As a result of an epidemiological transition from communicable to non-communicable diseases for last few decades, cardiovascular diseases (CVD) are being considered as an important cause of mortality ...and morbidity in many developing countries including Bangladesh. Performing an extensive literature search, we compiled, summarized, and categorized the existing information about CVD mortality and morbidity among different clusters of Bangladeshi population. The present review reports that the burden of CVD in terms of mortality and morbidity is on the rise in Bangladesh. Despite a few non-communicable disease prevention and control programs currently running in Bangladesh, there is an urgent need for well-coordinated national intervention strategies and public health actions to minimize the CVD burden in Bangladesh. As the main challenge for CVD control in a developing country is unavailability of adequate epidemiological data related to various CVD events, the present review attempted to accumulate such data in the current context of Bangladesh. This may be of interest to all stakeholder groups working for CVD prevention and control across the country and globe.
Background: Early stage breast cancer can often be cured with surgery alone though there are chances of recurrent disease and decrease in survival. Adjuvant poly-chemotherapy with docetaxel-based ...regimens can improve both disease-free and overall survival in patients with operable breast cancer.
Objective: This study was designed to evaluate the patient profile and current pattern of care with docetaxel based adjuvant regimen in operable breast cancer patients including the treatment outcome from clinical practice.
Materials and method: This prospective, observational, non-comparative study planned to enroll newly diagnosed operable breast cancer patients with high risk of recurrence after surgery. Selection of docetaxel-based treatment strategy and dosage of therapy was at the discretion of individual oncologists as per routine clinical practice. Patient data were recorded during inclusion, each cycle of therapy, and follow-up at 1 year (+/- 1 month) after inclusion.
Results: Between August 2008 and July 2011 a total of 85 patients with median age of 53 years (23-73 years) were enrolled and 53 (62.4%) patients were postmenopausal. Ductal carcinoma, the most common cancer type,was found in 73 (85.9%) patients. Receptor status was positive for estrogen, progesterone or Her2/neu/erbB2 in 65.9%, 47.1% and 5.8% patients, respectively. Mastectomy either partial or total was performed in 76 (89.4%) patients for the current disease. An average of 8 (range: 2-15) lymph nodes (LN) mostly in axilla were excised in 56 patients and average of 4 (range: 1-11) LN nodes were positive. Sentinel LNs were negative, excised in 4 patients. The mean tumor size was 5.5 cm and most (82.4%) patients were diagnosed at Stage II disease including some at Stage I and III (7.1%, 10.6%). Docetaxel (Taxotere®) was combined with cyclophosphamide alone or in addition with doxorubicin, epirubicin, 5 FU and trastuzumab either in combination or sequential regimen. Taxotere in combination with adriamycin and cyclophosphamide was planned for 63.5% patients. Trastuzumab as sequential therapy could be afforded by 1 patient only. Data regarding radiotherapy or hormone therapy was not recorded. At the end of four cycles, 83.5% of patients were found disease free and 5.9% had loco regional relapse. At 1 year 71 (93.4%) patients were alive, 63 (88.7%) were relapse-free and 8 (11.2%) had loco regional relapse. Nausea, vomiting, diarrhea, alopecia, anemia and neutropenia were most commonly reported adverse events classified as Grade 1 or Grade 2. Grade 3 neutropenia was reported in 5 patients and 2 patients reported grade 4 neutropenia. Grade 3 diarrhea was reported in 1 patient.
Conclusion: Docetaxel as adjuvant chemotherapy offered one year survival in 93.4% (71/76) of the patients and 88.7% (63/71 patients) were disease-free. The safety profile of docetaxel based regimens was expected and manageable.
Delta Med Col J. Jan 2019 7(1): 4-10
Background: Cefepime a parenteral fourth generation cephalosporin is active against many Gram-positive and Gram-negative organisms. The study aimed to evaluate the effectiveness and tolerability of ...cefepime when used alone or in combination with other antibiotics for the treatment of infections in hospital settings in Bangladesh.
Methods: This multi-centric, prospective observational study enrolled eligible males and females >18 years who had been prescribe cefepime as a part of treatment strategy regardless of the purpose of hospitalization. No therapeutic intervention was implied rather treatment strategy and dosage of cefepime was on individual physician’s discretion as per routine clinical practice. Percentage of patients who would have clinical success in terms of cure, improvement or failure was evaluated during the end of cefepime therapy. Patient’s overall tolerability to cefepime therapy as excellent, good, satisfactory and poor was considered for safety assessment. The outcome analysis was done in patients’ available follow-up at the end of therapy.
Results: A total of 1000 patients were enrolled in this study between March 2013 and September 2014 in different hospital settings of Internal Medicine, Coronary Care Unit, Orthopedic, Intensive Care Unit, Surgery and Nephrology (51.6%, 17.8%, 15.2%, 11.6%, 2.2% & 1.6%). The mean (±SD) age of patients was 50.1 (±14.7) years (range 18-100) and 64.3% were males. Bacteriology or culture sensitivity report was available with 67 patients at baseline and most common microorganisms were E coli (35.8%), Pseudomonas sp. (20.8%), Klebsiella sp. (16.4%), Staphylococcus sp. (11.9%) and Streptococcus sp. (7.4%) and others (7.4). Cefepime was used as medical or surgical prophylaxis in 52.2% of the patients. In 47.8% of patients cefepime was prescribed for treatment of infections including lower respiratory tract infections, trauma / fracture related wound infections, urinary tract infections, treatment of gangrene and septicaemia (39.7%, 31.8%, 10.9%, 9.2% & 8.4%). The dose of cefepime was 500 mg to 2 gm twice or thrice daily with the mean (±SD) duration of 6.1 (±2.1) days (range 2-14). 55 patients were lost to follow-up at the end of therapy and 25 died due to congestive heart failure, renal or hepatic failure and multiple organ failure. On physicians end of therapy overall clinical outcome evaluation, 70.7% of the patients were cured, 24.9% improved and 4.4% had no improvement or worsening in the sign and symptoms. Overall tolerability of cefepime was good in 56.6 %, excellent in 28.7%, satisfactory in 9.8% and poor in 4.9% of patients. No non-serious adverse event was reported in this study. Nonetheless, the 25 death cases would be considered as serious adverse events.
Conclusion: Cefepime therapy in different indications was effective in hospitalized patients for cure (67.5 %) or improvement (26.9 %) of sign and symptoms. It was also well tolerated in 85.3% of patients as assessed by the treating physicians
J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 17-24
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background: Most head and neck cancers are squamous cell carcinomas (SCCHN) that contribute to substantial morbidity and mortality worldwide. The disease is mostly diagnosed at locally advanced ...stage. Because treatment of head and neck cancers is complex and involves multiple modalities of surgery, radiotherapy and systemic therapy including chemotherapy and molecularly targeted agents; a multidisciplinary approach is needed. The study evaluated the current treatment approaches for patients newly diagnosed with SCCHN in Bangladesh.
Methods: This prospective, observational and non-comparative, study enrolled eligible males and females of 18 years newly diagnosed with SCCHN at any stage of disease. No therapeutic intervention was implied rather selection of treatment strategy and dosage of therapy was on discretion of individual oncologist as per routine clinical practice.
Results: A total of 64 patients with median age of 55 years were enrolled between August 2008 and July 2011. The majority of patients (42, 65.6%) were males. The major risk factors were betel leaf chewing along with jorda (smokeless tobacco) (62.5%) and cigarette smoking (32.8%), though most of the patients had multiple risk factors. No patient was diagnosed at early stage; all were in locally advanced disease at stage III (52, 81.3%) and IV (12, 18.8%). The oncologists prescribed neoadjuvant chemotherapy in half (32) of the patients, 19 (29.7%) patients received adjuvant chemotherapy and 13 (20.3%) received palliative chemotherapy. Only 3 (4.6%) of the patients received radiotherapy. Chemotherapy combination regimen included docetaxel, cisplatin and 5-fluorouracil (5-FU) and leucovorin was added to 2 patients. The dosage of chemotherapeutic agents was as per routine clinical practice of the oncologists. Neutropenia was the common hematological abnormality reported spontaneously in 16 (25%) patients. No serious adverse event was reported leading the patients to withdraw from therapy. During continuation of therapy 1 patient died due to sudden cardiac arrest who had medical history of previous myocardial infarction.
Conclusion: This registry revealed that squamous cell carcinoma of head and neck region are mostly presented in advanced stage in Bangladesh and the majority of the patients are treated with combination chemotherapeutic regimens.
Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 17-22
Bacteremia is common with manipulation of the teeth and periodontal tissues during dental procedures. Majority of dental office visits result in some degree of bacteremia that warrants antibiotic ...prophylaxis before a dental procedure to reduce the frequency, nature or duration of bacteremia. This study aimed to collect data on prophylactic use of cephradine which is most preferred in dental procedures in Bangladesh. A total 2219 of patients both adult and children above 5 years were enrolled to assess use of antibiotic, its dose and duration for antibiotic prophylaxis during dental procedures. Efficacy of antibiotic prophylaxis in terms of clinical cure, further dose modification and need to change antibiotic was evaluated at day 10 of antibiotic use and in case of root canal therapy at day 30. Any side effect of antibiotic use recorded within 3 days was considered for safety evaluation. This was a non-controlled, multicentre, observational study. 2016 (90.9%) of the patients received cephradine as prophylactic antibiotic with a mean dosage of 500mg (487.48+60.99) and duration of treatment was 3-7 days (5.47+1.03). Some of the dentists also preferred amoxicillin (149, 6.7%) and cephalexin (54, 2.4%) for prophylaxis. The majority of the patients (1657, 82.2%) who had prophylaxis with cephradine had no clinical sign of infection and some of the patients needed to change their initial dose or change of the antibiotic. Overall 1816 (81.8%) patients were found having no clinical sign of infection on antibiotic prophylaxis. Among the patients 239 (10.7%) needed to change the dose of prescribed antibiotic and 55 (2.4%) were required to change their prescribed antibiotic. However, the data on type of infection was not recorded. 109 (4.9%) patients were lost to follow up on Day 10. Prescribed antibiotic prophylaxis was not associated with adverse events in majority (91%) of the patients. Some of the patients reported diarrhea (104, 4.7%), stomach upset (68, 3.1%) and dizziness (31, 1.4%) during antibiotic use. However, those were self-limiting and no dose adjustment, discontinuation of therapy or withdrawal from the study was required. No serious adverse events were reported. Cephradine 500 mg for 5 days course was preferred as prophylactic antibiotic in dental procedures in this study. Majority of the patients had no clinical sign of infection on evaluation at day 10. Cephradine therapy was mostly not associated with adverse events in patients; however, diarrhea, stomach upset and dizziness were reported in some patients that were self-limiting.Bangladesh Journal of Dental Research and Education Vol.5(2) 2015: 49-54
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