A RIPPLE EFFECT OF COVID-19 PANDEMIC ON SHORTAGE OF MEDICINAL PRODUCTS AND ITS IMPACT ON PATIENT CARE

Objective: Shortages of medicinal products are complex global problems. Drug shortages remain a significant public health issue. Global shortages of medical products have a potential effect on patient health and total healthcare costs. Countries worldwide, especially those affected by Coronavirus disease 2019 (COVID-19), is experiencing a rapid increase in drug shortage, which causes several complications for physicians, health care provider, patients, health institutes and health regulatory bodies. Methods: To carry out the study of shortages, several efforts have been taken by the regulators and industries. Prominent amongst these include FDA's research the needs and the reforms made in the regulations about shortages. We also searched for electronic databases (PubMed, Science direct, Web of Science) using the terms (COVID-19 and shortage) or (medicine and COVID-19) for articles in periods of 2019 to 2021. Results: On assessment based on the report, the number of shortage drugs in 2020 is 835; Anesthesia drugs are highest during the COVID-19 outbreak data indicate the number of shortages is 143 in USA. It was found that generic products were mostly in short supply, with antimicrobial agents (63%) topping the list of therapeutic categories of medicines with interrupted supply, followed by oncology medicines (47%) and then anesthetic agents (38%) during COVID-19 pandemic. Conclusion: Many steps have been taken to reduce the impact of a shortage of health care. Agencies like the United States Food and Drug Administration (US FDA) and European Medicines Agency (EMA) has established guidelines and works with manufacturers and other partners to help prevent shortages. This article aims to the analysis the root cause of medicinal product shortages, their effects on the patient outcome, medication error, which occurs due to the substitution safe and effective therapies with alternative treatments, identify possible solutions and policies established to manage medicinal product shortages

Evaluation of MRSA chrome agar for the detection of methicillin resistant staphylococcus aureus

The aim of this study was to evaluate the efficacy of MRSA Chrome agar to detect methicillin resistant Staphylococcus aureus (MRSA) and compare it with 1µg oxacillin disc diffusion tests and detection of mecA gene by PCR. A total 116 Staphylococcus aureus (S. aureus), isolated from various clinical samples, were obtained from three tertiary care hospitals of Dhaka city. S. aureus was identified by colony characters, Gram stain and standard biochemical procedures. MRSA was detected by susceptibility to 1µg oxacillin disc, growth of denim blue color colonies of S. aureus on the Brilliance MRSA Chrome agar at 24 and 48 hours of incubation. PCR was performed for amplification of mecA gene as a gold standard method. Out of 116 isolated S. aureus, 33 (28.44%) were MRSA by oxacillin disc diffusion test where mecA gene was detected in 28 strains. On MRSA Chrome agar, 29 (25.0%) S. aureus produced denim blue colonies at 24 hours, of which 28 isolates possessed mecA gene. At 48 hours incubation, an additional 4 isolates yielded denim blue colonies from which mecA gene could not be identified. All the strains of S. aureus that produced denim blue colonies at 24 and 48 hours were resistant to oxacillin. The sensitivity, specificity and accuracy of oxacillin disc diffusion test were 100%, 94.31% and 95.68% and Chrome agar at 24 hours were 100%, 98.86% and 99.13% respectively. Thus MRSA Chrome agar could be good choice in clinical microbiology laboratory for rapid and accurate identification of MRSA. Ibrahim Med. Coll. J. 2013; 7(1): 1-

Application of gamma radiation and physicochemical treatment to improve the bioactive properties of chitosan extracted from shrimp shell

The aim of this study is to exploit a suitable chitosan extraction method from the chitin of indigenous shrimp shells by employing different physicochemical treatments and to improve different bioactive properties of this extracted chitosan (CS) by applying gamma radiation. Chitin was prepared from shrimp shell by pretreatment (deproteination, demineralization and oxidation). Chitosan was extracted from chitin by eight different methods varying different physicochemical parameters (reagent concentration, temperature and time) and assessed with respect to the degree of deacetylation, requirement of time and reagents. The method where chitin was repeatedly treated with 121°C for 30 min with 20 M NaOH, produced the highest degree of deacetylation (DD) value (92%) as measured by potentiometric titration, with the least consumption of time and chemicals, and thus, selected as the best suitable extraction method. For further quality improvement, chitosan with highest DD value was irradiated with different doses (i.e., 5, 10, 15, 20 and 50 kGy) of gamma radiation from cobalt-60 gamma irradiator. As the radiation dose was increased, the molecular weight of the wet irradiated chitosan, as measured by the viscosimetric method, decreased from 1.16 × 105 to 1.786 × 103, 1.518 × 103, 1.134 × 103, 1.046 × 103 and 8.23 × 102 dalton, respectively. The radiation treatment of chitosan samples increased the antimicrobial activity significantly in concentration dependent manner on both gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli) bacteria, as determined by the well-diffusion method. Four to five percent wet chitosan treated with a radiation dose range of 5.0–10.0 kGy rendered the highest antimicrobial activity with least energy and time consumption. Solubility, water binding capacity (WBC) and fat binding capacity (FBC) also improved due to irradiation of chitosan

Prevalence of Dermatophytic Infection and Detection of Dermatophytes by Microscopic and Culture Methods

Background: Dermatophytosis is considered as one of the major public health problems in the world and is the most commonly diagnosed skin disease in Bangladesh. The prevalence and characteristics of dermatophytic infections vary with climatic conditions, age, lifestyle and population migration patterns. Objective: To determine the prevalence of dermatophytic infection and sensitivity of different diagnostic procedures among the patients visiting dermatology outpatient department of Tairunnessa Memorial Medical College & Hospital, Gazipur, Bangladesh (TMMCH). Materials and Methods: This cross-sectional study was done during a period of 12 months from July 2015 to June 2016. Total 80 specimens were collected based on clinical presentations irrespective of age and sex. The diagnosis was confirmed by microscopic examination using 20% potassium hydroxide (KOH) and culture on Sabouraud’s dextrose agor medium. Results: Out of 80 samples, 31(38.75%) were found positive by culture and 21 (26.25%) were found positive by microscopic method which were also found positive by culture. This study found that most (51.62%) of the dermatophyteinfected cases were in the age group of 21−40 years followed by 41−60 years (29.03%) with male and female distribution 58.06% and 41.94% respectively The maximum number of infections was reported from groin followed by hands/legs and feet. Conclusion: The result of this study shows higher prevalence of dermatophytosis in both genders in this area. An accurate diagnosis can help in proper and effective treatment of dermatophytosis

Clinical Profile and Outcome of COVID -19 in Children with Pre-Existing Renal Disease

Background and Aim: Despite several studies about COVID-19, many factors remain unknown. Apart from pulmonary involvement, the other systemic association needs to be explored. Since information is lacking this study was conducted to see the impact of COVID-19 infection in children with kidney diseases. Methods: This retrospective study was carried out at Dhaka Shishu Hospital and Square Hospitals Ltd. All children below 18 years who had renal diseases and tested RT PCR positive for the SARS-COV-2 virus were included in the study.  Data regarding patient’s demography, clinical presentation, hospital course, and outcome were collected from the hospital database and were analyzed. Results: Among the COVID-19 positive pediatric patients, the proportion of patient with a history of kidney disease were 12%. The commonest age group belongs to 6 -10 years with a female predominance. Nephrotic syndrome (50%) was the commonest primary renal etiology followed by acute kidney injury (26%). Along with COVID-19 related symptoms like fever (38%) and respiratory tract infection (31%), a good number of them remain asymptomatic (27%) during diagnosis. Hypertension (50%) and hematuria (35%) were the two prevailing clinical findings. Moreover, anemia (65%), and elevated creatinine (50%) were found surprisingly higher irrespective of the primary etiology. A better outcome was observed in children under 5 years. Conclusion: Covid -19 is frequent in patients with a history of kidney diseases and it may present with an atypical presentation like hypertension and or hematuria. Hence, clinicians should increase their awareness and concern to deal with COVID-19 infection among renal patients

Description of patients who died within 30 days of surgery.

Description of patients who died within 30 days of surgery.</p

Surgical procedures categorized by CPT coding.

BackgroundThe COVID-19 pandemic has significantly impacted the surgical practice throughout the world, including elective surgical care. This study investigated the characteristics of patients undergoing elective surgery, the prevalence of COVID-19 infection, the surgical procedures performed, and 30-day mortality in general and pediatric surgical settings in selected tertiary-level hospitals in Bangladesh from November 2020 to August 2021.MethodsThis serial cross-sectional study included 264 patients scheduled for elective surgeries during the study period. All patients underwent COVID-19 real-time polymerase chain reaction (RT-PCR) testing within 24 hours before surgery. Data on age, sex, common comorbidities, surgical procedures, and 30-day mortality were collected and analyzed. Furthermore, comparisons were made between COVID-19 positive and negative patients.ResultsThe prevalence of COVID-19 infection among patients was 10.6%. Older age, a history of major surgery within the last three months, hypertension, and diabetes mellitus were significantly associated with COVID-19 infection. All COVID-19-negative patients underwent surgery, while only 46.4% of COVID-19-positive patients underwent surgery. The most common surgical procedures were related to the digestive system, breast, and urinary system. Only one patient (0.4%) died within 30 days after surgery among the COVID-19-negative patients, whereas two patients (7.1%) died among the COVID-19-positive patients: one before surgery and one after surgery.ConclusionsThis study provides valuable insights into the characteristics, burden of COVID-19 infection, and 30-day mortality of patients undergoing elective surgery in tertiary care centers in Bangladesh during the pandemic.</div

Quality of life of COVID-19 recovered patients: a 1-year follow-up study from Bangladesh

Abstract Background The COVID-19 pandemic posed a danger to global public health because of the unprecedented physical, mental, social, and environmental impact affecting quality of life (QoL). The study aimed to find the changes in QoL among COVID-19 recovered individuals and explore the determinants of change more than 1 year after recovery in low-resource settings. Methods COVID-19 patients from all eight divisions of Bangladesh who were confirmed positive by reverse transcription-polymerase chain reaction from June 2020 to November 2020 and who subsequently recovered were followed up twice, once immediately after recovery and again 1 year after the first follow-up. The follow-up study was conducted from November 2021 to January 2022 among 2438 individuals using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF). After excluding 48 deaths, 95 were rejected to participate, 618 were inaccessible, and there were 45 cases of incomplete data. Descriptive statistics, paired-sample analyses, generalized estimating equation (GEE) analysis, and multivariable logistic regression analyses were performed to test the mean difference in participants’ QoL scores between the two interviews. Results Most participants (n = 1710, 70.1%) were male, and one-fourth (24.4%) were older than 46. The average physical domain score decreased significantly from baseline to follow-up, and the average scores in psychological, social, and environmental domains increased significantly at follow-up (P < 0.05). By the GEE equation approach, after adjusting for other factors, we found that older age groups (P < 0.001), being female (P < 0.001), having hospital admission during COVID-19 illness (P < 0.001), and having three or more chronic diseases (P < 0.001), were significantly associated with lower physical and psychological QoL scores. Higher age and female sex [adjusted odd ratio (aOR) = 1.3, 95% confidence interval (CI) 1.0–1.6] were associated with reduced social domain scores on multivariable logistic regression analysis. Urban or semi-urban people were 49% less likely (aOR = 0.5, 95% CI 0.4–0.7) and 32% less likely (aOR = 0.7, 95% CI 0.5–0.9) to have a reduced QoL score in the psychological domain and the social domain respectively, than rural people. Higher-income people were more likely to experience a decrease in QoL scores in physical, psychological, social, and environmental domains. Married people were 1.8 times more likely (aOR = 1.8, 95% CI 1.3–2.4) to have a decreased social QoL score. In the second interview, people admitted to hospitals during their COVID-19 infection showed a 1.3 times higher chance (aOR = 1.3, 95% CI 1.1–1.6) of a decreased environmental QoL score. Almost 13% of participants developed one or more chronic diseases between the first and second interviews. Moreover, 7.9% suffered from reinfection by COVID-19 during this 1-year time. Conclusions The present study found that the QoL of COVID-19 recovered people improved 1 year after recovery, particularly in psychological, social, and environmental domains. However, age, sex, the severity of COVID-19, smoking habits, and comorbidities were significantly negatively associated with QoL. Events of reinfection and the emergence of chronic disease were independent determinants of the decline in QoL scores in psychological, social, and physical domains, respectively. Strong policies to prevent and minimize smoking must be implemented in Bangladesh, and we must monitor and manage chronic diseases in people who have recovered from COVID-19. Graphical Abstrac