Investigating the level of functional preparedness of selected Tehran hospitals in the face of biological events: a focus on COVID-19

Purpose This study aims to evaluate the functional readiness of selected hospitals in Tehran in the face of biological events focusing on the Coronavirus. Design/methodology/approach The current study is a cross-sectional, descriptive-analytical study, with the research population consisting of four hospitals in Tehran (Ministry of Health, Social Security, Azad and Military University). This study used data collection tools, standardized functional preparedness tools for hospitals using a biological approach and a standardized checklist of biological event preparations for the American Hospital Association. Interviews with the incident and disaster committee director and observation of each hospital’s existing documents, were used to collect data, which was then analyzed using SPSS-16 software. Findings According to the results, the average percentage of total hospital preparedness in biological events is 36.9%. With 53.3%, the selected military hospital has the most preparation, whereas the Ministry of Health has the lowest preparation with 28.3%. Surge capacity management and communication had the most remarkable preparedness rate of 68.75% (adequate preparedness), biological consultants, meeting management and post-disaster recovery had the lowest preparedness rate of 0% (extremely weak preparedness). Practical implications The average functional preparedness of selected hospitals in Tehran was assessed at an insufficient level in this study. Given the recurrence of disease waves, these results are helpful in increasing hospital preparedness for impending events. Improving preparedness in most areas, especially in post-disaster recovery seems necessary. Originality/value Given the COVID-19 pandemic, it is important to assess hospitals’ readiness to increase capacity and respond to this scourge. Few studies have been done in this field in the world. This study investigates this issue in the capital of Iran. The finding of this study suggest authorities’ attention to this issue and the creation of severe and prompt solutions and measures and the use of military hospital experiences to improve biological threat preparedness.

Predictors of Psychological Impact Among the Healthcare Workers Exposed to Covid-19 Cases in a Tertiary Hospital of Bangladesh

Background: The unprecedented global pandemic caused by SARS-CoV-2 creates considerable psychological problems among the health care workers (HCW). The present study aimed to determine the predictors of psychological impact (in terms of depression, anxiety and stress) among the HCWs exposed Covid-19 cases in Combined Military Hospital (CMH) Dhaka. Methods: This cross-sectional study was conducted at CMH Dhaka among purposively selected 390 HCWs. Data were collected through face-to-face interview using a pre-tested semi-structured questionnaire with validated and reliable tools. The study was conducted in the Combined Military Hospital Dhaka from 15 July 2020 to 30 September 2020. Results: Among the 390 respondents, 21.6%, 43.1% and 24.1% had depression, anxiety and stress symptoms, respectively. Being married (OR=0.391, 95% CI=0.160-0.953), graduate (OR=2.977; 95% CI=1.181-7.509) and attending 41-80 patients per day (OR=1.996; 95% CI=0.965-4.125) was significantly associated with depressive symptoms. In respect of anxiety, being graduate (OR=2.788, 95% CI=1.228 -6.333) and HSC qualified (OR=2.714, 95% CI=1.073-6.869), staying in family accommodation (OR=2.720, 95% CI=1.136 - 6.516), with nuclear family (OR=0.459, 95% CI=0.281-0.750), smoker (OR=1.827, 95% CI=0.987 - 3.384), doctor (OR=0.362, 95% CI=0.173- 0.758), having service length <20 years (OR=2.229, 95% CI=1.158 - 4.289), service in current place of posting for <20 months (OR=0.460, 95% CI=0.241-0.880), attended 41-80 patient daily (OR=1.720, 95% CI=0.933 - 3.169) and performing overtime duty (OR=2.568, 95% CI=1.609-4.099) were significantly associated with anxiety symptoms. Being graduate (OR=2.249, 95% CI=0.866-5.844), with nuclear family type (OR=0.423, 95% CI=0.249-0.721), having duty place at emergency (OR=2.135, 95% CI=0.902-5.053), being a nurse (OR=0.364, 95% CI=0.162-0.819), having service length <10 years (OR=2.570, 95% CI=1.207-5.472) and performing overtime duty (OR=2.214, 95% CI=1.3101-3.742) were significantly associated with stress symptoms. Conclusion: Psychological problems among the HCW found very common in our study which needs psychological crisis interventions to protect the mental health of HCWs. JOPSOM 2021; 40(1): 1-13

Assessment of Biochemical Changes Among Covid-19 Cases in a Tertiary Hospital of Bangladesh During Early Pandemic

Background: Corona virus disease 2019 (COVID-19) involves various organs of the body causing several biochemical changes which plays an essential role in estimating the patients’ condition and prognosis, directing treatment, and even evaluating the curative effects. The present study aimed to assess the biochemical changes among the COVID-19 patients during early pandemic. Methods: This cross sectional study was conducted at Combined Military Hospital (CMH) Dhaka among purposively selected 237 confirm COVID-19 cases. Data were collected through face to face interview and review of medical records using a pre-tested semi-structured questionnaire. The study was conducted in the Combined Military Hospital Dhaka from 15 April 2020 to 31 May 2020 Results: Highest number of the respondents were in the age group of 31-40 years (37.1%) with male predominance (83.1%). About 95.6% were Muslim and 58.6% were educated up to secondary level. About 87.8% had contact with a confirmed case and having 47.7%, 37.2%, 15.1% cardiovascular, endocrine and respiratory comorbidities respectively. Fever (34.6%) was the most common presenting symptoms followed by cough (22.9%), sore throat (10.6%). Neutrophilia observed in 26.16%, lymphopenia in 20.7%, thrombocytopenia in 14.3% cases, 30.0% with positive D-dimer test, 22.4% either sepsis or systemic infection in procalcitonin estimation, 28.3% with increased ferritin, 28.7% with positive C reactive protein, 21.1% with increased LDH. Chi-square analysis revealed a statistically significant association between cardiovascular and endocrine diseases with several biochemical changes (p<0.05). Conclusion: Early identification of various biochemical changes would help the physician for appropriate assessment and management. JOPSOM 2021; 40(1): 34-42

HMGB1 Inhibition to Ameliorate Organ Failure and Increase Survival in Trauma

Several preclinical and clinical reports have demonstrated that levels of circulating high mobility group box 1 protein (HMGB1) are increased early after trauma and are associated with systemic inflammation and clinical outcomes. However, the mechanisms of the interaction between HMGB1 and inflammatory mediators that lead to the development of remote organ damage after trauma remain obscure. HMGB1 and inflammatory mediators were analyzed in plasma from 54 combat casualties, collected on admission to a military hospital in Iraq, and at 8 and 24 h after admission. In total, 45 (83%) of these patients had traumatic brain injury (TBI). Nine healthy volunteers were enrolled as controls. HMGB1 plasma levels were significantly increased in the first 8 h after admission, and were found to be associated with systemic inflammatory responses, injury severity score, and presence of TBI. These data provided the rationale for designing experiments in rats subjected to blast injury and hemorrhage, to explore the effect of HMGB1 inhibition by CX-01 (2-O, 3-O desulfated heparin). Animals were cannulated, then recovered for 5–7 days before blast injury in a shock tube and volume-controlled hemorrhage. Blast injury and hemorrhage induced an early increase in HMGB1 plasma levels that coincided with severity of tissue damage and mortality. CX-01 inhibited systemic HMGB1 activity, decreased local and systemic inflammatory responses, significantly reduced tissue and organ damage, and tended to increase survival. These data suggest that CX-01 has potential as an adjuvant treatment for traumatic hemorrhage.

Frequency and Antimicrobial Susceptibility Pattern of Gram-Negative Bacilli Isolated From Urine Specimens at a Tertiary Care Setting

OBJECTIVES: To find out the frequency and pattern of conventional antibiotic susceptibility of gram-negative bacilli cultured from urine specimens of patients at a tertiary care setting. METHODOLOGY: This study was conducted at the Microbiology Department of Combined Military Hospital Multan from June 2016 to May 2017. The data in this retrospective descriptive study was collected from urine culture records of the Microbiology Department, CMH Multan. Only those urine specimens who revealed positive gram-negative bacilli cultures were included in the study. Drug susceptibility patterns of these isolates were recorded against routinely used antibiotics (e.g. Nitrofurantoin, Imipenem, Sulbactum-cefoperazone, Gentamicin and Ciprofloxacin) and evaluated accordingly. RESULTS: A total of 1703 urine specimens were submitted for culture and antibiotics susceptibility testing during the period of study. A total of 128 specimens showed growth of gram-negative rods. Imipenem (95% sensitivity), Sulbactam- Cefoperazone (88% sensitivity) and Nitrofurantoin (87% sensitivity) were highly effective antibiotics against the cultured gram-negative bacilli in the study. CONCLUSION: This study showed that E. coli is the commonest cause of urinary tract infection (UTIs), followed by Klebsiella and Enterobacter species among gram-negative bacilli in our set up. In-vitro efficacy of Imipenem, Sulbactam- Cefoperazone and Nitrofurantoin was found to be the highest against these gram-negative bacilli as compared to other antimicrobials. On the contrary, in-vitro efficacy of ciprofloxacin and gentamycin was found to be extremely low.

Maternal and Fetal Outcome of Pregnancy with COVID- 19 in A Tertiary Level Hospital, Bangladesh

Introduction: Pregnant women have long been recognized as a vulnerable population during infectious disease pandemics due to physiological changes in the immune, pulmonary, cardiac and coagulation systems. It is essential to acquire knowledge of pregnancy outcomes, potential complications and neonatal health conditions born to an infected mother with COVID-19. Material and methods: This cross-sectional observational study was conducted in Combined Military Hospital (CMH), Jashore from June 2020 to July 2021 among 100 hospitalized laboratory-confirmed COVID-19 positive pregnant women, patients who had clinical symptoms of COVID but RT PCR negative were excluded. The aim of the study was to evaluate the clinical profile and maternal and fetal outcome of pregnancy. Relevant data were recorded in a preformed data collection sheet and analyzed by SPSS version 20. Results: Among 100 COVID-19 positive hospitalized pregnant women, the mean age of participants was 27years (range 19-40 years), Maximum infection rate observed during 12 to 28 weeks of gestation among the participants, 21% got infected at 37 to 40 weeks of gestation and 20% got infected at 32 to 36 weeks. Seventy-four percent patients underwent delivery during the study & 23% of them continued with ongoing pregnancy; 67 of the participants underwent LUCS and 7 vaginal deliveries were done, 3% had abortion and IUFD 1% ,61% were multipara and 39% were Primipara, associated co-morbidities were subclinical hypothyroidism(15%), pregnancy induced HTN(12%) and GDM(8%); 36% participants were asymptomatic and 44% had mild symptoms, rate of LUCS was higher than (90.64%) vaginal delivery. Among the 73 live births, 80.82% were term and 10.18% were preterm of neonates, small for gestational was seen in the case of 20.55% neonates. Testing for SARS-CoV-2 was performed in all neonatal throat swabs and found positive in one case only. Eighty-six percent neonates were well-baby and 9.58% neonates required NICU admission. There were 2 neonatal deaths due to severe prematurity and 2 babies were found to have congenital cardiac anomaly and cleft lip, cleft palate. Though 36% of patients were asymptomatic but 10% were severe and in the critical stage. HDU support needed for 8% of patients and ICU support for 6%. Conclusion: This cross-sectional study supports that pregnant women with COVID-19 infection are at increased risk of adverse pregnancy and birth outcomes and a low risk of congenital transmission. Availability of ICU in critical conditions is needed for better pregnancy outcomes. J Bangladesh Coll Phys Surg 2022; 40: 10-16

Evaluation of Pressure Ulcer Among the Critically Ill Patients Admitted in a Tertiary Hospital

Background: All over the world pressure ulcer is a significant health care problem due to high morbidity and mortality rates and also high health care cost. This study was carried out with the objectives to identify the characteristics and associated factors of pressure ulcer among the critically ill patients admitted in a tertiary military hospital. Few studies have been conducted on pressure ulcer in Bangladesh and very few in military hospitals. Methodology: This was a cross sectional study conducted among purposively selected 53 critically ill admitted pressure ulcer patients in CMH Dhaka from 01 July 2018 to 31 December 2018 and data were collected by face to face interview and checklist. Results: Among the study population half (50.9%) were aged between 61-80 years with the mean age 69.13 years. The most common anatomical site of pressure ulcer were buttock (51.9%) followed by sacrum (38.5%) and 30.2% had multiple pressure ulcer. Among the critically ill patients, 81.1% had developed pressure ulcer after admission into hospital. The most common place of pressure ulcer was geriatric HDU (30.2%) and officers ward (18.9%). Among the pressure ulcer patients 79.2% were male. Most common stage of pressure ulcer were stage II (66.0%) followed by stage I (18.9%), stage III (13.2%) and stage IV (1.9%). All of them were bedridden and half (50.9%) were completely immobile. According to Braden Scale, about half (50.9%) had high risk for development of pressure ulcer followed by moderate risk (26.4%) and there were none beyond risk. About three fourth (73.6%) of pressure ulcer patients had hypertension & cerebrovascular diseases. Age group of 60-90 years, SSC & above educational group, male sex, immobility, low Braden score group patients are statistically significant (p < 0.05), and hypertensive and cerebrovascular diseased patients are not statically significant (p > 0.05) but having clear trends to be associate factors of pressure ulcer. Conclusion: The number of pressure ulcer were increasing with the increase of age. The higher age, male sex, immobilization, low Braden score, hypertension, and cerebrovascular diseased patients were more prone for development of pressure ulcer among the critically ill patients. J Bangladesh Coll Phys Surg 2022; 40: 23-30

Outcome of Preterm Admissions at the Neonatal Unit of a Tertiary Care Military Hospital of Bangladesh

Introduction: Preterm deliveries contribute to major morbidity and mortality in developing countries. They are a leading cause of admission in neonatal care units. It is a major hindrance to the attainment of the Sustainable Development Goal (SDG)-3 targets given its high contribution to neonatal mortality. Early detection of its risk factors and advances in the management have ensured better survival of preterm births. This study was conducted to determine the prevalence, underlying causes, morbidity patterns and outcome of preterm admissions to a neonatal intensive care unit (NICU) of a tertiary care center in Combined Military Hospital (CMH) Sylhet. Material and Methods: A descriptive study was conducted in CMH Sylhet from July 2018 to June 2020. All live preterm babies delivered at CMH Sylhet during the study period were included. Information obtained included gestational age at birth, gender, cause for preterm birth, problems during admission and outcome. Results: During this period, a total of 662 neonates were admitted out of which 107 (16.2%) were preterm with gestational ages ranging from 27 completed weeks to less than 37 completed weeks with a mean gestational age 33.2 weeks (± 2.7 weeks) and birth weights from 800 - 2600 gm with a mean of 2100 gm (± 700 gm). There were 52 males and 55 females (M: F 0.95). One hundred and thirty three (20.1%) were delivered by normal vaginal delivery while 529 (79.9%) were delivered by Caesarean section. The duration of hospital stay ranged from 1 - 45 days, with a mean duration of 15 days (± 9.2 days). The commonest reason for prematurity was premature rupture of membrane (PROM) (39.3%) followed by gestational diabetes mellitus (GDM) (35.5%), hypertensive disorders in pregnancy (30.8%), multiple pregnancy (29.9%) and inadequate ante natal care (ANC) (20.6%). The commonest morbidity in the patients in the present study was neonatal jaundice (90.7%) followed by respiratory problems (78.5%), sepsis (17.8%) and congenital heart disease (CHD) (15.9%). Case fatality rate for patients with respiratory distress syndrome (7.7%) and sepsis (5.3%) were common. Overall survival rate was 91.6% and was significantly (p <0.001) higher in the moderate to late preterm category compared to the very preterm and extremely preterm births. Conclusion: PROM, GDM, hypertensive disorders in pregnancy, multiple pregnancy and inadequate ante natal care were significantly associated with preterm birth. Neonatal jaundice, respiratory problems, sepsis and CHD were common morbidities observed. Case fatality rate was significant in neonates with respiratory distress syndrome and sepsis and overall survival rate was 91.6%. So, at-risk mothers should receive intensified antenatal care to mitigate preterm birth. J Bangladesh Coll Phys Surg 2022; 40: 39-44

SEMEN ANALYSIS; CORNER STONE IN EVALUATING INFERTILITY

Objective: To study the patterns and distribution of various abnormal semen parameters in infertile males. Study Design: Cross sectional study. Place and Duration of Study: Department of Pathology, Combined Military Hospital, Karachi, from Nov 2019 to Oct 2020. Methodology: The study included 364 patients who presented with primary and secondary infertility. Consecutive convenient sampling was done. Semen analysis was performed using World Health Organization latest guidelines. Samples were categorized as normospermia, azoospermia, oligospermia, asthenozoospermia and necrospermia. Results: The study comprised of 364 samples of infertile males. Normal sperm count was observed in 317 (87%) males, azoospermia in 28 (7.6%) and oligospermia in 19 (5.2%) males. Low ejaculated volume and higher non-motile sperms were noted in oligospermia samples in comparison with normospermia samples. Asthenozoospermia was observed in 102 (28%) and oligoasthenospermia was noted in 15 (4.1%) samples. Conclusion: Good quality semen analysis is a corner stone to diagnose the cause of male infertility.Sperm concentration and motility are the important markers of normal male reproductive system and are related to each other.

COMPARISON OF LOCAL METHYLCOBALAMINE INJECTION VERSUS LOCAL BUPIVACAINE INJECTION FOR THE TREATMENT OF ACUTE HERPETIC NEURALGIA

Objective: To compare the reduction in mean pain score with local Methylcobalamin injection versus local Bupivacaine injection in patients with acute herpetic neuralgia. Study Design: Quasi experimental study. Place and Duration of Study: Dermatology Outpatient Department, Pak Emirates Military Hospital, Rawalpindi, from Jun to Dec 2019. Methodology: Total 100 patients, having pain score more than 3, fulfilling the selection criteria were divided into two groups. Group A was treated with daily subcutaneous injection Bupivacaine, whereas Group B was treated with daily subcutaneous injection Methycobalamin at the site of neuralgia. Patients were followed up for 4 weeks. The pain score was noted. All the data was entered and analyzed on SPSS version 21. Results: In this study mean age of patients in group A was 43.82 ± 15.76 years and in group B was 44.76 ± 16.92 years. The mean visual analogue pain score at 4th week in the group A patients was 1.14 ± 0.32 and in group B was 1.90 ± 0.97. Statistically significant difference was found in group A (local Bupivacaine) with visual analogue score (VAS) at 4th week (pvalue=0.002). Conclusion: The local Bupivacaine injection showed significant reduction in mean pain score than local Methylcobalamin injection in patients with acute herpetic neuralgia.