scholarly journals Epidemiology and clinical features of community acquired pneumonia: hospital based study

2018 ◽  
Vol 6 (7) ◽  
pp. 2260
Author(s):  
Avinash Lamb ◽  
Amol Harinathrao Patil
Keyword(s):  
Streptococcus Pneumoniae ◽  
Clinical Features ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Lower Lobe ◽  
Community Acquired Pneumonia ◽  
Care Hospital ◽  
Female Ratio ◽  
Female Patients ◽  
Common Organism

Background: Community acquired pneumonia (CAP) is an infection affecting a significant proportion of population from all age groups across the globe with considerable morbidity and mortality. There is a need for data from various parts of India to better understand the epidemiology of CAP. Present study is an attempt to present the relevant data from a tertiary care hospital in Rajkot, Gujarat during the study period.Methods: This observational prospective descriptive study was done during November 2014 to April 2016 at Department of TB and chest diseases, PDU Hospital at Rajkot in Gujarat. 50 patients with clinical features suggestive of CAP were enrolled. Male and female patients (above age of 12 years) admitted to TB and Chest ward or patients on OPD basis were selected for the study. The diagnosis of CAP was mainly clinical with some assistance from radiological picture. All patients were thoroughly examined particularly with regards to detailed history, clinical examination, predisposing factors and associated co-morbid conditions. Sputum examination-gram stain and culture sensitivity was done in all patients, where sputum was available. Sputum examination for acid fast bacilli (AFB) by Ziehl Nelson staining technique was done. Age and sex distribution of patients, microorganisms isolated and the clinical features were described and analyzed.Results: The mean age was 38.38±17.41 (SD) years. Male patients were 34 (68%) and female patients were 16 (32%). Male to female ratio was 2.1:1. In this study, 47 (94%) patients were admitted in the hospital for the management and 3 (6%) patients were treated on the OPD basis. Fever and cough were most common symptoms whereas dull note on affected side and crepitations were the commonest signs elicited. In this study, the most common predisposing factor was smoking which accounted for 20 (40%) patients. The most common lobe involved was Left Lower lobe accounting for 20 (40%) patients and least common lobe involved was left upper lobe accounting for 2 (4%) patients. Streptococcus pneumoniae was the most common organism isolated in 8 (16%) patients and second common organism was Klebsiella isolated in 7 (14%) patients.Conclusions: Males, especially smokers were more commonly affected and Streptococcus pneumoniae was the most common organism isolated. The study gives the hospital based data from the region regarding epidemiology and clinical features of community acquired pneumonia.

scholarly journals Risk factors, clinico-epidemiological profile of tuberculosis among children attending a tertiary care hospital: a two year study

2018 ◽  
Vol 5 (3) ◽  
pp. 851
Author(s):  
Ravikumar Tenali ◽  
Naveen Kumar Badri ◽  
Jithendra Kandati ◽  
Munilakshmi Ponugoti
Keyword(s):  
Risk Factors ◽  
Clinical Features ◽  
Tertiary Care ◽  
Epidemiological Surveillance ◽  
P Value ◽  
Tuberculous Lymphadenitis ◽  
Care Hospital ◽  
Female Ratio ◽  
Extra Pulmonary ◽  
Epidemiological Profile

Background: TB remains as the one among the top 10 causes of death worldwide. In 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease with 0.4 million with HIV. At least 1 million children become ill with TB each year. Children represent about 10-11% of all TB cases. Having knowledge of the risk factors for tuberculosis infection in children is important to evaluate the level of ongoing transmission of infection and to help adapt activities within national TB control programs. The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.Methods: The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.Results: 98 cases of TB were confirmed out of total 628 with a prevalence of 17.07% in the   study with 78 PTB cases and 20 EPTB. Females were more with male to female ratio of 0.7:1.5-9 years was the most common age group in the study. Statistically significant association was found between old history of ATT, HIV positivity, contact with an open case of TB and malnutrition (p value<0.05). TB meningitis was the most common EPTB (10/20 cases) followed by tuberculous lymphadenitis (5/20). 69.39% (68/98 cases) were smear positive, radiologically 59.18% of cases were positive and Tuberculin skin test was positive in 46.94%.Conclusions: Childhood tuberculosis is a neglected entity in developing countries due to underreporting and difficulties in diagnosis due to variable clinical picture in children. Hence epidemiological surveillance studies in children are required to determine the actual prevalence of pulmonary and extra pulmonary cases of tuberculosis. Increased efforts are required to isolate TB bacilli from body fluids to identify early the childhood cases and manage them to prevent disease burden in the community.

scholarly journals Prevalence and correlates of psychological distress among cancer patients in a tertiary care hospital in northern India

2019 ◽  
Vol 6 (5) ◽  
pp. 2223 ◽  
Author(s):  
Amita Mason ◽  
Ruchi Juyal ◽  
Sai Chandan Das ◽  
Deep Shikha ◽  
Sunil Saini ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Cancer Patients ◽  
Formal Education ◽  
Economic Status ◽  
Tertiary Care ◽  
Depression Scale ◽  
Care Hospital ◽  
Cross Sectional ◽  
Female Ratio ◽  
Female Patients

Background: Patients diagnosed with cancer are usually exposed to high level of mental stress and hence invariably lend in psychological distress. This study aimed to estimate the prevalence of psychological distress amongst cancer patients and determine its association with socio-demographic factors.Methods: This hospital based cross-sectional study was conducted at a cancer research institute of district Dehradun. Purposive sampling was used to select the hospital and recruiting patients. All eligible patients, giving written consent for the study were interviewed and distress related information was gathered using the Hospital Anxiety and Depression Scale (HADS). The data were collected for two months and sample size of 208 was achieved. Data was entered in SPSS 22.0 and association of different variables with psychological distress was determined by chi-square test..Results: The mean age of the surveyed cancer patients was 51.05±15.68 years and the male female ratio was 1.7. Prevalence of psychological distress was found to be 38.5% and significantly more female patients than male patients (47.4% and 33.3% respectively) had distress. The association between psychological distress and increasing age, sex, literacy and employment status was found to be significant.Conclusions: Approximately 39% of cancer patients had psychological distress (anxiety/ depression/ both). The prevalence of psychological distress was found to be significantly higher in female patients, older age, patients with no formal education, unemployment and lower socio-economic status. Appropriate psychiatric interventions/ counselling following diagnosis and during therapy may be effective in reducing distress and improving quality of life in cancer patients.

scholarly journals Relationship between Radiological Findings with Bacterial Etiology of Community Acquired Pneumonia in Pediatric Population

2021 ◽  
Author(s):  
Nidhi Pandey ◽  
Garima Mittal ◽  
Nitika Agarwal ◽  
Barnali Kakati ◽  
R.K. Agarwal
Keyword(s):  
Sample Size ◽  
Tertiary Care ◽  
Radiological Finding ◽  
Clinical Signs ◽  
Lower Lobe ◽  
Community Acquired Pneumonia ◽  
World Health ◽  
Care Hospital ◽  
Number Of Patients ◽  
The Right

Pneumonia continues to be a major cause of morbidity and mortality in children. Pneumonia is the leading killer of children worldwide. For the diagnosis of pneumonia, the World Health Organization has introduced guidelines for the management of cases to reduce the mortality of these diseases on the basis of simple clinical signs followed by the empirical treatment with antibiotics. More than 99% of deaths related to pneumonia among children occur in countries having a low and middle income. To study the Radiological finding of Community-Acquired Pneumonia (CAP) in children. Across sectional study was conducted in which the sample size for the study was calculated from the expected prevalence of CAP based on other studies (74%). The sample size calculated by the required criterion for this study is 96. I was able to cover 118 patients as per the inclusion criteria in this study. The Patients of pediatric age groups and either sex attending tertiary care hospital with complaints suggestive of CAP. In this study total number of patients are 118 included who presented with the signs and symptoms suggestive of pneumonia. The findings of chest X-Ray of Right Lung with respect to different bacterial agents. Consolidation of the Right upper lobe is found to be statistically significant with respect to Streptococcus pneumonia and consolidation of the right lower lobe is found to be statistically significant with respect to bacteria Staphylococcus aureus whereas there is no statistically significant association with respect to other bacteria. The radiological finding of CAP in children attending pediatric OPD was observed that there was no association with any other bacteria.

scholarly journals Clinico-pathological and demographic profile of patients with carcinoma stomach: a tertiary care experience

2019 ◽  
Vol 6 (6) ◽  
pp. 2145
Author(s):  
Shabir Ahmad Mir ◽  
Mir Intikhab ◽  
Hanief Mohamed Dar ◽  
Mumtazdin Wani
Keyword(s):  
Gastric Cancer ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Histopathological Diagnosis ◽  
Care Hospital ◽  
Female Ratio ◽  
Demographic Profile ◽  
History Of ◽  
Carcinoma Stomach ◽  
Gastric Malignancy

Background: Gastric cancer is a common malignancy all over the world, and our valley is not an exception. Under this background, we conducted the present study at our tertiary care hospital to look into the clinico-demographic profile of this disease.  Aim was to determine the clinico-pathological and demographic profile of patients with carcinoma stomach attending to our tertiary care hospital.Methods: This prospective study was conducted in unit-II of department of general surgery in Shri Maharaja Harisingh hospital Srinagar, over a period of 5.5 years from July 2012 to December 2017. All patients with histopathological diagnosis of gastric malignancy were included and analysed.Results: Male to female ratio was 1.4:1 with mean age of 63.23 years. The most common histopathological type of gastric malignancy was adenocarcinoma (85.84%) followed by lymphoma. The most common location of the gastric cancer was distal third of the stomach. Fifty-seven patients (50.4%) were offered definitive surgery and 21(18.58%) were managed by palliative surgery. Out of 113 patients, 87 patients (76.9%) had present or past history of smoking. The most common presentation in our study was dyspepsia.Conclusions: Profile of gastric carcinoma in our institution is not in wide variance with that of other studies. A significant proportion of patients presented with an advanced or unresectable disease because of the delay in proper screening. All patients with history of dyspepsia (age >50 years) and anemia should undergo screening upper gastrointestinal (UGI) endoscopy at the earliest, so that we can detect the lesion at the initial stage.

scholarly journals Clinical profile of amoebic liver abscess patients admitted in a tertiary care hospital

2016 ◽  
Vol 48 (1-2) ◽  
pp. 20-23 ◽  
Author(s):  
Bishnupada Paik ◽  
Swapan Kumar Sarkar ◽  
Poritosh Kumar Chowdhury ◽  
Saad Ahmed
Keyword(s):  
Clinical Features ◽  
Liver Abscess ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Clinical Profile ◽  
Amoebic Liver Abscess ◽  
Care Hospital ◽  
College Hospital ◽  
Female Ratio ◽  
The Mean

Amoebic liver abscess is an important cause of space occupying lesions of the liver, especially in tropical and sub tropical regions. It is the most frequent complication of invasive amebiasis. It may be found in all age groups but relatively rare in children. The signs and symptoms vary according to the severity of illness. The present study was done to evaluate the clinical profile of patients with amoebic liver abscess for age, gender, clinical features, site of abscess, number of abscess, treatment modality by intravenous metronidazole along with percutaneous needle aspiration and prognosis. A prospective study of 86 admitted patients of amoebic liver abscess were included in this study which was carried out in the medicine department of Khulna Medical College Hospital over a period of 2 years from July 2010 to June 2012. Mean age of patients was 45 years. Male female ratio was 7:1. The mean duration of fever was 17.9 days and the mean duration of pain was 14.1 days. The duration of fever for more than 2 weeks was seen in 38 cases. Regarding clinical features, the major symptoms of fever, pain abdomen and dysentery were seen in 81, 78 and 10 cases respectively. The major signs as determined by clinical and radio imaging studies were hepatomegaly in 76, right lobe abscess in 60, left lobe abscess in 12, multiple abscesses in both lobes in 18, ascites in 5 and right sided pleural effusion in 12 cases respectively. All the cases underwent percutaneous needle aspiration. 5 cases died out of 86 patients.Bang Med J (Khulna) 2015; 48 : 20-23

scholarly journals Clinical spectrum and out comes of snake bite patients admitted in a tertiary care hospital , A prospective observational hospital based study

JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Sameer Anand ◽  
Owais Ahmed ◽  
Vijay Kundal
Keyword(s):  
Clinical Features ◽  
Rural Areas ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Snake Bite ◽  
World Health ◽  
Major Public Health Problem ◽  
Care Hospital ◽  
Female Ratio ◽  
Snake Bites

Background: Snakebite is a major public health problem and its prevalence is high in India. Insufficient epidemiological data and global neglect of this condition prompted the World Health organization to recognize it as a ‘‘neglected tropical disease’’ Objective: To study demographic characteristics of snakebite victims, to see clinical symptoms of bite and outcomes of snakebite. Methods: A prospective observational hospital-based study carried out from November 2016 to October 2017, in patients with a history of snakebite. Results:Total 300 patients were included in this study,170 (56.67%) were bitten by heamotoxic snakes and 130 (43.33%) were bitten by neurotoxic snakes. Majority of patients  were in the age group of 20-39 years  ( n=153; 51%). Men outnumbered women( n=190; 63.33%), with male to female ratio of 1.7: 1. Higher incidence of snake bite was found in July – September (n=135;45.00 %) followed by April to June( n=124; 41.33%).Majority of patients were farmers in rural areas ( n=242; 80.80%).Out of 300 patients,80required ICU care.In patients with neuroparalytic snake bites, clinical features were; ptosis (n=126; 96.92%),ophthalmoplegia  (n=98; 75.38%),respiratory paralysis (n=60; 46.15%),bulbar weakness ( n=74; 56.92%) andabdomen pain(n=25; 19.23%).Clinical features in patients of haemotoxic snake bites were ; bleeding from bite site(n=110; 65.29%) , cellulitis(n=100; 58.82%), gum bleed(n=53; 31.18%), ecchymosis(n=49; 28.82%),epistaxis(n=27; 15.82%),gastrointestinal bleeding(n=25; 14.71%) andhaemoptysis(n=19; 11.18%). Complications  observed  were  acute kidney injury ( n=62; 20.67%) , respiratory failure ( n=51; 17.00%) , DIC( n=7; 2.33%) and  ARDS( n=5; 1.67%) . Out of 170 hemotoxic snake bite patients, 157 (92.35%)  patients  recovered  and 13 (7.65%) patients  died and out of 130 neurotoxic snake bites, 124 (95.39%) patients  recovered and 6 (4.61%)  patients   died, overall mortality was 6.3%. In our study, bite to needle time  was less than 1 hour in 47 patients (15.66%), less than  6 hrs in 120 patients (40%) and more than 24 hours in 45 (15%). Conclusion: Snakebite is common in adult males between 20 to 50 years and the commonest site is the lower limb. The majority of the victims are farmers who work in fields. A maximum number of cases presented within 1-6 hours of bite using a tourniquet on the affected limb as first aid. The complications and mortality of snakebite are high.

scholarly journals Epidemiological and Clinical factors associated with mortality of confirmed Covid-19 cases admitted and treated in a tertiary care hospital of Patna, Bihar

2021 ◽  
Vol 33 (1) ◽  
pp. 30-40
Author(s):  
Alok Ranjan ◽  
Sanjay Pandey ◽  
C M Singh ◽  
Pragya Kumar ◽  
Arshad Ayub ◽  
...  
Keyword(s):  
Kidney Diseases ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Case Fatality ◽  
P Value ◽  
Care Hospital ◽  
Clinical Factors ◽  
Cross Sectional ◽  
Female Ratio ◽  
Factors Associated

Background: A significant proportion of the individuals having the illness of moderate to severe nature due to COVID-19 infection require immediate critical care. High incidence of mortality among elderly population or those with comorbid conditions were reported. Objectives: The study was carried out with objectives to assess the epidemiological and clinical factors associated with mortality among the COVID-19 cases admitted and treated in AIIMS, Patna. Methods: This was a hospital‑based cross‑sectional analytical study of epidemiological and clinical features of COVID‑19‑positive patients admitted and treated during the outbreak from March 20, to August 31, 2020. Results: The median age of COVID-19 cases was 51.5 years (IQR : 37-62 years) which was significantly higher (p-value = 0.001) as compared to females. Male-female ratio of cases was 2.88:1. Out of 1696 cases, the case-fatality rate was 309 (18.22%). The mean age of cases who died due to COVID-19 was significantly higher (p-value=0.001) as compared to those who survived. The odds of mortality was significantly higher in males as compared to females (Adjusted OR = 1.534, 95% CI = 1.10 – 2.13, p=0.011). The odds of mortality showed a significant increasing trend with increasing age (Mantel-Hanszel p-value for trend = 0.015). The covariates like gender, age groups 45-59, 60-74 and 75>=, breathlessness and CKD were found to be significantly associated with mortality after controlling for the confounders. Conclusions: Factors like gender, higher age, lower oxygen saturation causing breathlessness and chronic kidney diseases could be attributed to high risk of mortality in COVID-19 patients.

scholarly journals Aetiological Evaluation of Patients with Meningitis in a Tertiary Care Hospital of Bangladesh

2019 ◽  
Vol 46 (2) ◽  
pp. 26-31
Author(s):  
Sadia Islam ◽  
Md Nazmul Hasan ◽  
Md Azharul Hoque ◽  
Mohammad Selim Shahi ◽  
Md Atikur Rahman ◽  
...  
Keyword(s):  
Tuberculous Meningitis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Case Report Form ◽  
Care Hospital ◽  
Pyogenic Meningitis ◽  
Female Ratio ◽  
Female Patients ◽  
Number Of Patients ◽  
Male Patients

Meningitis is a global health problem as mortality is high and a large proportion of survivors suffered from significant morbidity. The physicians are facing this challenge of emergency identification of this clinical syndrome, establishing its etiology and its prompt treatment not only to ensure survival but also to prevent long term sequelae in these patients. Poor outcomes caused by bacterial meningitis due to delays in diagnosis and treatment. In Bangladesh, the epidemiological study regarding meningitis in adults is rare. Rapid & easily available as well as specific test or means are also not in our hand. The aim of this study was to evaluate the aetiology of patient with meningitis in tertiary care hospital of Bangladesh.The main objective was to evaluate the aetiology of meningitis of patients admitted in medical wards of a tertiary care hospital. The study was a descriptive type of observational study. The study was carried out in the Department of Medicine, Dhaka Medical College Hospital, a tertiary level hospital of Bangladesh from first July 2013 to thirty first December 2013. A total 50 patients were enrolled with Meningitis, diagnosed on clinical, biochemical, other investigational background , fulfilling the inclusion and exclusion criteria. Patients having feature of meningitis was enrolled in the study after getting informed written consent from patient or attendant. Detail demographic data were collected from the informant was recorded in structured case report form. Clinical examination and relevant investigation with CSF study were done. Routine follow up of the patient was done. Data analysis was conducted with SPSS software. Among the 50 patient the mostly affected groups were below 40 years of age comprising 66%. The mean(±SD) age was 33.04 ±18 years. There was an overall male preponderance with a male to female ratio 1.63:1 (N=31 vs N=19). The highest number of patients were presented with fever (100%), headache (98%) and altered mental status (88%). Among all 50 cases of meningitis 27(54%) were diagnosed as pyogenic, 9 (18%) were tuberculous meningitis and 14(28%) were viral . Out of 27 pyogenic meningitis cases 19 (70.37%) developed convulsion, out of 9 tuberculous meningitis 3 (33.33%) developed convulsion and 11 (78.57%) out of 14 viral cases had convulsion, that is convulsion was more common in viral cases. Sixteen male patients (51.61%) and 11 female patients (57.89%) had pyogenic meningitis, 5 male patients (16.12%) and 4 female patients (21.05%) had tuberculous meningitis. On the other hand, 10 (32.25%) male and 4 (21.05%) female had viral meningitis. P value was 0.369, So the male and female difference was not statistically significant. Diagnosis was made on the basis of clinical findings and CSF study. Pyogenic were more common than viral cases and tubercular meningitis. Meningitis is foremost causes of morbidity and mortality. It is recommended that provision of proper health care support, Proper and rapid detection and others investigation facilities reduce the disability. In the interim, this study provides data that can inform public health strategies directed at assessing and reducing meningitis severity and meningitis events. Bangladesh Med J. 2017 May; 46 (2): 26-31

Community acquired pneumonia-current scenario among immunocompromised patients in a tertiary care hospital

2016 ◽  
Vol 5 (01) ◽  
pp. 4715
Author(s):  
A. V. Sowmya* ◽  
G. Jayalakshmi ◽  
David Agatha
Keyword(s):  
Diabetes Mellitus ◽  
Antimicrobial Therapy ◽  
Tertiary Care ◽  
Community Acquired Pneumonia ◽  
Polymicrobial Infection ◽  
Resistance Pattern ◽  
Care Hospital ◽  
Immunocompromised Patients ◽  
Drug Resistant ◽  
Etiologic Agents

Pneumonia is a common illness accounting for majority of hospitalizations worldwide with significant mortality and morbidity. Antimicrobial therapy, being the main stay of treatment, the choices of antibiotics depends on the nature of the etiologic agents and the host factors. The current study was aimed to identify the bacterial & fungal etiologic agents of Community Acquired Pneumonia (CAP) in Immunocompromised (IC) patients, with their antimicrobial resistant pattern and to analyze the associated immunocompromised states. Various respiratory samples from study group of 75 immunocompromised patients with features of pneumonia were collected, processed and the isolates were identified with their antimicrobial susceptibility& resistance pattern according to CLSI guidelines. The results were analyzed statistically. Diabetes mellitus is the most common immunocompromised state (48%) associated with CAP. Monomicrobial and polymicrobial infection rates were 80.36% and 19.64% respectively. Gram negative pathogens and fungal pathogens were identified in 60% and 25.37% of culture positive cases respectively. Diabetes mellitus is commonly found in association with polymicrobial infection (19.44%) and fungal infection (16.66%). Drug resistant strains comprise about 75% of MRSA strains, 72.72 % of ESBL producers and 3.44% of Amp C producers. As the number of elderly people with associated IC state is on rise, with change in the pattern of microbial etiologic agents causing CAP, a prior knowledge of the host and microbial factors will help in formulating empirical antimicrobial therapy and proper treatment thereby curbing the spread of infections by drug resistant pathogens and the associated morbidity and mortality.

scholarly journals Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

2021 ◽  
Author(s):  
Sukriti Das ◽  
Bipin Chaurasia ◽  
Dipankar Ghosh ◽  
Asit Chandra Sarker
Keyword(s):  
Head Injury ◽  
Road Traffic ◽  
Head Injuries ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Acute Subdural Hematoma ◽  
Care Hospital ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
The Government

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

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