Pattern of anti-diabetic drugs prescribed in a tertiary care hospital of Bangladesh

Background: Globally, diabetes mellitus is a common endocrine disorder. This study was conducted for collecting the demographic details of diabetic patients and determining the pattern of drugs prescribed among them in outpatient department of a tertiary healthcare center.Methods: A descriptive type of cross-sectional study was carried out at the outpatient department of Endocrinology, Dhaka Medical College Hospital, Bangladesh from 1 May to 31 July, 2015. Diabetic patients receiving the management for at least 6 months were enrolled and interviewed by the researchers after getting informed written consent. Structured case record form was used for demographic data & prescription details. Data were analysed using computer in SPSS 22 and Microsoft Excel 2010.Results: Altogether 105 patients, 40 males (38.1%) and 65 females (61.9%) were enrolled with urban predominance (69.5%) where 51 (48.6%) were in the age group 47-61 years with a mean of 53.4 (SD±10.6) years. 70 (66.7%) had diabetic history of less than 5 years and 66 (62.9%) had at least one concurrent illness. Hypertension accounted for majority (34.3%) of complications. On an average, 5.62 (SD±3.16) drugs were advised per prescription for diabetes as well as associated co-morbidities and majority (23.8%) had 4 drugs. The majority of drugs (74.3%) were from local manufacturers. Most patients (62.9%) were prescribed with oral drugs singly. Metformin alone predominated in 41% prescriptions followed by the combination of Metformin and Sitagliptin (31.4%).Conclusions: The findings can serve as a guide to choose the formulation and combination of anti-diabetic drugs in this part of the world before developing & marketing any new drug

Effect of estradiol valerate on endometrial thickness in polycystic ovary syndrome having ovulation induction with letrozole

Background: PCOS is a common endocrine disorder in women of reproductive age. Letrozole is an orally active aromatase inhibitor and as effective as chlomiphene citrate for induction of ovulation. Estrogen is important in the regeneration and growth of the endometrium prior to ovulation prepare the tissue to respond to progesterone post ovulation in PCOS patients. Aim of the study was to assess the effects of estradiol valerate on endometrial thickness in PCOS having ovulation induction with letrozole. Methods: This randomized controlled study was conducted in the department of reproductive endocrinology and infertility, BSMMU, Dhaka, with 1 year duration. A total 80 diagnosed cases of PCOS patients with subfertility were included in this study. Among them 40 patients received letrozole and estradiol valerate and 40 patients received letrozole and placebo. Results: On day 8, mean endometrial thickness was not statistically significant between two groups (p=0.436). On day of triggering, mean endometrial thickness was significantly higher in intervention group 9.2±1.4 mm than control group 8.2±1.4 mm (p=0.004). Mean changes of endometrial thickness on day of triggering compared with on day 8 was significantly higher in intervention group 3.2±1.5 mm than control group 2.5±1.6 mm (p=0.043). Pregnancy rate was higher in intervention group 13 (38.2%) than control group 8 (22.2%) with relative risk 1.72, 95% CI (0.82-3.63%), that was not statistically significant between two groups (p=0.144). Conclusions: Mean changes of endometrial thickness on day of triggering were significantly higher in intervention group than control group. The pregnancy rate achieved with letrozole+estradiol valerate combination was higher than that achieved with letrozole and placebo group

Association of Socio-demographic Attributes with Mothers Knowledge regarding Childhood Diarrhea

Background: Childhood diarrheal diseases have a major impact on morbidity and mortality and these deaths are due to dehydration and mismanagement or delayed management of the disease. The mothers’ knowledge in management of diarrhea is likely related to its mortality and morbidity. The study aimed to determine the association between socio demographic attributes and mother’s knowledge on childhood diarrhea. Materials and Methods:In this cross sectional analytic study, 170 mothers who had at least one child aged below five years old were selected purposively from the out-patient department of ICDDR,B, Dhaka. Data were collected using a structured questionnaire by face to face interview. The level of knowledge was categorized as poor, average and good. Univariate and bivariate analysis were done with level of significance P<0.05. Results:The mean age of the respondents was 27 (SD=±5.6) years. Among them 46.5% were educated up to primary level and 47% had average monthly income between 5001 and 10000 taka. In the case of accessibility to mass media, 20% were found who never watch TV, 75.9% participants were found who never listen to radio, and 87.6% were found who never read newspaper. Despite the level of average knowledge was 59.5% but the proportion of the level of good knowledge was 17% among the respondents. Socio-demographic characteristics such as age, education and income (p<0.001) were significantly associated with mothers knowledge. Conclusion:The mothers had inadequate knowledge about diarrhea and their socio-demographic parameters are strongly associated with mother’s knowledge regarding diarrhea

Performance Evaluation of Cognitive Radio Network Based on 2-D Markov Chain, Journal of Telecommunications and Information Technology, 2015, nr 3

The objective of cognitive radio network is to enhance the wireless network spectrum utilization. In such a network, two types of users are enlisted, namely primary user (PU) and secondary user (SU). The PU can access any channel in case of its availability, but SU users have lower priority and can access a channel only when it is unused by PUs. The performance of such a network solely depends on two traffic parameters: probability of false alarm and probability of misdetection. In this paper the performance of such a network is analyzed based on two dimensional Markov chain including those parameters. The main contribution of this paper is to evaluate blocking probability and PU and SU throughput using the state transition chain instead of existing statistical analysis

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Prevalence of Substance Abuse among Female Residential Students of Dhaka University

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Sustainable Empowerment Initiatives among Rural Women through Microcredit Borrowings in Bangladesh

Microcredit is an effective instrument that has been recognized to alleviate poverty, especially in developing countries such as Bangladesh. This study seeks to use microcredit as an instrument to bridge the gap between the accessibility of microcredit among poor rural women and sustainable socio-economic development, providing novelty to the concept of “sustainability of empowerment”. In addition, this study employed poor rural women to estimate the empowerment performance of microcredit borrowers compared to non-borrowers in the same socio-economic environment as it relates to microcredit in rural Bangladesh. A regression analysis was used to accomplish these objectives. This study also used propensity score matching techniques to find an easy way to access microcredit. The empirical results not only involve participation in microcredit accessibility but also the particular qualitative attributes of women empowerment. The results also suggest that sustainability is accompanied by affluence among microcredit borrowers, as indicated by women empowerment. The outcome of the empirical analysis shows that there is a significant impact of microcredit on increasing participation in the overall decision-making process, in legal awareness, independent movements, and mobility, as well as enhancing living standards to encourage sustainable women empowerment. This study recommends future investigations for microcredit providers to explore how to build an integrated, holistic approach to women empowerment in Bangladesh

Status of implementation of short answer question in anatomy examination of MBBS course in Bangladesh

Background and objective: Short answer question (SAQ) format has been introduced as a major component of summative professional examinations of MBBS (Bachelor of Medicine and Surgery) course in Bangladesh over a decade. No systematic evaluation has yet been conducted on implementation of SAQ as directed in curriculum to assess the medical students in the summative examination of MBBS course. The present study assessed the weightage given to the different components of cognitive domain in SAQs in anatomy in first Professional MBBS Examination under the University of Dhaka. Materials and method: This cross-sectional study was conducted in the Department of Anatomy, Ibrahim Medical College. Anatomy SAQ papers, Paper I and Paper II, from January 2009 to July 2014 of University of Dhaka were selected. A total of 24 SAQ papers containing 572 questions were included in this study. Every question in a paper was categorized as recall, understanding application types. Then the total number of marks allocated for each of the type of questions were calculated and compared with the total marks (98) allocated for the questions in a paper. Then the resultant weightage of marks were compared with the curricular directive weightage of marks allotted for SAQ. Result: On analysis it was found that during the period from 2009 to 2014 76.58% and 23.42% SAQ were recall and understanding types respectively. No question was found to assess the application component of the cognitive domain of the students. Conclusion: The study revealed that SAQ introduced as an assessment tool in undergraduate medical curriculum was not properly implemented and its desired objectives were not fully achieved. IMC J Med Sci 2018; 12(2): 69-72. EPub date: 19 August 2018 Address for Correspondence: Dr. Jesmin Akhter, Associate Professor, Department of Anatomy, Ibrahim Medical College, 1/A, Ibrahim Sarani, Segunbagicha, Dhaka, Bangladesh. E mail: [email protected]

Case Report HAEMORRHAGIC CORPUS LUTEUM MIMIC APPENDICITIS

Haemoperitoneum secondary to ruptured corpus luteum is a rare complication for women of reproductive life. The differential diagnosis of hemoperitoneum includes various types of acute abdomen that usually associated with acute lower abdominal pain and swelling lower abdomen. The differential diagnosis includes ruptured ectopic pregnancy, ruptured chocolate cyst, twisted ovarian tumor, pelvic inflammatory disease and pelvic peritonitis. Ruptured hemorrhagic corpus luteum is an uncommon cause of acute abdomem. Its occurrence is unknown but is likely quite frequent and without symptoms. Most cases are self limiting; enquire only observation with abdominal pain relieved with analgesics. Some need laparoscopy or laparotomy to achieve homeostasis if the patient is haemodynamically unstable