Mt. Washington Pediatric Hospital

Background: End stage renal disease (ESRD) is a major and growing public health problem in Bangladesh. It is linked to higher hospitalization rates, lost productivity, illness, and early death, and it is a major cost on people, health care systems, and societies. Haemodialysis as a life saving measure can save patients but out-of-pocket expenditure of Haemodialysis in Bangladesh is high in comparison to their monthly family income. Therefore, it places a significant financial strain on the families of the disease victims. The aim of this study was to find out the out-of-pocket expenditure of ESRD patients for maintenance haemodialysis. Methods: This descriptive cross sectional study was carried out among 160 ESRD patients getting haemodialysis at Dialysis centre of a selected tertiary government hospital in Dhaka during the period of January to December 2022. Simple random sampling technique was followed. Data were collected by face to face interview with a semi-structured questionnaire and by check list reviewing medical documents. Results: The mean (±SD) age of the respondents was 49.28 ±12.706 years. Majority (60.6%) were male and 39.4% were female. Majority (29.4%) had secondary followed by 21.9% who had higher secondary level of education. About three fourths (71.9%) were from urban, 18.8% from rural, 8.1% from semi-urban areas and 1.3% were slum dwellers. The median of monthly family income was Tk. 20000 (interquartile range 15750). The median (IQR) total direct cost was Tk. 15983 (7203). The mean (±SD) total indirect cost was Tk. 5431.25±1128.17. The mean (±SD) total haemodialysis cost was Tk. 24205.59 ±17164.580. Conclusion: Out-of-pocket expenditure of Haemodialysis in Bangladesh is high in comparison to monthly family income and it poses huge financial burden to the families of the victims of end stage renal disease. The study recommended cost effective measures like subsidized or free of cost treatment of ESRD and free of cost haemodialysis of patients to reduce the financial burden of the families. Bangladesh Armed Forces Med J Vol 56 No (1) June 2023, pp 28-34

Defining the complex role of the microbiome in colorectal cancer (CRC) and the discovery of novel, pro-tumorigenic microbes are areas of active investigation. In the present study, culturing and reassociation experiments revealed that toxigenic strains of Clostridioides difficile drove the tumorigenic phenotype of a subset of CRC patient-derived mucosal slurries in germ-free ApcMin/+ mice. Tumorigenesis was dependent on the C. difficile toxin TcdB and was associated with induction of Wnt signaling, reactive oxygen species, and pro-tumorigenic mucosal immune responses marked by infiltration of activated myeloid cells and interleukin-17 (IL-17)-producing lymphoid and innate lymphoid cell subsets. These findings suggest that chronic colonization with toxigenic C. difficile is a potential driver of CRC in patients.

Abstract Throughout middle childhood and adolescence, hostile intent attributions fairly consistently predict levels of aggression. Across 28 published studies in early childhood, however, researchers have found less consistent relationships. We believe this may be due to a majority of these studies using an inappropriate methodological approach for early childhood, forced‐choice questioning. We tested the use of open‐ended vs. forced‐choice questions about intent in 118 Head Start preschool children. In response to a forced choice question, only about 30% of children attributed intent correctly to a video depicting clearly purposeful behavior. And across 18 video vignettes depicting ambiguous provocation, children's intent attribution scores based on a forced‐choice approach demonstrated neither reliability nor validity. Conversely, children's intent attribution scores in response to open‐ended questions demonstrated reliability, correspondence with other aspects of social information processing, and predictive validity in the form of relations to teacher reports of social competence and aggression. Researchers should refrain from utilizing forced‐choice approaches to intent attributions in early childhood unless also conducting intent understanding checks.

Introduction Thoracic outlet syndrome (TOS) is a rare, often perplexing disorder caused by compression of neurovascular structures, leading to cervicogenic–brachial pain and other symptoms in neck and upper limb. Thoracic outlet syndrome is a group of disorders, not a single disorder, and patients may present with a wide variety of signs and symptoms. The wide range of symptoms and signs in TOS may confound clinicians unfamiliar with this condition (Sanders et al ., 2008; Ferrante, 2012; Foley et al ., 2012). Again, because TOS is a group of disorders, there is no “gold standard” to establish the diagnosis. This may lead to misdiagnosis or overdiagnosis of TOS in patients who present with symptoms suggesting TOS but who have other causes for their symptoms. It is, therefore, imperative that physicians be familiar with the range of symptoms and signs of TOS and testing that either supports or refutes this diagnosis. It is also critical that the diagnosis be correctly established before proceeding to invasive interventions for a presumed diagnosis of TOS, including botulinum neurotoxin (BoNT) injections. One of the many emerging applications for BoNT therapy is for the treatment of musculoskeletal pain disorders, including TOS. While the efficacy of BoNT on decreasing pain associated with cervical dystonia and chronic migraine is established, the antinocioceptive mechanism of action of BoNT is not fully understood (Mense, 2004; Aoki, 2005). Reports of reduced pain with BoNT have been reported in various musculoskeletal pain disorders, including joint pain, myofascial pain and cerebral palsy (Barwood et al ., 2000; Gobel et al ., 2006; Singh et al ., 2009). Although there are numerous reports in the literature citing the efficacy of BoNT for pain and other symptoms associated with TOS, additional research is needed to establish the role of BoNT in TOS and other pain disorders (Jordan et al ., 2007; Danielson and Odderson, 2008; Torriani et al ., 2010; Foley et al ., 2012). The proposed mechanism of action includes reduced muscle spasm leading to decreased compression of neurovascular structures (Jordan et al ., 2007; Tsao, 2007; Danielson and Odderson, 2008). Injection of BoNT into muscles also leads to denervation atrophy, which may reduce compression and neurogenic or vasogenic symptoms. It has also been reported that BoNT reduces the release of nocioceptive neurotransmitters, which could also be a contributing factor in reduced pain in TOS.

This article presents findings from a qualitative evaluation of an HIV/STI (sexually transmitted infection) prevention intervention for urban African American youth (Project ÒRÉ), which was delivered to groups of 3 to 8 adolescents who were members of the same friendship network. Sixteen focus groups ( N = 63) were conducted with youth following their participation in the intervention. Results demonstrate high acceptability of the intervention. Both males and females revealed multiple benefits of attending the intervention with friends including feeling more comfortable, experiencing general satisfaction with the program, experiencing greater ease in talking and expressing self, being able to reveal sensitive information, and being able to relate to each other’s experiences. Additional themes were presented only by males including feeling a sense of cohesion, the ability to protect each other from HIV/STIs in the future, and feeling safe. These results suggest that delivering HIV/STI and other prevention interventions within adolescents’ friendship networks may offer unique benefits not found with traditional programs that include random groupings of youth who are not familiar with each other.

Obese children and adolescents have unique needs for specialized medical equipment while hospitalized and might require special diets and physical activity options as part of their medical treatment. It is important that patients with a diagnosis of obesity be identified on admission so that appropriate equipment and resources can be provided. We examined what components a healthy hospital environment should include and sought to determine if children's hospitals provide a healthy hospital environment that offers these components. In addition, we sought to determine if children's hospitals have policies in place to identify children with obesity so that appropriate resources and services can be offered to treat that diagnosis. We surveyed National Association of Children's Hospitals and Related Institutions member hospitals via a Web-based questionnaire and found that the majority of them do not have policies in place to identify patients with obesity. We did find that the majority of hospitals reported innovative programs or services to provide a healthy hospital environment for their patients, visitors, and staff but acknowledged limitations in providing some services. Specifically, children's hospitals can and should improve on their identification and management of obese pediatric patients.