Risk Factors of Mortality in Severely-malnourished Children Hospitalized with Diarrhoea

This case-control study was conducted in the Dhaka Hospital of ICDDR,B to identify the risk factors of mortality in severely-malnourished children hospitalized with diarrhoea. One hundred and three severely-malnourished children (weight-for-age <60% of median of the National Center for Health Statistics standard) who died during hospitalization were compared with another 103 severely-malnourished children who survived. These children were aged less than three years and admitted to the hospital during 1997. On admission, characteristics of the fatal cases and non-fatal controls were comparable, except for age. The median age of the cases and controls were six and eight months respectively (p=0.05). Patients with low pulse rate or imperceptible pulse had three times the odds of death compared to the control group (p<0.01). The presence of clinical septicaemia and clinical severe anaemia had 11.7 and 4.2 times the odds of death respectively (p<0.01). Patients with leukocytosis (>15,000/cm3) had 2.5 times the odds of death (p<0.01). Using logistic regression, clinical septicaemia [adjusted odds ratio (AOR)=8.8, confidence interval (CI) 3.7-21.1, p=0.01], hypothermia (AOR=3.5, CI 1.3-9.4, p<0.01), and bronchopneumonia (AOR=3.0, CI 1.2-7.3, p<0.01) were identified as the significant risk factors of mortality. Severely-malnourished children (n=129) with leukocytosis, imperceptible pulse, pneumonia, septicaemia, and hypothermia had a high risk of mortality. The identified risk factors can be used as a prognostic guide for patients with diarrhoea and severe malnutrition

Spectrum of Hospital Acquired Acute Kidney Injury in Critically ill Children in a Tertiary Level Hospitall

Introduction: Although hospital acquired acute kidney injury (hAKI) is common and significantly increases the risk of hospital mortality, little is known about its frequency in developing countries where ICU facilities are limited. The purpose of this study was to investigate the frequency, cause, and outcome of hAKI in critically ill children in a tertiary level hospital.Materials and Methods: In this prospective cross-sectional study, a total 36 critically ill patients with hAKI were analyzed. hAKI was diagnosed according to the AKIN criteria. The clinical data of the patients admitted to the Pediatrics and Allied Departments in this hospital from November 2014 to October 2015 were collected.Results: A total of 3950 patients were admitted during the study period and 1103 (27.9%) were critically ill patients. Among the critically ill children, 36 (3.3%) were diagnosed with hAKI. Among different age groups, the highest incidence (5.05%) of hAKI was seen in children aged above 10 years. Sepsis was the major cause of hAKI accounting for 44.1% followed by antibiotics (27.1%), hypovolemia (13.6%), nephrotoxic agents (10.2%), and contrast agents (5.0%). Renal replacement therapy was required only in 8.3% of the cases.Conclusions: In comparison to other studies, this study showed a low incidence of hAKI where ICU facilities are limited. Among the hospital admitted critically ill patients, a significant number of patients may develop AKI mostly due to sepsis and use of antibiotics. Keywords: Hospital acquired AKI; Sepsis; Critically ill children; Incidenc

Risk Factors of Mortality in Severely-malnourished Children Hospitalized with Diarrhoea

This case-control study was conducted in the Dhaka Hospital of ICDDR,B to identify the risk factors of mortality in severely-malnourished children hospitalized with diarrhoea. One hundred and three severelymalnourished children (weight-for-age &lt;60% of median of the National Center for Health Statistics standard) who died during hospitalization were compared with another 103 severely-malnourished children who survived. These children were aged less than three years and admitted to the hospital during 1997. On admission, characteristics of the fatal cases and non-fatal controls were comparable, except for age. The median age of the cases and controls were six and eight months respectively (p=0.05). Patients with low pulse rate or imperceptible pulse had three times the odds of death compared to the control group (p&lt;0.01). The presence of clinical septicaemia and clinical severe anaemia had 11.7 and 4.2 times the odds of death respectively (p&lt;0.01). Patients with leukocytosis (&gt;15,000/cm3) had 2.5 times the odds of death (p&lt;0.01). Using logistic regression, clinical septicaemia [adjusted odds ratio (AOR)=8.8, confidence interval (CI) 3.7-21.1, p=0.01], hypothermia (AOR=3.5, CI 1.3-9.4, p&lt;0.01), and bronchopneumonia (AOR=3.0, CI 1.2-7.3, p&lt;0.01) were identified as the significant risk factors of mortality. Severely-malnourished children (n=129) with leukocytosis, imperceptible pulse, pneumonia, septicaemia, and hypothermia had a high risk of mortality. The identified risk factors can be used as a prognostic guide for patients with diarrhoea and severe malnutrition

Integrated Landscape Approach: Closing the Gap between Theory and Application

Recently, the integrated landscape approach has gained increasing interest of the scientific community, as well as of organizations active in the field of sustainable development. However, the enthusiastic welcome is challenged by little consensus on theory, terminology and definitions. Moreover, the operationalization of the approach into practice is a major challenge. In this paper, we present a framework to operationalize the integrated landscape approach in practice by putting a long-term collaboration between scientists and various stakeholder at center stage. Based on encompassing understanding of landscape-level processes and interactions, four pillars addressing different steps of a joint-learning circle are described and illustrated with examples. We consider the integrated landscape approach to be a prime way of targeting the Sustainable Development Goals (SDGs), but novel forms of collaboration between scientists and other stakeholders based on long-term commitments will be needed for operationalization in practice

Determining clinical biomarkers to predict long-term SARS-CoV-2 antibody response among COVID-19 patients in Bangladesh

BackgroundInformation on antibody responses following SARS-CoV-2 infection, including the magnitude and duration of responses, is limited. In this analysis, we aimed to identify clinical biomarkers that can predict long-term antibody responses following natural SARS-CoV-2 infection.MethodologyIn this prospective study, we enrolled 100 COVID-19 patients between November 2020 and February 2021 and followed them for 6 months. The association of clinical laboratory parameters on enrollment, including lactate dehydrogenase (LDH), neutrophil–lymphocyte ratio (NLR), C-reactive protein (CRP), ferritin, procalcitonin (PCT), and D-dimer, with predicting the geometric mean (GM) concentration of SARS-CoV-2 receptor-binding domain (RBD)-specific IgG antibody at 3 and 6 months post-infection was assessed in multivariable linear regression models.ResultThe mean ± SD age of patients in the cohort was 46.8 ± 14 years, and 58.8% were male. Data from 68 patients at 3 months follow-up and 55 patients at 6 months follow-up were analyzed. Over 90% of patients were seropositive against RBD-specific IgG till 6 months post-infection. At 3 months, for any 10% increase in absolute lymphocyte count and NLR, there was a 6.28% (95% CI: 9.68, −2.77) decrease and 4.93% (95% CI: 2.43, 7.50) increase, respectively, in GM of IgG concentration, while any 10% increase for LDH, CRP, ferritin, and procalcitonin was associated with a 10.63, 2.87, 2.54, and 3.11% increase in the GM of IgG concentration, respectively. Any 10% increase in LDH, CRP, and ferritin was similarly associated with an 11.28, 2.48, and 3.0% increase in GM of IgG concentration at 6 months post-infection.ConclusionSeveral clinical biomarkers in the acute phase of SARS-CoV-2 infection are associated with enhanced IgG antibody response detected after 6 months of disease onset. The measurement of SARS-CoV-2 specific antibody responses requires improved techniques and is not feasible in all settings. Baseline clinical biomarkers can be a useful alternative as they can predict antibody response during the convalescence period. Individuals with an increased level of NLR, CRP, LDH, ferritin, and procalcitonin may benefit from the boosting effect of vaccines. Further analyses will determine whether biochemical parameters can predict RBD-specific IgG antibody responses at later time points and the association of neutralizing antibody responses

AROMATASE INHIBITOR FOR OVULATION INDUCTION: A COMPARATIVE STUDY BETWEEN LETROZOLE AND CLOMIPHEN CITRATE IN ANOVULATORY INFERTILE WOMEN

The study was designed to compare the effectiveness of Letrozole and clomiphen citrate in the treatment of anovulatorv infertility. Thirty patients were selected randomly who had anovulatorv infertility. In letrozole group, fifteen patients got 5-7.5 mg of letrozole orally and in clomiphen citrate group, 100-150 mg of clomiphen citrate was given orally for maximum of six cycles and in both the groups the drugs were started from day 3-7 of the menstrual cycle. There were no significant differences between the age, duration and type of fertility. But statistically significant increase of follicular development in letrozole group (ñ=0.020). Mean endometrial thickness was 8.33±1.54 and 5.36±1.84 respectively in letrozole and in clomiphen citrate group (ñ =0.048). There was no significant difference in ovulation in both the groups but pregnancy was more (33.3%) with the letrozole group. Letrozole is an effective agent for ovulation induction. It can be used as an alternative to CC as a first-line of treatment for ovulation induction. (Bangladesh J Physiol Pharmacol 2009; 25(1&amp;2) : 10-12

Implementation of a context-specific accreditation assessment tool for affirming quality midwifery education in Bangladesh : a qualitative research study

Background: Only recently did midwifery become a profession in Bangladesh. As such, sufficient quality education, both theory and practice, remains a challenge. In 2018, a context-specific accreditation assessment tool for affirming quality midwifery education was therefore developed and implemented. Objectives: To describe both the positive and negative aspects of the implementation of an accreditation process at midwifery education institutions in Bangladesh and to sketch out areas for possible improvement. Method: Forty focus group discussions were conducted with 276 policymakers, regulatory authorities and educators involved in midwifery education and services in Bangladesh. The Consolidated Framework for Implementation Research (CFIR) was used in a directed content analysis approach. Results: The accreditation assessment tool was developed using a participatory and consensus-building approach, building on existing policies, which resulted in the national ownership of its implementation. Staff from clinical sites were not included in the accreditation process; unless this changes, this will make it difficult for Bangladesh to achieve the set accreditation standards. The accreditation process has improved communication between the midwifery teaching institutions, policymakers and regulatory authorities. Educators started to visit the clinical sites more frequently. The planning process was complex and time-consuming, and emphasis was put on the importance of developing a plan of action for measuring improvements. Conclusion: In the move from the initial assessment of an accreditation process to its implementation, it is essential to make public the results found at all educational institutions. This encourages acceptance, while soliciting feedback and suggestions for future action. Only then can an accreditation process have an impact on the provision of high-quality midwifery education and services. This paper aims to encourage and guide other countries in their development, planning and implementation of a national accreditation process for midwifery education

Effects of acne severity and acne-related quality of life on depressive symptoms among adolescents and young adults: A cross-sectional study in Bangladesh

Introduction: Depression is a common mental health disorder and one of the major causes of disability. This study aimed at investigating the relationship of acne severity and acne-related quality of life with depressive symptoms, and the mediating effect of acne-related quality of life in a relationship between acne severity and depressive symptoms. Methods: This is a cross-sectional study. Data were collected from acne patients attending a tertiary-level hospital, using a questionnaire that comprised three validated instruments – Investigator’s Global Assessment (a single item) scale, Cardiff Acne Disability Index, and Beck Depression Inventory for measuring acne severity, acne-related quality of life, and depressive symptoms, respectively. Logistic regression and linear regression were used to examine the association between acne severity and depressive symptoms and a correlation between the acne-related quality of life and depressive symptoms, respectively. A mediation analysis was also performed to see the mediation effects of acne-related quality of life in a relationship between acne severity and depressive symptoms. Results: A total of 185 acne patients (155 females, 83.8%) with a mean age was 22.55 ±8.67 years were included in the study. Adolescents and young adults with severe and moderate acne had 6.14- and 2.28 times higher odds of depression compared to their peers with mild acne, respectively. Patients with low levels of acne-related quality of life had a higher level of depressive symptoms (β= 0.42, p &lt; 0.001). The total effect (direct + indirect) was also significant (β= 0.27, 95% CI: 1.29–4.09), implying the effect of acne severity on depression. Conclusion: The present study suggests that acne severity and acne-related quality of life were associated with depressive symptoms among patients with acne vulgaris. The study also indicates that the relationship between acne severity and depressive symptoms might occur through a chain-mediating effect of acne disability in this population

Rice farmers’ technical efficiency under abiotic stresses in Bangladesh

This study was an attempt to investigate the economic performance of stress tolerant rice varieties in different abiotic stress prone areas (submergence, drought, and salinity) of Bangladesh. The study used production frontier approach to measure the technical efficiency at the farm level. Benefit-cost analysis revealed that farmers in all stress environments obtained positive margin on cash cost basis and the profit became negative on full cost basis in all environments with exception for submergence. That means rice production was marginally benefited to farmers in all the stress environments. Farm specific technical efficiency of all stress environments indicated that large farmers were comparatively more efficient due to their economic solvency as they could apply adequate amount of inputs in due time with proper doses. Inefficiency model indicated that farm size, farmers ‘education, households’ size, farming experience, extension contact, and main occupation of the farmers, were the important factors causing variations in the efficiency. However, BRRI released stress tolerant rice varieties had significant positive impact on technical efficiency. Plausible policies have been recommended according to the study outcomes