and Lung Infections in Bangladeshi Patients

Abstract Nocardiosis is an acute or chronic infectious disease that may occur in cutaneous, pulmonary and disseminated form in both immunocompromised and immunocompetent host. It may become potentially severe due to delayed diagnosis and incomplete or ineffective treatment. So the aim of the study was to isolate Nocardia spp. from suspected samples, mainly from chronic unhealed wounds and to identify appropriate antimicrobials by susceptibility testing in Bangladeshi patients. Methods: From January 2015-2017, 62 samples were collected which were studied for Nocardial identification and susceptibility testing. Results: Out of total 62 cases, 18 (29.03%) cases were Nocardia positive cases. Besides 6 Acinetobacter spp. and 2 Actinomyces spp. with other varied pathogens were isolated. Among 18 identified nocardiosis patients, majority (10) were post surgery cases, 6 suspected skin and glandular tuberculosis (TB) cases, one had breast sinus, and one was suspected pulmonary TB case. In terms of susceptibility of nocardial isolates, 100% were susceptible to linezolid, 88.9% to amikacin and 78% to trimethoprimsulphamethoxazole

A pilot study regarding the consequence of the COVID-19 pandemic on healthcare education in India and the implications

Introduction: The early approaches to prevent the spread of COVID-19 included lockdown and social distancing measures leading to university closures. These measures forced unparalleled changes to the delivery of healthcare education. Concerns included the preparedness of faculty and students to e-learning as well as the routine availability and funding of equipment and internet bundles. This needed addressing with fully trained healthcare professionals required given rising inappropriate use of antibiotics in India, growing prevalence of non-communicable diseases as well as patients with joint co-morbidities. Consequently, a need to ascertain the current impact of the pandemic on healthcare student education across India. Materials and Methods: Pilot study among ten purposely selected healthcare educators in both private and public universities. The questionnaire built on published studies. Results: Identified challenges included a lack of familiarity with online education, no bedside teaching, lack of equipment and affordability of internet bundles, poor internet connectivity and postponed examinations. Ways forward included faculty training on e-learning, providing students with loans and other financial support to purchase equipment and internet bundles, establishing COVID-19 prevention protocols and protective equipment, recording lectures and tutorials to make up for lost time, and simulated methods to teach clinical aspects. Conclusion: Despite the challenges, there was a rapid move to online learning among surveyed universities. Alongside this, courses to address lack of familiarity with e-Learning approaches with hybrid teaching approaches here to stay. The next step will be to undertake a wider study and use the combined findings to provide future guidance

Pilot study on the current management of children with COVID-19 in hospitals in Bangladesh; findings and implications

Objective: The focus on COVID-19 in children in low- and middle-income countries including Bangladesh has been on addressing key issues including poor vaccination rates as well as mental health issues, domestic violence and child labour. However, the focus on optimally managing children in hospitals is changing with new variants and concerns with the development of hyperinflammatory syndromes. There are also concerns with the overuse of antimicrobials to treat patients with COVID-19 in hospitals enhancing resistance rates. The Bangladesh Paediatric Association have developed guidelines to improve patient care building on national guidance. Consequently, there is a need to document the current management of children with COVID-19 in Bangladesh and use the findings for future guidance. Methods: Rapid analysis of the management of children with COVID-19 among eight private and public hospitals in Bangladesh with varying numbers of in-patient beds using purposely developed case report forms (CRFs). The CRFs were piloted before full roll-out. Results: Overall low numbers of children in hospital with COVID-19 (4.3% of in-patient beds). The majority were male (59.6%) and aged 5 years or under (63.5%). Reasons for admission included respiratory distress/ breathing difficulties with 94.2% of COVID-19 cases confirmed. All children were prescribed antibiotics empirically, typically those on the Watch list of antibiotics and administered parenterally, with only a small minority switched to oral therapy before discharge. There was appreciable prescribing of Vitamins (C and D) and zinc and encouragingly limited prescribing of other antimicrobials (antivirals, antimalarials and antiparasitic medicines). Length of stay was typically 5 to 10 days. Conclusion: Encouraging to see low hospitalisation rates and limited use of antimicrobials apart from antibiotics. Concerns with high empiric use of antibiotics and limited switching to oral formulations can be addressed by instigating antimicrobial stewardship programmes. We will be monitoring this

Pulmonary Tuberculosis and Drug Resistance in Dhaka Central Jail, the Largest Prison in Bangladesh

There are limited data on TB among prison inmates in Bangladesh. The aim of the study was to determine the prevalence of pulmonary tuberculosis (TB), its drug resistance and risk factors in Dhaka Central Jail, the largest prison in Bangladesh.Cross sectional survey with, active screening of a total number of 11,001 inmates over a period of 2 years. Sputum samples from TB suspects were taken for acid- fast bacilli (AFB) microscopy, culture and drug susceptibility testing. (5.37, 4.02–7.16).The study results revealed a very high prevalence of TB in the prison population in Dhaka Central Jail. Entry examinations and active symptom screening among inmates are important to control TB transmission inside the prison. Identifying undiagnosed smear-negative TB cases remains a challenge to combat this deadly disease in this difficult setting

The impact of the COVID-19 pandemic on the education of medical, dental and non-medical healthcare professionals in Bangladesh : findings and connotation

Lockdown measures in response to the COVID-19 pandemic had an appreciable impact on the education of all medical, dental, and non-medical healthcare professional (HCP) students. These included the closure of universities necessitating a rapid move to e-learning and new approaches to practical’s. However initially, there was a lack of knowledge and expertise regarding e-learning approaches and the affordability of internet bundles and equipment. We initially con-ducted two pilot studies to assess such current challenges, replaced by a two-stage approach including a full investigation involving 32 private and public universities during the early stages of the pandemic followed by a later study assessing the current environment brought about by the forced changes. Top challenges at the start of the pandemic included a lack of familiarity with e-learning approaches, cost of the internet, lack of IT equipment and the quality of the classes. Universities offered support to staff and students to a varying degree to address identified challenges. Since then, e-learning approaches have widened the possibilities for teaching and learning at convenient times. However, challenges remain. In conclusion, there were considerable challenges at the start of them pandemic. Several key issues have been addressed with hybrid learning here to stay. Remaining challenges include a lack of ICT equipment. However, new innovations will continue

Impact of the COVID-19 pandemic on dental and medical education in Bangladesh : a pilot study and the implications

Objective: Lockdown and other measures, including the closure of universities, introduced by Governments across countries in response to the COVID-19 pandemic have appreciably impacted on the education of dental and medical students across countries. Key challenges included the need to rapidly move to e-learning as well as instigate new approaches to practicals for health science students. This involves lecturers and students necessarily needing to rapidly adapt to e-learning and other approaches. There have also been affordability issues among students to regularly access the Internet, and purchase the necessary equipment, particularly among those from low- and middle-income countries such as Bangladesh. Consequently, there is an urgent need to assess current challenges among senior level physicians and educators in Bangladesh regarding the education of dental and medical students arising from the current pandemic, and how these are being addressed, to provide future direction. This is particularly important in Bangladesh with high rates of both infectious and non-infectious diseases. Materials and Methods: Pragmatic investigation involving a purposely developed questionnaire based on previous studies and the experience of the co-authors. The questionnaire was distributed to 15 senior-level educators with the findings analysed by themes. Results: Key issues included little experience with e-learning at the start of the pandemic among both staff and students, poor internet access and cost of internet bundles. In addition, fear and anxieties among both students and staff. The colleges responded by instigating teaching classes for educators on e-learning and providing adequate personal protective equipment for staff and students during teaching and practical sessions. These formed the basis of future recommendations. Other recommendations included increased flexibility among staff and students. Conclusion: The pandemic posed appreciable challenges to both staff and students attending dental and medical colleges in Bangladesh. Some of the key issues are starting to be addressed

The impact of COVID-19 on the teaching of non-medical healthcare professionals in Bangladesh : observations and implications from a pilot study

Objective: At the start of the Covid-19 pandemic, educational establishments, including universities, were closed. Educators in high-income countries quickly shifted all education online, building on available infrastructures and approaches. However, there were concerns in developing countries regarding the necessary skills among students and faculty and financial support for equipment and the internet. Consequently, a pilot was undertaken in Bangladesh to determine the impact of Covid-19 on the non-medical education system, building on similar research with healthcare professionals. Materials and Methods: A purposively designed questionnaire was disseminated among eight non-medical healthcare educators in private and public universities. Results and Discussion: Private university educators reported their universities readily adopted e-learning systems and resumed classes more quickly than public universities. Both private and public university educators shared similar challenges, including a lack of training on e-learning initially, variable internet connections, affordability of internet bundles, concerns with available devices, and mental stress of faculty and students. Private universities reduced their tuition fees, extended submission deadlines, and shared class recordings to address challenges. Public universities arranged student loans, established Covid-19 testing centers, and trained students in biosafety practices and molecular tests to volunteer in testing facilities. Conclusion: Lessons learned from the pandemic emphasize introducing hybrid education systems with full technological and financial support, alongside biosafety education in the curriculum

Socio demographic characteristics of TB and non-TB cases and odds ratios (95% CI) for risk factors for tuberculosis.

<p>OR = odds ratio; AOR = adjusted odds ratio; CI = confidence interval.</p