Gross Morphological Variation of Luminal Diameter of the Trachea in Different Age and Sex Groups of Bangladeshi Cadavers

Background: The tracheobronchial tree is a branched distribution system that carries air from the trachea down to the acini which are the gas exchange units of the lung. In the trachea air speed is high and the airway is particularly vulnerable to obstruction by foreign bodies and tumors. The study of the morphological variations of luminal diameter of the trachea is of profound clinical importance as it may help the clinicians for smooth conduction of some maneuvers like endotracheal intubation and bronchoscopic procedure. It also helps the surgeons to deal with resection and reconstruction of the trachea. Objective: The present study was carried out to establish a Bangladeshi standard regarding the luminal diameter of the trachea and to minimize the dependency on foreign standards. Materials and Methods: This cross sectional descriptive study was performed on 70 post mortem human trachea (44 male and 26 female) to find out the difference in luminal diameter of the trachea of Bangledeshi people in relation to age and sex. The specimens were collected from the morgue in the department of Forensic Medicine, Mymensingh Medical College, Mymensingh by purposive sampling technique. All specimens were grouped into three groups according to age ? Group A, B and C. Dissection was performed according to standard autopsy techniques. The trachea was cut horizontally through the upper border of the 5th tracheal ring and the luminal diameter was measured. The average diameter was expressed in centimeter. All data were recorded in the predesigned data sheet and statistical analysis was done using computer based statistical package, SPSS to evaluate the significance of variance between the different findings. Results: In the present study the maximum luminal diameter of the trachea was 1.65 in Group A, 2.05 in Group B and 1.85 cm in Group C. The minimum luminal diameter of the trachea was 0.7 cm in Group A, 0.85 cm in Group B and in Group C 0.85 cm. The mean (±SD) luminal diameter of the trachea was 1.24 ± 0.3, 1.39 ± 0.3 and 1.29 ± 0.23 cm in Group A, B and C respectively. The maximum mean luminal diameter of the trachea was in Group B (1.39 cm) and minimum was in Group A (1.24 cm). The mean difference of luminal diameter of the trachea between groups was statistically non significant at p>0.5 level. The maximum mean (±SD) luminal diameter of the trachea was 1.50 ± 0.3 cm in male in Group B and minimum mean (±SD) luminal diameter of the trachea was 1.17 ± 0.26 cm in female in Group C. The mean luminal diameter of the male trachea was found to be greater than that of the female trachea among the age group. Mean difference between sexes in Group B was statistically highly significant at p<0.001 level but not significant in Group A and C. Conclusions: The study would help to increase the information pool on the luminal diameter of the trachea of Bangladeshi people

Earthquake preparedness in an urban area: the case of Dhaka city, Bangladesh

Abstract This study aims to assess people’s preparedness for a potential earthquake in Dhaka, the capital of Bangladesh. We have employed a model with six dimensions of holistic individual preparedness. A self-reported online survey included 677 total participants. The multiple linear regression model and the Spearman rank correlation were used as needed. The majority of the participants (> 65%) did not have experience with any earthquake preparedness program, despite the fact that 92% of the population surveyed claimed to have experienced an earthquake in their region. More than 50% of those who experienced earthquakes acquired knowledge. 30% of people do not have access to immediate financial support in the event of a crisis. It was estimated that almost 50% of the population did not have earthquake insurance. Females lack the adaptability of males. A person’s level of earthquake preparedness was significantly associated with their level of education, household head occupation and monthly income, type of residential unit, and experience of earthquake preparedness program. Therefore, these factors should be considered while figuring out how to better prepare for earthquakes. A combination of holistic earthquake preparedness programs and effective education is generally required for competent holistic earthquake preparedness

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

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or &gt;= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care