diagnostic dilemma and hindrance. The patient was a migrant worker and had history of sexual exposure and previous blood transfusion. Initially, he did not disclose his personal history to his general and specialist physicians. Therefore, the several consulted physicians could not reach his true diagnosis. After getting admission, we became able to explore his personal history which guided us prompt reaching in his proper diagnosis finally. Moreover, we sometimes fail to make a patient friendly environment to share everything due to social stigma, lack of welcoming environment, lack of good doctor-patient relationship. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 222-223
{"title":"A Case Report of Chronic Diarrhoea and Itchy Rash- are We Missing Something?","authors":"Synthia Farhana, Hemonta Podder, G. Ghosh, K. Tarafder, M. Mortuza, G. Acherjya","doi":"10.3329/bjm.v34i20.66184","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66184","url":null,"abstract":"A proper and complete history is very important to reach the ultimate diagnosis and complete evaluation of a patient. Otherwise, the typical presentation can also be sometimes missed which leads to delay or even miss the actual diagnosis of a patient. However, we hereby present a case of a HIV (Human Immunodeficiency) patient where an incomplete history put the physician into a diagnostic dilemma and hindrance. The patient was a migrant worker and had history of sexual exposure and previous blood transfusion. Initially, he did not disclose his personal history to his general and specialist physicians. Therefore, the several consulted physicians could not reach his true diagnosis. After getting admission, we became able to explore his personal history which guided us prompt reaching in his proper diagnosis finally. Moreover, we sometimes fail to make a patient friendly environment to share everything due to social stigma, lack of welcoming environment, lack of good doctor-patient relationship.\u0000J Medicine 2023; Vol. 34, No. 2(1) Supplement: 222-223","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"42 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90199337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66175
Adnan Shareef, Mahbuba Islam, Muddassir Ahmed Haroon, Sharon Roy, A. Anam
This Quality Improvement Project (QIP) was aimed to assess the acceptability and utility of the National Early Warning Score 2 (NEWS2) in a Bangladeshi level-2 care setting.All nurses and physicians were trained on NEWS2 scores and proper response before starting the QIP. Utilization of NEWS2 and patient outcome were documented and analyzed. Acceptability was recognized by increase in utilization, and utility by reduction in unnoticed deterioration of patients. With modified NEWS2 chart, it became well adopted and utilized by the nurses. Data from 3828 patients showed statistically significant reduction in unnoticed deterioration evident by lowering of sudden cardiac arrest and ICU transfer (0.35% vs 2.6% and 2.33% vs 6.6%, p= <0.0005) after and before implementation of the NEWS2, respectively.With adequate training, motivation, and appropriate modification, the NEWS2 can become a well-accepted, widely adopted, and realistic bedside monitoring tool in resource limited settings like Bangladesh. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188
该质量改进项目(QIP)旨在评估孟加拉国二级护理环境中国家预警评分2 (NEWS2)的可接受性和效用。在开始QIP之前，所有护士和医生都接受了NEWS2评分和正确反应的培训。记录并分析NEWS2的使用情况和患者预后。可接受性是通过增加利用率来确认的，而效用是通过减少患者未被注意的恶化来确认的。修改后的NEWS2表得到了护士的广泛采用和使用。3828例患者的数据显示，在实施NEWS2后和实施前，通过降低心脏骤停和ICU转移，未被注意到的恶化发生率分别有统计学意义(0.35% vs 2.6%， 2.33% vs 6.6%， p= <0.0005)。通过充分的培训、激励和适当的修改，NEWS2可以在孟加拉国等资源有限的环境中成为一种被广泛接受、广泛采用和现实的床边监测工具。孟加拉国J医学2023;第34卷，第2(1)号补编:188
{"title":"Prevention of Unnoticed Deterioration And Improvement In Outcome of Critically Ill Patients By Implementation of National Early Warning Score 2 In A High Dependency Unit In Bangladesh: A Quality Improvement Project","authors":"Adnan Shareef, Mahbuba Islam, Muddassir Ahmed Haroon, Sharon Roy, A. Anam","doi":"10.3329/bjm.v34i20.66175","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66175","url":null,"abstract":"This Quality Improvement Project (QIP) was aimed to assess the acceptability and utility of the National Early Warning Score 2 (NEWS2) in a Bangladeshi level-2 care setting.All nurses and physicians were trained on NEWS2 scores and proper response before starting the QIP. Utilization of NEWS2 and patient outcome were documented and analyzed. Acceptability was recognized by increase in utilization, and utility by reduction in unnoticed deterioration of patients. With modified NEWS2 chart, it became well adopted and utilized by the nurses. Data from 3828 patients showed statistically significant reduction in unnoticed deterioration evident by lowering of sudden cardiac arrest and ICU transfer (0.35% vs 2.6% and 2.33% vs 6.6%, p= <0.0005) after and before implementation of the NEWS2, respectively.With adequate training, motivation, and appropriate modification, the NEWS2 can become a well-accepted, widely adopted, and realistic bedside monitoring tool in resource limited settings like Bangladesh.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188 ","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85064540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66096
Girish Mathur
The doctor-patient relationship is central to the practice of medicine and is essential for the delivery of high-quality healthcare in the diagnosis and treatment of disease. There is utmost need for effective communication in medical practice. Communication is the key that unlocks a number of benefits. It leads to increased patient satisfaction, better understanding of the treatment, improved compliance, and overall better health. Therefore, clearer communication better understanding, and thus, better outcomes in the patients’ and attendants’ satisfaction. The need for communication with patients should be emphasized as it helps patients feel at ease, reduces their anxiety and builds their confidence, makes patients/clients feel valued, and reduces the chances of medical errors. Some of the key barriers to effective communication are such as personal barriers: negative attitude by doctors towards communication and giving it a low priority due to their concern primarily to treat illness rather than focus on patients’ other needs which may be psychological or related to social wellbeing. Human failings, such as tiredness and stress: A lack of inclination to communicate with patients. This can be due to lack of time, uncomfortable topics, lack of confidence and concerns relating to confidentiality. Inconsistency in providing information and giving conflicting information by different healthcare providers. Organizational barriers, lack of time, pressure of work being subjected to interruptions. If the complains are justified it is important that you apologize and ask the relatives what they would like to be done about it. Any problem that the family feels or experience should be actively identified and appropriate action should be taken to resolve them. If their demanding behavior continues, set the limit and you can tell them that you cannot do better than what is being done. If the relatives insist on continuing to disagree about the patient’s management, it may be necessary to call some senior doctor to try to explain and convince them. Imparting bad news is an emotional experience for the doctor as well as the patient and requires additional targeted strategies. When you speak to the patient they get the chance to clarify their doubts. Medical schools/ Colleges must be encouraged to provide the best possible communication skills training as part of the core undergraduate curriculum. This training should have set objectives and clear methods of assessment. More communication skills training programs should be developed at post graduate level. Doctors should use the appraisal process as a vehicle for discussing the success of communication skills training. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 178
{"title":"Communication: A Basic Skill of Medical Practice","authors":"Girish Mathur","doi":"10.3329/bjm.v34i20.66096","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66096","url":null,"abstract":"The doctor-patient relationship is central to the practice of medicine and is essential for the delivery of high-quality healthcare in the diagnosis and treatment of disease. There is utmost need for effective communication in medical practice. Communication is the key that unlocks a number of benefits. It leads to increased patient satisfaction, better understanding of the treatment, improved compliance, and overall better health. Therefore, clearer communication better understanding, and thus, better outcomes in the patients’ and attendants’ satisfaction. The need for communication with patients should be emphasized as it helps patients feel at ease, reduces their anxiety and builds their confidence, makes patients/clients feel valued, and reduces the chances of medical errors. Some of the key barriers to effective communication are such as personal barriers: negative attitude by doctors towards communication and giving it a low priority due to their concern primarily to treat illness rather than focus on patients’ other needs which may be psychological or related to social wellbeing. Human failings, such as tiredness and stress: A lack of inclination to communicate with patients. This can be due to lack of time, uncomfortable topics, lack of confidence and concerns relating to confidentiality. Inconsistency in providing information and giving conflicting information by different healthcare providers. Organizational barriers, lack of time, pressure of work being subjected to interruptions. If the complains are justified it is important that you apologize and ask the relatives what they would like to be done about it. Any problem that the family feels or experience should be actively identified and appropriate action should be taken to resolve them. If their demanding behavior continues, set the limit and you can tell them that you cannot do better than what is being done. If the relatives insist on continuing to disagree about the patient’s management, it may be necessary to call some senior doctor to try to explain and convince them. Imparting bad news is an emotional experience for the doctor as well as the patient and requires additional targeted strategies. When you speak to the patient they get the chance to clarify their doubts. Medical schools/ Colleges must be encouraged to provide the best possible communication skills training as part of the core undergraduate curriculum. This training should have set objectives and clear methods of assessment. More communication skills training programs should be developed at post graduate level. Doctors should use the appraisal process as a vehicle for discussing the success of communication skills training. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 178","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135139869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66121
Helal Uddin Ahmed
There is some addictive use of the internet which ultimately refers to a disorder. Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviors regarding computer use and internet access that led to impairment or distress. The diagnosis “Internet Gaming Disorder” (IGD) has been included in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. This proposed condition is limited to gaming and does not include problems with general use of the internet, online gambling, or use of social media or smartphones.Co morbidity found in this addictive behavior like depression and anxiety. Treatment options are limited, including Cognitive behavioral therapy, family therapy, couple therapy, antidepressant, anti-anxiety drugs and naltrexone. The mental health professionals, information technologists, young and students affairs professionals should be alert to this disorder. Internet addiction is a growing concern in today’s digital age. With the widespread availability and use of the internet, many people are finding it difficult to control their usage, leading to negative consequences in their daily lives. Some of the issues and concerns related to internet addiction include: Social isolation, Poor academic or work performance, Physical health problems, Sleep disturbances, Risks of Cyber bullying, financial problems, Behavioral and Relationship issues. It is important to seek help if you or someone you know is struggling with internet addiction. Management options may include psychotherapy, support groups, and behavior modification techniques to help individuals regain control of their internet use and improve their overall well-being and sometimes medication need when intractable behavioral issues persist. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 183-184
{"title":"Internet addiction: issues and concerns","authors":"Helal Uddin Ahmed","doi":"10.3329/bjm.v34i20.66121","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66121","url":null,"abstract":"There is some addictive use of the internet which ultimately refers to a disorder. Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviors regarding computer use and internet access that led to impairment or distress. The diagnosis “Internet Gaming Disorder” (IGD) has been included in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. This proposed condition is limited to gaming and does not include problems with general use of the internet, online gambling, or use of social media or smartphones.Co morbidity found in this addictive behavior like depression and anxiety. Treatment options are limited, including Cognitive behavioral therapy, family therapy, couple therapy, antidepressant, anti-anxiety drugs and naltrexone. The mental health professionals, information technologists, young and students affairs professionals should be alert to this disorder. Internet addiction is a growing concern in today’s digital age. With the widespread availability and use of the internet, many people are finding it difficult to control their usage, leading to negative consequences in their daily lives. Some of the issues and concerns related to internet addiction include: Social isolation, Poor academic or work performance, Physical health problems, Sleep disturbances, Risks of Cyber bullying, financial problems, Behavioral and Relationship issues. It is important to seek help if you or someone you know is struggling with internet addiction. Management options may include psychotherapy, support groups, and behavior modification techniques to help individuals regain control of their internet use and improve their overall well-being and sometimes medication need when intractable behavioral issues persist. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 183-184","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135140813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66142
Md Nuruzzaman
Sepsis is a life-threatening syndrome caused by an exaggerated host immune response to infection. Despite advances in diagnosis and treatment, sepsis remains a major global health concern, with significant morbidity and mortality rates. Current concepts in sepsis management emphasize the need for early recognition and treatment of the condition, with a focus on the optimization of fluid resuscitation, antibiotic therapy, and supportive care. Recent studies have shown that a multifaceted approach to sepsis management, involving a combination of pharmacological and non-pharmacological interventions, may improve outcomes. This approach includes the use of biomarkers for early diagnosis, goal-directed therapy to optimize resuscitation, and the implementation of protocols for timely initiation of appropriate antimicrobial therapy. Furthermore, recent studies have highlighted the importance of individualized patient care in sepsis, with a focus on tailoring treatment to the specific needs of the patient. There is also growing interest in the use of novel therapies for sepsis, such as immunomodulatory agents, extracorporeal therapies, and stem cell therapies. These therapies have shown promising results in preclinical studies, and may provide new avenues for the treatment of sepsis in the future. Overall, the current concept of sepsis management emphasizes early recognition and intervention, individualized patient care, and a multifaceted approach to treatment. Further research is needed to identify optimal approaches to sepsis management and to develop novel therapies for this complex condition. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 195
{"title":"Sepsis: Current Concepts","authors":"Md Nuruzzaman","doi":"10.3329/bjm.v34i20.66142","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66142","url":null,"abstract":"Sepsis is a life-threatening syndrome caused by an exaggerated host immune response to infection. Despite advances in diagnosis and treatment, sepsis remains a major global health concern, with significant morbidity and mortality rates. Current concepts in sepsis management emphasize the need for early recognition and treatment of the condition, with a focus on the optimization of fluid resuscitation, antibiotic therapy, and supportive care. Recent studies have shown that a multifaceted approach to sepsis management, involving a combination of pharmacological and non-pharmacological interventions, may improve outcomes. This approach includes the use of biomarkers for early diagnosis, goal-directed therapy to optimize resuscitation, and the implementation of protocols for timely initiation of appropriate antimicrobial therapy. Furthermore, recent studies have highlighted the importance of individualized patient care in sepsis, with a focus on tailoring treatment to the specific needs of the patient. There is also growing interest in the use of novel therapies for sepsis, such as immunomodulatory agents, extracorporeal therapies, and stem cell therapies. These therapies have shown promising results in preclinical studies, and may provide new avenues for the treatment of sepsis in the future. Overall, the current concept of sepsis management emphasizes early recognition and intervention, individualized patient care, and a multifaceted approach to treatment. Further research is needed to identify optimal approaches to sepsis management and to develop novel therapies for this complex condition. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 195","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135140815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66173
Makamam Mahmud
Sheehan’s syndrome is a rare condition involving injury to the pituitary gland following excessive blood loss during delivery. Its presentation is too variable sometimes, it may be remained asymptomatic for long times. Here we are presenting a 50 yr-old woman presented with recurrent vomiting admitted in the Rajshahi Medical College Hospital. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 217
{"title":"Recurrent Vomiting, an Atypical Presentation of Sheehan’s Syndrome","authors":"Makamam Mahmud","doi":"10.3329/bjm.v34i20.66173","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66173","url":null,"abstract":"Sheehan’s syndrome is a rare condition involving injury to the pituitary gland following excessive blood loss during delivery. Its presentation is too variable sometimes, it may be remained asymptomatic for long times. Here we are presenting a 50 yr-old woman presented with recurrent vomiting admitted in the Rajshahi Medical College Hospital.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 217","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"46 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72570554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66095
M. Kafle
Anemia is common in patients with chronic kidney diseases (CKD). It is a common complication of advanced CKD. Its prevalence in CKD stage 5 populations is over 50%. The hormone “erythropoetin” (EPO) secreted by the kidneys is essential in the maintenance of adequate hemoglobin in human body. Scientific Presentation BJM Vol. 34 No. 2(1) Suppliment 2023 177 Apart from failure of EPO secretion, many other factors including chronic inflammation, uremic bone marrow suppression, hyperparathyroidism, poor absorption of substrates from the uremic gastrointestinal tract etc. contribute to development of anemia in patients living with advanced kidney failure and dialysis. Iron deficiency state due to absolute or relative iron deficiency is common in CKD population. Furthermore, nutritional anemia is common in general population in our part of the world. Majority of this is also a result of iron deficiency. Replenishing iron stores in the body is the first strategy in the management of this condition. Besides the use of iron, deficiencies of other substrates like vitamin B12 should also be taken into account while managing anemia in CKD. Ferric citrate can be used as an hematinic and phosphate binder as well. Blood transfusion was invariable treatment strategy in the remote past. Though oral and parenteral iron and other hematinics are routinely used in the management of CKD, various erythropoesis stimulating agents (ESAs) used as injectable solutions lead the current therapeutic strategy in the treatment of anemia in patients with end stage renal disease (ESRD) and renal replacement therapies. More recently newer agents, the prolylhydroxylase inhibitors (PHI) like roxadustat which act as hypoxic ischemic factor (HIF) stabilizers have been more appealing to the patients and the clinicians. In contrast to the parenteral administration of ESAs, these new agents can be administered orally. While anemia is common, ideal treatment for anemia in CKD is still unsolved riddle and demands further research. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 177-178
{"title":"Chronic kidney disease and anemia: updated management issues","authors":"M. Kafle","doi":"10.3329/bjm.v34i20.66095","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66095","url":null,"abstract":"Anemia is common in patients with chronic kidney diseases (CKD). It is a common complication of advanced CKD. Its prevalence in CKD stage 5 populations is over 50%. The hormone “erythropoetin” (EPO) secreted by the kidneys is essential in the maintenance of adequate hemoglobin in human body. Scientific Presentation BJM Vol. 34 No. 2(1) Suppliment 2023 177 Apart from failure of EPO secretion, many other factors including chronic inflammation, uremic bone marrow suppression, hyperparathyroidism, poor absorption of substrates from the uremic gastrointestinal tract etc. contribute to development of anemia in patients living with advanced kidney failure and dialysis. Iron deficiency state due to absolute or relative iron deficiency is common in CKD population. Furthermore, nutritional anemia is common in general population in our part of the world. Majority of this is also a result of iron deficiency. Replenishing iron stores in the body is the first strategy in the management of this condition. Besides the use of iron, deficiencies of other substrates like vitamin B12 should also be taken into account while managing anemia in CKD. Ferric citrate can be used as an hematinic and phosphate binder as well. Blood transfusion was invariable treatment strategy in the remote past. Though oral and parenteral iron and other hematinics are routinely used in the management of CKD, various erythropoesis stimulating agents (ESAs) used as injectable solutions lead the current therapeutic strategy in the treatment of anemia in patients with end stage renal disease (ESRD) and renal replacement therapies. More recently newer agents, the prolylhydroxylase inhibitors (PHI) like roxadustat which act as hypoxic ischemic factor (HIF) stabilizers have been more appealing to the patients and the clinicians. In contrast to the parenteral administration of ESAs, these new agents can be administered orally. While anemia is common, ideal treatment for anemia in CKD is still unsolved riddle and demands further research.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 177-178","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"293 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79538128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66177
J. Ahmad, L. Nizhu, M. Haroon, Amani Anam
Background: Acute medicine is concerned with the immediate and early management of adult patients suffering from a wide range of medical conditions requiring urgent care. It is a new concept in the context of our country. Given the current situation of the burden of patients against available resources, management of acute conditions under the umbrella of acute medicine may have a promising result. Methods: All the information was collected from the department of Acute Medicine of Square Hospitals Limited since it started its journey on the 15th October, 2022. Data of first 175 days (15th October, 2022 to 7th April, 2023) were compiled and the outcome was observed. Results: Among 615 patients of department of Acute Medicine, 50% were male and 50% were female. Among them 84% were managed within 72 hours; 92.4% improved and 7.2% needed treatment escalation. Among the patients who got improved, 76% were shifted to cabin and 13% were discharged home after management of acute condition. Conclusion: The observation revealed better patient outcome with less hospital stay. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 218
{"title":"Acute Medicine: A New Horizon","authors":"J. Ahmad, L. Nizhu, M. Haroon, Amani Anam","doi":"10.3329/bjm.v34i20.66177","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66177","url":null,"abstract":"Background: Acute medicine is concerned with the immediate and early management of adult patients suffering from a wide range of medical conditions requiring urgent care. It is a new concept in the context of our country. Given the current situation of the burden of patients against available resources, management of acute conditions under the umbrella of acute medicine may have a promising result.\u0000Methods: All the information was collected from the department of Acute Medicine of Square Hospitals Limited since it started its journey on the 15th October, 2022. Data of first 175 days (15th October, 2022 to 7th April, 2023) were compiled and the outcome was observed.\u0000Results: Among 615 patients of department of Acute Medicine, 50% were male and 50% were female. Among them 84% were managed within 72 hours; 92.4% improved and 7.2% needed treatment escalation. Among the patients who got improved, 76% were shifted to cabin and 13% were discharged home after management of acute condition.\u0000Conclusion: The observation revealed better patient outcome with less hospital stay.\u0000J Medicine 2023; Vol. 34, No. 2(1) Supplement: 218","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78553632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66183
M. Azam, Md Abu Sayeed Mustafa
Background: Acute-on-chronic liver failure (ACLF) is characterised by the presence of organ failure in patients with decompensated cirrhosis and is associated with high short-term mortality. Different international entities have taken initiatives to define the condition in different times but recommendations and definitions from The European Association for the Study of the Liver- Chronic Liver Failure (EASL-CLIF) Consortium Acute-on-Chronic Liver Failure in Cirrhosis (CANONIC) study are most comprehensive and widely accepted till date. Only limited data are available on the prevalence, clinical characteristics, and short-term outcomes of ACLF in Bangladesh. It would be very useful for clinicians to identify patients with ACLF early and initiate focused therapy including referral to transplant centers if these data are available. Objective: To evaluate frequency, clinical presentation, and outcome of acute-on-chronic liver failure among decompensated cirrhosis of liver patients. Methods: This prospective observational study was carried out at the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Shahbagh, Dhaka, Bangladesh from July, 2019 to September, 2021. Total 175 patients with decompensated cirrhosis of liver were screened, out of which 22 patients dropped out due to various reasons. Purposive type of non-probability sampling technique was used. Formal ethical clearance was taken from the IRB and ethical measures were ensured in concordance with the Declaration of Helsinki. An informed written consent was taken from all participants. Diagnosis of decompensated cirrhosis was based on clinical, biochemical, radiological and endoscopic findings. Laboratory data sent within 24 hours were collected. Oxygen saturation was measured using fingertip pulse oximeter. Investigations for ACLF triggers were done as necessary which included but not limited to urine routine and microscopic examination, urine culture, blood culture, and Anti HEV IgM. Patients’ prognosis and survivability were observed by follow up phone call at 30 days. All data were recorded in a separate case record form and finally, it was analyzed by SPSS 23. Results: Out of 153 patients, 49 patients (32%) had ACLF: grade 1 ACLF in 26 (17%), grade 2 in 18 (11.8%), and grade 3 in 5 (3.3%) patients. Patients had an average age of 59.54±11.55 years with no significant difference between ACLF and no ACLF groups. Most patients in both groups had others (NAFLD, autoimmune hepatitis, secondary biliary cirrhosis, none) as the main underlying cause of cirrhosis. Bacterial infection, GI bleeding, HEV infection, reactivation of HBV were the precipitating events in 81.6% of patients with ACLF, with bacterial infection being the most common trigger (63.3%). Overall, 44.9% ACLF patients died within 30 days of admission. Older age, male sex, hepatic encephalopathy, GI bleeding, presence of any trigger and higher CTP score were associated with increa
{"title":"Frequency, Clinical Presentation, and Outcome of Acute-on-chronic Liver Failure among Decompensated Cirrhosis of Liver Patients in a Tertiary Care Hospital","authors":"M. Azam, Md Abu Sayeed Mustafa","doi":"10.3329/bjm.v34i20.66183","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66183","url":null,"abstract":"Background: Acute-on-chronic liver failure (ACLF) is characterised by the presence of organ failure in patients with decompensated cirrhosis and is associated with high short-term mortality. Different international entities have taken initiatives to define the condition in different times but recommendations and definitions from The European Association for the Study of the Liver- Chronic Liver Failure (EASL-CLIF) Consortium Acute-on-Chronic Liver Failure in Cirrhosis (CANONIC) study are most comprehensive and widely accepted till date. Only limited data are available on the prevalence, clinical characteristics, and short-term outcomes of ACLF in Bangladesh. It would be very useful for clinicians to identify patients with ACLF early and initiate focused therapy including referral to transplant centers if these data are available.\u0000Objective: To evaluate frequency, clinical presentation, and outcome of acute-on-chronic liver failure among decompensated cirrhosis of liver patients.\u0000Methods: This prospective observational study was carried out at the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Shahbagh, Dhaka, Bangladesh from July, 2019 to September, 2021. Total 175 patients with decompensated cirrhosis of liver were screened, out of which 22 patients dropped out due to various reasons. Purposive type of non-probability sampling technique was used. Formal ethical clearance was taken from the IRB and ethical measures were ensured in concordance with the Declaration of Helsinki. An informed written consent was taken from all participants. Diagnosis of decompensated cirrhosis was based on clinical, biochemical, radiological and endoscopic findings. Laboratory data sent within 24 hours were collected. Oxygen saturation was measured using fingertip pulse oximeter. Investigations for ACLF triggers were done as necessary which included but not limited to urine routine and microscopic examination, urine culture, blood culture, and Anti HEV IgM. Patients’ prognosis and survivability were observed by follow up phone call at 30 days. All data were recorded in a separate case record form and finally, it was analyzed by SPSS 23.\u0000Results: Out of 153 patients, 49 patients (32%) had ACLF: grade 1 ACLF in 26 (17%), grade 2 in 18 (11.8%), and grade 3 in 5 (3.3%) patients. Patients had an average age of 59.54±11.55 years with no significant difference between ACLF and no ACLF groups. Most patients in both groups had others (NAFLD, autoimmune hepatitis, secondary biliary cirrhosis, none) as the main underlying cause of cirrhosis. Bacterial infection, GI bleeding, HEV infection, reactivation of HBV were the precipitating events in 81.6% of patients with ACLF, with bacterial infection being the most common trigger (63.3%). Overall, 44.9% ACLF patients died within 30 days of admission. Older age, male sex, hepatic encephalopathy, GI bleeding, presence of any trigger and higher CTP score were associated with increa","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79884793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66171
Bornali Chowdhury, Ahmed Mursel Anam, S. Huq, Adnan Shareef, Mymuna Binte Mukarrom
Background: Polymyxin B and colistin are most potent antibiotics for treating carbapenem resistant infections due tomultidrugs resistant organisms that are currently rising remarkably and alarm signs for global health. These are last resorts options for bacteremia during crisis time when pathogens are only sensitive to polymyxins. Most common life threatening complication is respiratory muscle paralysis due to neuromuscular blockage that lead to apnea, acute type 2 respiratory failure and death. Main aim of this quality Improvement project (QIP)was to demonstrate therapeutic effectiveness and outcomes of I/V calcium gluconate during administration of polymyxins. Methods: This QIP was conducted at acute medicine and HDU of a tertiary care hospital for 2 months in Bangladesh. Patients who got I/V calcium gluconate with polymyxins in January and February, 2023 were compared with similar data without calcium gluconate for prior 4 months. Data analysis and interpretation done by unpaired t test. Results: Primary outcome shows statistically significant decrease dintubation and mechanical ventilation due to sudden respiratory failure and ICU transfer after getting I/V calcium gluconate during polymyxins(30.8%,n=13 and 88.9% ,n=9 and p= <0.005). Conclusion: This study showsstrongly visible positive outcome in prevention of acute respiratory failure by polymyxins in critically ill patients. We feel that all physicians may practice this study in acute medicine and critical care setup. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 216
{"title":"Prevention of Acute Respiratory Failure Due to Administration of Polymyxins by Intravenous Calcium Gluconate in Critically Ill Patients for Treating Carbapenem Resistant Infections in Acute Medicine Unit: A Quality Improvement Project (Qip)","authors":"Bornali Chowdhury, Ahmed Mursel Anam, S. Huq, Adnan Shareef, Mymuna Binte Mukarrom","doi":"10.3329/bjm.v34i20.66171","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66171","url":null,"abstract":"Background: Polymyxin B and colistin are most potent antibiotics for treating carbapenem resistant infections due tomultidrugs resistant organisms that are currently rising remarkably and alarm signs for global health. These are last resorts options for bacteremia during crisis time when pathogens are only sensitive to polymyxins. Most common life threatening complication is respiratory muscle paralysis due to neuromuscular blockage that lead to apnea, acute type 2 respiratory failure and death. Main aim of this quality Improvement project (QIP)was to demonstrate therapeutic effectiveness and outcomes of I/V calcium gluconate during administration of polymyxins.\u0000Methods: This QIP was conducted at acute medicine and HDU of a tertiary care hospital for 2 months in Bangladesh. Patients who got I/V calcium gluconate with polymyxins in January and February, 2023 were compared with similar data without calcium gluconate for prior 4 months. Data analysis and interpretation done by unpaired t test.\u0000Results: Primary outcome shows statistically significant decrease dintubation and mechanical ventilation due to sudden respiratory failure and ICU transfer after getting I/V calcium gluconate during polymyxins(30.8%,n=13 and 88.9% ,n=9 and p= <0.005).\u0000Conclusion: This study showsstrongly visible positive outcome in prevention of acute respiratory failure by polymyxins in critically ill patients. We feel that all physicians may practice this study in acute medicine and critical care setup.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 216 ","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91036425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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