High prevalence of multidrug resistant uropathogens: a recent audit of antimicrobial susceptibility testing from a tertiary care hospital in Bangladesh

Objectives: Urinary tract infections due to multi drug resistant bacteria have been on the rise globally with serious implications for public health. The objective of this study was to explore the prevalence of multi drug resistant uropathogens and to correlate the urinary tract infections with some demographic and clinical characteristics of patients admitted in a tertiary care hospital in Bangladesh. Methods: A cross sectional prospective study was conducted at Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh among clinically suspected urinary tract infection patients from January to December, 2018. Clean-catch midstream or catheter-catch urine samples were subjected to bacteriological culture using chromogenic agar media. Antimicrobial susceptibility testing of the isolates was done by KirbyBauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Descriptive statistical methods were used for data analysis. Results: Culture yielded a total of 537 (42.8%) significant bacterial growths including 420 (78.2%) multi drug resistant uropathogens from 1255 urine samples. Escherichia coli was the most common isolate (61.6%) followed by Klebsiella spp. (22.5%), Pseudomonas spp. (7.8%), Staphylococcus aureus (5.4%) and Enterobacter spp. (2.6%) with multi drug resistance frequency of 77.6%, 71.9%, 90.5%, 86.2% and 92.9% respectively. There was female preponderance (M:F; 1:1.97; P=0.007) but insignificant differences between paediatric and adult population (43.65% vs. 42.57%) and also among different age groups. Diabetes, chronic renal failure, fever and supra-pubic pain had significant association as co-morbidities and presentations of urinary tract infections (P<0.05). Multi drug resistance ranged from 3.7 to 88.1% including moderate to high resistance found against commonly used antibiotics like ciprofloxacin, cephalosporin, azithromycin, aztreonam, cotrimoxazole and nalidixic acid (28.6 to 92.9%). Isolates showed 2.4 to 32.2% resistance to nitrofurantoin, amikacin, netilmicin and carbapenems except Pseudomonas spp. (66.7% resistance to nitrofurantoin) and Enterobacter spp. (28.6 to 42.9% resistance to carbapenems). Conclusion: There is very high prevalence of multi drug resistant uropathogens among hospitalized patients and emergence of carbapenem resistance is an alarming situation. Antibiotic stewardship program is highly recommended for hospitals to combat antimicrobial resistance

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Tunable microwave resonator using liquid metal and 3D printed fluidic channel for the development of microwave spectroscopy

This thesis presents an innovative and practical approach to developing planar resonant-based spectroscopy in microwave sensor technology. Resonant based microwave sensors have drawn attention for decades now in terms of sensing and measuring materials dielectric properties because of demonstrating a higher accuracy, precision, and sensitive measurement compared to non-resonant based sensors. This method has been mostly used on binary solvents due to their ability to display a highly delicate response to the materials under test. This thesis presents a comprehensive analysis of the sensor design and fabrication, sensor characterization, and testing samples to achieve the materials' frequency selective response. Microwave resonator sensors are limited in their current form to a single fixed resonant frequency, leading to issues in selectivity among materials or mixtures with similar dielectric properties. The first study presents a successful effort of achieving a frequency-tunable resonator circuit by utilizing the liquid metal and 3D printed microchannel with a modified split ring resonator. The resonator utilizes liquid metal in a microfluidic channel to change the resonant frequency of the resonator over a wide, continuous spectrum by changing the effective capacitance of the sensor. In the second study, highly sensitive interdigitated capacitive traces have been added with the designed sensor structure for material sensing. The designed and fabricated sensor demonstrated an operating resonant frequency that could be tuned between 2.1 and 2.8 GHz for both solid and liquid sensing. The sensitivity of the designed sensor structure is investigated by sensing standard solid samples, and sensitivity variation was noticed due to the increased reactive loading introduced by the liquid metal. Experimental validation of the sensor and standard liquid mixtures confirmed that the frequency tunability enables similar dielectric materials to be distinctly identified using multiple frequency spectra. Specific attention was made towards materials with identical dielectric properties at specific frequencies, simulated with the Debye model, and matched experimentally with dielectric probe validation. The device enables multi-phase material detection with the ability to investigate dielectric properties over a frequency spectrum rather than a single point.Applied Science, Faculty ofEngineering, School of (Okanagan)Graduat

Risk factors and etiology of neonatal sepsis after hospital delivery: A case-control study in a tertiary care hospital of Rajshahi, Bangladesh.

BackgroundSepsis is one of the major causes of neonatal death worldwide as well as in Bangladesh. The objective of the present study was to identify the risk factors and causative organisms of neonatal sepsis after delivery in a tertiary care hospital, Bangladesh.MethodsThis was a case-control study conducted in the neonatal ward of Rajshahi Medical College Hospital (RMCH), a 1000-bed tertiary hospital situated in Rajshahi, Bangladesh. Neonates diagnosed as neonatal sepsis by clinical and laboratory parameters were included as cases in this study. Admitted neonates unsuspected or undiagnosed for sepsis were considered as controls. Maternal and neonatal information and their laboratory reports were collected and analyzed. Both bivariate and multiple logistic regression models were used to identify the risk factors of neonatal sepsis.ResultsA total of 91 cases and 193 controls were included in the study. Maternal history of urinary tract infection (UTI) during the third trimester of pregnancy (aOR 2.75, 95% CI: 1.04-7.23, p ConclusionsStrengthening the existing facility for antenatal screening for early diagnosis and treatment of maternal infection during pregnancy as well as identifying high-risk pregnancy for adequate perinatal management is necessary to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics according to local epidemiology and culture and sensitivity reports may minimize the increasing hazards of antibiotic resistance

Association Between Hair Diseases and COVID-19 Pandemic-Related Stress: A Cross-Sectional Study Analysis

INTRODUCTION: Psychological stress from the ongoing coronavirus disease 2019 (COVID-19) pandemic can potentially aggravate the course of several stress-sensitive skin and hair diseases. This study aimed to determine the potential association of COVID-19 stress with hair diseases, such as telogen effluvium (TE), alopecia areata (AA), and seborrheic dermatitis (SD), among medical students in Bangladesh. METHODS: This online-based cross-sectional study was conducted among 404 medical students of Bangladesh using a self-administered questionnaire, including sociodemographic information, status of hair diseases (i.e., TE, AA, and SD), COVID-19 fear scale, impact of event scale specific for COVID-19 (IES-COVID-19), and COVID-19 student stress questionnaire (CSSQ) scale, to determine pandemic-related stress. The logistic regression model was used to analyze the association. RESULTS: Overall prevalence of TE, AA, and SD was 61.1, 24.7, and 57.7%, respectively, with female predominance in case of TE and male predominance in case of AA and SD. More than half of the participants had COVID-19-related fear and traumatic stress symptoms. In the multiple logistic regression model, smoking [adjusted odds ratio (aOR) 2.93, 95% CI 1.29–6.65 for AA and aOR 4.19, 95% CI 1.83–9.56 for TE], COVID-19-related fear (aOR 1.70, 95% CI 1.01–2.89 for AA and aOR 2.620, 95% CI 1.25–5.48 for TE), and COVID-19-related traumatic stress symptoms (aOR 1.84, 95% CI 1.08–3.13 for AA, aOR 2.61, 95% CI 1.19–5.68 for TE, and aOR 1.92, 95% CI 1.14–3.25 for SD) were the risk factors of hair fall disorders. CONCLUSION: Our study showed that a large number of medical students experienced TE, AA, and SD during the pandemic era. COVID-19-related stress and fear potentially have an association with these diseases

Two level logistic regression analysis of factors influencing skilled birth attendant during delivery among Bangladeshi mothers: A nationally representative sample.

BackgroundIn order to minimize the maternal and child mortality rate, the presence of skilled birth attendants (SBA) during delivery is essential. By 2022, 4th health, population and nutrition sector programme in Bangladesh aims to increase the percentage of deliveries performed by SBA to 65 percent. The objective of the present study was to determine the rate and associated factors of usage SBA among Bangladeshi mothers during their delivery.MethodsThis study utilized secondary data that was collected by Bangladesh Demographic and Health Survey (BDHS) 2017-18. The usage of SBA was measured by a question to respondent, who assisted during your delivery? It was classified into two classes; (i) skilled birth attendant (qualified doctors, nurses, midwives, or paramedics; family welfare visitors, community skilled birth attendants, and sub-assistant community medical officers) (code 1), and (ii) unskilled birth attendant (untrained traditional birth attendants, trained traditional birth attendants, relatives, friends, or others) (code 0). Two logistic regression model was used to determine the associated factors of SBA after removing the cluster effect of the outcome variable.ResultsThis study found 53.2% mothers were delivered by SBA in Bangladesh, among them 56.33% and 42.24% mothers were delivered by nurse/midwife/paramedic and doctor respectively. The two level logistic model demonstrated that geographical location (division), type of residence, religion, wealth index, mothers' body mass index, mothers' education level, mothers' occupation, total ever born children, mothers' age at first birth (year), number of ANC visits, husbands' education level and husbands' occupation were significant (pConclusionsThis study revealed that still 46.8% mothers are delivered by unskilled birth attendant, this might be treated of Bangladesh Government to achieve SDGs indicator 3.1.2 by 2030. Counseling could be integrated during ANC to increase awareness, and should ensure for every Bangladeshi mothers visit ANC service during their pregnancy at least 4 times

Willingness to work during initial lockdown due to COVID-19 pandemic: Study based on an online survey among physicians of Bangladesh

Published: February 9, 2021Background: During the catastrophic situation of the COVID-19 pandemic, the role of the health care workers (HCWs) is the most crucial, and their absenteeism, whether due to inability or unwillingness, becomes a major concern for the national health system. Hence, the present study aimed to determine the willingness and its associated factors to work during the COVID-19 pandemic among the physicians of Bangladesh. Methods: This was a cross-sectional study conducted from April 21 to May 10, 2020, using an online survey among the Bangladeshi physicians living in the country. Both univariate and multivariable binary logistic regression models were used to determine the predictors of the willingness of the physicians to work during the COVID-19 pandemic. Results: More than 69% physicians reported that they were willing to work during the COVID-19 pandemic, 8.9% reported that they were not willing, while 21.4% of participants were not sure about their willingness. Younger age, having experience of treating patients during previous pandemics, working in the emergency departments and high self-reported compliance to the recommended PPE were important predictors of being willing to work during COVID-19 pandemic. Concern for family and risk of transmitting the infection to family members were most commonly reported as major barriers of working during the pandemic (30%) followed by having comorbidities (25%), lack of adequate safety measures (25%), fear of being infected (12.2%), not involved in clinical practice (12.5%) etc. Conclusions: Though the majority of the physicians were willing to work during the COVID-19 pandemic, sufficient supply of PPE, support to maintain recommended quarantine and isolation policy after risky hospital duty along with adequate and effective training can increase their willingness to continue their sacred duty during this crucial pandemic.Md. Abdur Rafi, M. Tasdik Hasan, Dewan Tasnia Azad, Syeda Fatema Alam, Vivek Podder, Sahadat Hossain, S. M. Quamrul Akther, Fatema Ashraf, Md. Golam Hossai

Adverse events following immunization with ChAdOx1 nCoV-19 and BBIBP-CorV vaccine: A comparative study among healthcare professionals of Nepal.

BackgroundAdverse events following immunization (AEFI) against SARS-CoV-2 are common as reported by clinical trials and contemporary evidence. The objective of the present study was to evaluate the local and systemic adverse events following vaccination with ChAdOx1 nCoV-19 and BBIBP-CorV among the healthcare professionals (HCPs) of Nepal.MethodsThis cross-sectional study was conducted among 606 vaccinated HCPs of Kathmandu, Nepal. Data was collected from June 15 to 30, 2021 using a self-administered online survey tool. Multiple binary logistic regression models were used to predict the adverse events according to the vaccine types and doses after adjusting for age, sex, comorbidity and previous SARS-CoV-2 infection.ResultsThe mean (SD) age of the participants was 35.6 (13.2) years and 52% of them were female. Almost 59% of participants were vaccinated with two doses and around 54% of total of them took the ChAdOx1 nCoV-19 vaccine. At least one local and systemic adverse event was reported by 54% and 62% of participants after the first dose and 37% and 49% after the second dose of ChAdOx1 nCoV-19 and by 37% and 43% after the first dose and 42% and 36% after the second dose of BBIBP-CorV vaccine respectively. Injection site pain, swelling and tenderness at the injection site were the most frequently reported local AEFI while, fatigue, headache, fever and myalgia were the most frequently reported systemic AEFI. The logistic model demonstrated that the risk of both local and systemic adverse events was higher among the ChAdOx1 nCoV-19 vaccine recipients compared to the BBIBP-CorV vaccine. Almost 10% of individuals reported a post-vaccination SARS-CoV-2 infection and most of them occurred after taking the first dose of vaccine.ConclusionsRecipients of both the ChAdOx1 nCoV-19 and BBIBP-CorV vaccine among the HCPs of Nepal reported only mild and constitutional symptoms including injection site pain and tenderness, headache, fever, fatigue, etc. after vaccination

Rate of skilled birth attendant delivered Bangladeshi mothers.

Rate of skilled birth attendant delivered Bangladeshi mothers.</p