Household members of diarrhea patients are at higher risk of developing diarrheal diseases (>100 times for cholera) than the general population during the 7 days after the diarrhea patient is ...admitted at a health facility. There is growing evidence demonstrating that theory-driven water, sanitation, and hygiene (WASH) interventions are likely to yield greater behavior change than those based on health education alone. The Cholera Hospital-Based Intervention for 7-Days (CHoBI7) mobile health (mHealth) program is a theory-driven WASH intervention initially delivered to a diarrhea patient by a health promoter during a health facility visit and reinforced through weekly voice and text messages. In the recent randomized controlled trial (RCT) of the CHoBI7-mHealth program in Bangladesh, this intervention significantly reduced diarrheal disease and stunting, and increased handwashing with soap and stored drinking water quality over the 12-month program period. The aim of this study was to assess the underlying mechanism of change of this intervention. Handwashing with soap was measured by 5-hour structured observation. Stored drinking water quality was assessed by the presence of Escherichia coli during unannounced spot checks. Psychosocial factors were measured among 1,468 participants in the CHoBI7-mHealth RCT. Perceived susceptibility, response efficacy, self-efficacy, dirt reactivity, and diarrhea knowledge were mediators of the CHoBI7-mHealth program’s effect on stored drinking water quality at the 1-week follow-up. Self-efficacy, response efficacy, and diarrhea knowledge were mediators of the intervention’s effect on handwashing with soap habit maintenance and stored drinking water quality at the 12-month follow-up. This study demonstrates how theory-driven approaches for intervention design can facilitate WASH behavior change.
During the time a diarrhea patient presents at a health facility, the household members of the patient are at higher risk of developing diarrheal diseases (> 100 times for cholera) than the general ...population. The Cholera-Hospital-based-Intervention-for-7-Days (CHoBI7) is a health facility-initiated water treatment and handwashing with soap intervention designed to reduce transmission of diarrheal diseases between patients and their household members. The present research aimed to (1) develop a scalable approach to integrate the CHoBI7 intervention program into services provided at government and private health facilities in Bangladesh; and (2) tailor the intervention program for the household members of all diarrhea patients, irrespective of the etiology of disease.
We conducted 8 months of formative research, including 60 semi-structured interviews, 2 group discussions, and a pilot study. Thirty-two interviews were conducted with diarrhea patients and their family caregivers, government stakeholders, and health care providers both to explore existing WASH and diarrhea patient care practices in health facilities and to identify considerations for scaling the CHoBI7 program. Fifty-two diarrhea patient households participated in a pilot study of a modified version of the CHoBI7 intervention program for tailoring. Twenty-eight interviews and 2 group discussions were conducted with pilot households to explore experiences with and recommendations for intervention delivery.
The intervention program was modified based on formative research findings. Pilot study participants recognized the benefits of the CHoBI7 intervention program and made suggestions to improve the acceptability and feasibility of the intervention. Modifications included 1) providing additional pictorial modules, cues to action, enabling technologies, and supplies for safe drinking water and handwashing with soap behaviors in the health facility; 2) switching out technology prone to breaks and leaks as well as sourcing plastic technologies from a high-quality, local manufacturer; and 3) including instructions discouraging the non-use or misuse of technologies and supplies. Considerations for scalability include the local availability and marketing of enabling technologies and supplies, staff for program delivery in health facilities, and potential integration into existing government or health promotion programs.
Formative research identified important considerations for the content, delivery, and scalability of the CHoBI7 health facility-initiated WASH intervention program.
Background: Elevated blood glucose is common in the early stage of stroke. Besides, blood glucose level increases during acute stroke in nondiabetic patients.
Objective: Objective of the study was to ...assess the glycemic status during acute stroke in nondiabetic patients, find the rate of newly developed diabetes during acute stroke and rate of newly developed Impaired Fasting Glucose, Impaired Glucose Tolerance during acute stroke.
Methods: The purposive sampling method was used to identify the patients and by proper history taking, documentary papers and laboratorial support evidenced by HbA1c level less than 6.5% (This means patient to be non diabetic). Data were collected from 100 patients. It was conducted from August, 2018 to February, 2019 in the Department of Medicine of Dhaka Medical College Hospital. The data were collected through questionnaire ,pre-tested earlier and data collection sheet illustrating the glycemic status during acute stroke among the nondiabetic patients.
Results: While analyzing the lab investigations among the respondents, mean HbA1c level was found 5.69± 0.65 mmol/L level which was found normal among the entire patient group. Patients Fasting Blood Sugar(FBS) was tested and mean FBS level was 5.94±0.86. In 62% of the patients, IFG was found, and in 12% of patients, FBS value was found to be diabetic while 26% showed normal glycemic status. Average OGTT(2 hours after 75 gm glucose) impression was 8.53± 2.02 mmol/L. OGTT level was normal among 30%, 54% patients had IGT and 16% of the respondents were found diabetic.
Conclusion: The study finds that, in patients with no history of diabetes who have acute stroke, may develop moderately elevated glucose levels which may affect short term and long term stroke related morbidity and mortality.
J MEDICINE JAN 2021; 22 (1) : 22-26
Abstract
Background
The Cholera Hospital-Based Intervention for 7 Days (CHoBI7) mobile health (mHealth) program was a cluster-randomized controlled trial of diarrhea patient households conducted in ...Dhaka, Bangladesh.
Methods
Patients were block-randomized to 3 arms: standard message on oral rehydration solution use; health facility delivery of CHoBI7 plus mHealth (no home visits); and health facility delivery of CHoBI7 plus 2 home visits and mHealth. The primary outcome was reported diarrhea in the past 2 weeks collected monthly for 12 months. The secondary outcomes were stunting, underweight, and wasting at a 12-month follow-up. Analysis was intention-to-treat.
Results
Between 4 December 2016 and 26 April 2018, 2626 participants in 769 households were randomly allocated to 3 arms: 849 participants to the standard message arm, 886 to mHealth with no home visits arm, and 891 to the mHealth with 2 home visits. Children <5 years had significantly lower 12-month diarrhea prevalence in both the mHealth with 2 home visits arm (prevalence ratio PR: 0.73 95% confidence interval {CI}, .61–.87) and the mHealth with no home visits arm (PR: 0.82 95% CI, .69–.97). Children <2 years were significantly less likely to be stunted in both the mHealth with 2 home visits arm (33% vs 45%; odds ratio OR: 0.55 95% CI, .31–.97) and the mHealth with no home visits arm (32% vs 45%; OR: 0.54 95% CI, .31–.96) compared with children in the standard message arm.
Conclusions
The CHoBI7 mHealth program lowered pediatric diarrhea and stunting among diarrhea patient households.
Clinical Trials Registration
NCT04008134.
In this trial, young children in diarrhea patient households receiving the CHoBI7 mobile health program had less stunting and diarrhea compared with those only receiving the standard recommendation on oral rehydration solution for dehydration.
Background: Raised blood glucose is common in diabetic patients in early phase of stroke. It is also known that blood glucose level increases during acute stroke in non diabetic patients.
Objective: ...Objective of this study was to assess the association between family history of diabetes and newly developed diabetes, impaired fasting glucose, impaired glucose tolerance during acute stroke in non diabetic patients.
Methods: The purposive sampling method was applied to identify the patients by appropriate history taking about diabetes among the patients and their 1st degree relatives, documentary papers and laboratorial support evidenced by HbA1c level less than 6.5% (This means patient to be non diabetic). Data were collected from 100 patients. The data were collected by questionnaire, pre-tested earlier and data collection sheet illustrating the family history of diabetes mellitus and glycemic status during acute stroke among the nondiabetic patients. It was conducted from January, 2021 to July, 2021 in the Department of Medicine of Dhaka Medical College Hospital.
Results: The study found that, mean age of the patents was 61.76±7.33 years. Family history of Diabetes Mellitus (first degree relative) was found among 48% patients.52% patients did not give family history of Diabetes Mellitus. During analysis of the lab investigations among the participants, mean HbA1c level was found 5.69± 0.65 mmol/L which was found normal among the entire patient group. Patients Fasting Blood Sugar (FBS) was tested and mean FBS level was 5.94±0.86.Among the respondents 48% gave family history(1st degree relative) of Diabetes of which 8.3% revealed normal glycemic status , 66.7% showed IGT and 25.0% were diabetic. On the other hand 52% respondents had no family history of Diabetes, among them 50% showed no glycemic abnormality, 42.3% showed IGT and only 7.7% were diabetic.
Conclusion: In a nutshell, the study finds that, in patients with no history of diabetes who have acute stroke, may develop moderately elevated glucose levels and it is significantly higher in those who have family history of diabetes mellitus.
J Dhaka Med Coll. 2021; 29(1): 38-42
Breast cancer remains a significant public health concern, with staging at diagnosis being a critical factor in prognosis and treatment planning. While biomedical markers have been extensively ...studied, there is a growing interest in understanding the diagnostic impact of various factors on the staging of breast cancer. This cross-sectional study was conducted on 50 patients with diagnosed breast cancer, further stratifying them by stage (I-IV) and correlating with different factors which includes socio demographic factors too. A significant association was found between the less than <12 years of age of menarche (p-value 0.038), more than one children (p value 0.014) and no breast feeding history (p-value 0.05) with advanced cancer stage (stage IV). No significant association was observed among age of menopause, marital status with cancer staging. Among the clinical features of respondents, the size of the breast lump, presence of nipple retraction, and axillary lymph node enlargement were found more with stage IV. The findings suggested that while certain social factors like marital status may not directly influence the stage at diagnosis, the number of children a patient has could be an indicator of later-stage diagnosis. About 40% of respondents were diagnosed at stage IV, followed by 28% at stage III, indicating a trend towards late diagnosis. This may reflect broader societal and behavioural patterns that affect health-seeking behaviour and access to healthcare. The staging of breast cancer based on these clinical features not only guides the therapeutic approach, including the decision for surgery, chemotherapy, and radiation therapy, but also has implications for the patient's survival outcomes. Understanding these associations aids clinicians in developing personalized treatment plans and also plays a role in the development of screening guidelines aimed at early detection.
Background: Cytogenetic analysis performed at diagnosis is considered to be the most important prognostic factor in AML. Objective: The purpose of this study was to observe the pattern of cytogenetic ...abnormalities in adult patients with de novo AML. Method: Total fifty-two newly diagnosed de novo AML patients were selected for the study. Six cytogenetic abnormalities including t(8;21), t(15;17), inv(16), BCR-ABL1, FLT3-ITD & NPM1 mutations were detected by Real-Time PCR. Results: In this study, 36 (69.2%) patients showed different cytogenetic abnormalities. The t(15;17) was found to be the most common. t(15;17), t(8;21) and inv(16) were found only in M3, M2 and M4 FAB subtypes, respectively. Significant association was found with increasing age and cytogenetic risk groups. BCR-ABL1 mutation showed significant relation with increased age. FLT3-ITD mutation showed significant association with increased WBC count and inv16 was significantly associated with relatively less bone marrow blast percentage. Conclusion: Cytogenetic study should be performed routinely in all cases of AML for proper diagnosis, prediction of prognosis and implementation of effective therapeutic measures.
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