Dhaka Community Hospital Trust

In 2023, Bangladesh became the first country to achieve World Health Organization (WHO) validation of elimination of visceral leishmaniasis as a public health problem, defined as maintenance of annual kala-azar incidence at <1 case per 10,000 population at the subdistrict (upazila) level. The pillars of the programme are early diagnosis and effective treatment, indoor residual insecticide spraying, improved case detection, social mobilization and operational research, and effective disease surveillance. The Bangladesh National Kala-azar Elimination Programme was established in 2008, with introduction of rapid diagnostics and newer treatment modalities in health complexes at sub-district level in the endemic area in 2012-2015, initiation of blanket IRS in affected communities in 2012-2013 and adoption of a digital surveillance system in 2015. All subdistricts achieved and maintained the elimination threshold from 2017 onward. We present documentation of the course of KA elimination in Bangladesh and provide a perspective on the components necessary to maintain current success into the future.

ABSTRACT Mucoadhesion is an effective approach for increasing the retention time of topical ophthalmic therapeutics, particularly in dry eye, as it may mitigate rapid nasolacrimal drainage and improve their limited bioavailability. Using the gelation properties of mucin, the major glycoprotein of the mucosa, to assemble drug loaded nanocarriers that would consolidate considerably on the ocular mucosa and facilitate sustained release is a facile approach to integrate mucoadhesion into topical formulations. However, mucin‐based nanoparticles tend to aggregate due to their limited stability in colloidal solution form. This study reports on the synthesis and stabilization of mucin in nanoparticle form using alginate as an electrostatic stabilizer, and then the subsequent loading of antioxidant coenzyme Q10. Simultaneous ionotropic gelation of both alginate and mucin is employed to obtain self‐assembling polymeric nanocarriers with superior mucoadhesive properties (&gt;80% adheres to the ocular mucosa for 0.25 gm formulation), improved shelf stability, and desired shear‐thinning behavior whereas coenzyme Q10 was encapsulated with high encapsulation efficiency (&gt;96%) and sustained release for up to 4 days. Extensive in vivo assessment reveals the efficacy of the nanocarriers in improving dry eye symptoms. This study demonstrates a novel and straightforward way to synthesize stabilized alginate‐mucin nanoparticles for the effective delivery of coenzyme Q10.

Background: Tibial shaft fractures are among the most frequently encountered long bone injuries. Due to limited soft tissue coverage and subcutaneous location, the tibia is prone to complications such as non-union, infection and malalignment. The suprapatellar approach for intramedullary nailing has recently gained favour for its potential benefits over the traditional infrapatellar method, reducing anterior knee pain and facilitating easier intraoperative imaging. The aim of this study was to assess the radiological and functional outcome of closed tibial shaft fractures treated with interlocking nails through suprapatellar approach. Methods: This prospective observational study was conducted in the Department of Orthopaedics, National Institute of Traumatology and Orthopedics Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka, Bangladesh, from March 2022 to March 2023. Total 33 patients with closed tibial shaft fractures were included in the study. Results: The study included 33 patients (mean age 38.3±11.6 years), predominantly male (69.7%). Right-sided fractures were more common (60.6%). Most injuries (81.8%) were due to motor vehicle accidents. AO type 42A fractures were most frequent (54.5%). Anterior knee pain was minimal, with a mean VAS of 0.5. Radiological union occurred in 90.9% within 21 weeks (mean 17.9±3.5). Complications were rare (12.1%). Most patients achieved a ROM of 130–139°, with fair to good functional outcomes in over 90% of cases. Conclusions: Suprapatellar nailing offers a reliable and minimally painful solution for managing closed tibial shaft fractures with favourable radiological and functional outcomes.

Due to protean presentations, poor sensitivity of radiographs and variable reliability of synovial fluid analysis, diagnosis of Calcium pyrophosphate deposition disease (CPPD) is a challenge. This study addressed the diagnostic performance of musculoskeletal ultrasound (MSK-USG) in identifying CPPD features in hyaline cartilage, fibrocartilage, tendon, and synovial fluid. We compared ultrasound findings in CPPD to those in osteoarthritis (OA) and gout and healthy control. In this retrospective exploratory study, MSK-USG performed between February 2022 and July 2023 were reviewed. Patients retrospectively fulfilled the ACR/ EULAR classification criteria 2023 (score ≥ 56) were included (n = 16). Clinical phenotypes included acute CPP arthritis (44%), CPPD with OA (44%), and chronic CPP arthritis (12%). Ultrasound images were evaluated at common CPPD target sites: hyaline cartilage and fibrocartilage of the knee, wrist triangular fibrocartilage, metacarpophalangeal joints, joint capsules, tendons, and synovial membranes. Ultrasound images of CPPD cases were compared to those of OA, gout, and healthy controls. Sensitivity, specificity, and predictive values were calculated for Ultrasound features. Compared to healthy controls, Ultrasound features showed a sensitivity of 94.12% (CI: 71.31–99.85), specificity of 100% (CI: 86.77–100), positive predictive value of 100%, and negative predictive value of 99.59% in diagnosing CPPD. Ultrasound findings in hyaline cartilage showed a sensitivity & a specificity of 100% each. Fibrocartilage involvement showed a sensitivity of 93.75% and specificity of 86.67%. Whereas these figures were lowest for tendons with sensitivity of 12.5% (CI: 1.55–38.35) and specificity of 86.67% (CI: 69.28–96.24), respectively. Compared to OA, sensitivity and specificity were 100% and 93.75%, respectively. Specificity was lower when compared to gout (40%). MSK-USG demonstrated high diagnostic accuracy in identifying CPPD, especially in hyaline cartilage and fibrocartilage. While these findings support the use of Ultrasound as an adjunctive diagnostic tool, particularly in distinguishing CPPD from OA, the small sample size and retrospective design limit generalizability. Prospective studies with larger cohorts and crystal-confirmed cases are needed for validation.

A 2.6-year-old girl weighing 10kg was diagnosed as Severe Coarctation of Aorta in October 2008. Subsequently, she underwent Balloon angioplasty in April 2009 &amp; later stenting of coarct area was performed with a covered stent in April 2014. In January 2024 she came for follow up after a long gap and re-coarctation was noticed in echocardiography. Balloon dilatation of the covered stent was performed with a 16 × 40 mm Z-med balloon successfully at 17 years of age. Successful journey of this patient since her first admission to pediatric ICU till today led us to write this report. Cardiovasc j 2024; 17(1): 45-47

Background: Tonsillectomy is a very common surgery performed by Ear Nose Throat (ENT) surgeons. There are different methods of tonsillectomy .A number of different complications are related to this surgery. Objective: To find out the complications of tonsillectomy by dissection method. Materials and Method: It was a prospective study carried out in the department of ENT, Medical College for Women and Hospital, Uttara, for a period of six months, from 1st July to 31st December 2023. Only patients admitted for tonsillectomy by dissection method were included in the study. Patients of tonsillitis with enlarged adenoids and other oral pathologies were excluded from this study. Data was collected using pre-designed data collection sheet. Data was processed and analyzed using SPSS software program, version 29 for windows. Results: This study showed that there was a preponderance of female patients (61.43%), with maximum patients being in the age group of 21-40 years (52.85%). On the 7th post operative day (POD), throat pain was the main complaint (48.57%), compared to 1st POD where dysphagia predominated (34.28%). Conclusion: This study aimed at finding out the different complications of tonsillectomy by dissection method, including parameters like patient factors, time taken by different types of surgeons to perform the surgery. This would help surgeons to become more efficient so as to guide the future ENT surgeons and to minimize the complications for better patient compliance. J Med Coll Women Hosp. 2024; 20(2): 64-71

Asynchronous digital health (eg, web-based portal, text, and email communication) can overcome practical barriers associated with in-person and remote synchronous (real-time) consultations. However, little is known about the effectiveness and acceptability of asynchronous digital health to support care for individuals with asthma (eg, asthma reviews). We aimed to systematically review the qualitative and quantitative evidence on the role of asynchronous digital health for asthma care. Following Cochrane methodology, we searched 6 databases (January 2001-July 2022; search update: September 2023) for quantitative, qualitative, or mixed methods studies supporting asthma care using asynchronous digital health. Screening and data extraction were duplicated. We assessed the risk of bias in the clinical outcomes of randomized controlled trials included in the meta-analysis using the revised Cochrane risk of bias tool. For the remaining studies, we evaluated the methodological quality using the Downs and Black checklist, critical appraisal skills program, and mixed methods appraisal tool for quantitative, qualitative, and mixed methods studies, respectively. We determined the confidence in the evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) criteria. We conducted a meta-analysis of trial data and a thematic analysis of qualitative data. We included 30 studies (20 quantitative, 6 qualitative, and 4 mixed methods) conducted in 9 countries involving individuals with asthma, their caregivers, and health care professionals. Asynchronous digital consultations linked with other functionalities, compared to usual care, improved asthma control (standardized mean difference 0.32, 95% CI 0.02-0.63; P=.04) and reduced hospitalizations (risk ratio 0.36; 95% CI 0.14-0.94; P=.04). However, there were no significant differences in quality of life (standardized mean difference 0.16; 95% CI -0.12 to 0.43; P=.26) or emergency department visits (risk ratio 0.83; 95% CI 0.33-2.09; P=.69). Patients appreciated the convenience of asynchronous digital health, though health care professionals expressed concerns. Successful implementation necessitated an organizational approach. Integrative synthesis underscored the ease of asking questions, monitoring logs, and medication reminders as key digital functionalities. Despite low confidence in evidence, asynchronous consultation supported by digital functionalities is an effective and convenient option for nonemergency asthma care. This type of consultation, well accepted by individuals with asthma and their caregivers, offers opportunities for those facing challenges with traditional synchronous consultations due to lifestyle or geographic constraints. However, efficient organizational strategies are needed to manage the associated workload. PROSPERO CRD42022344224; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=344224. RR2-10.1371/journal.pone.0281538.