Persistence of Fatigue among COVID-19 Survivors in Bangladesh: A Two-month after Follow-up Study

Background: A limited number of studies have exclusively assessed fatigue among post-COVID patients. Our study aimed to assess the persistence and associations of fatigue among COVID-19 survivors after two months of recovery from their primary illness. Methods: During hospital admission from August to September, 2020, a total of 400 patients were diagnosed to be suffering from fatigue using Chalder fatigue scale. After obtaining informed written consent, patients were followed up two months later over telephone. A total of 332 participants participated in the interview (63 patients could not be traced and another 5 patient died within two months). Patients were asked to categorize their present fatigue condition based on a simplified questionnaire developed for telephone interview. Results: Among study participants, 62.9% (n=207) were found to be still suffering from fatigue two months after their hospital discharge. A significant association of fatigue was found with age (p=0.000), hypertension (RR: 1.51; CI: 1.15-1.99; p=0.002), diabetes mellitus (RR: 1.45; CI: 1.08-1.95; p=0.010), ischemic heart disease (RR: 2.04; CI: 1.15-3.64; p=0.011), on admission SpO2 (p=0.000), on admission serum ferritin (p=0.000), d-dimer (p=0.000), CRP (p=0.000), and Hb% (p=0.019). Binary logistic regression model revealed significant association of age and onadmission SpO2 with persistence of fatigue. Conclusions: Fatigue is a highly prevalent symptom among the COVID-19 survivors with significant association between fatigue and patients clinical and laboratory markers. Bangladesh J Medicine July 2022; 33(1) : 57-63

COVID-19 and It’s Impact on Cardiovascular System

not available Bangladesh J Medicine July 2022; 33(1) : 76-84

COVID-19 and Dengue Co-infection in a Young Girl: A Case Report

During COVID-19 pandemic, the increasing incidence of dengue in Monsoon season has become a further threat especially in the dengue endemic countries of Southeast Asia like Bangladesh. Co-infection of dengue with COVID-19 has created a number of practical challenges to combat the diseases simultaneously, especially at a time when healthcare resources are already exhausted tackling the COVID pandemic. We are presenting the case report of a 14 year old girl who suffered from both RT-PCR positive COVID -19 infection & NS1 positive Dengue. She was managed in a Private Hospital of Dhaka as Dengue fever Group C (due to severe plasma leakage) with severe COVID-19 infection (as required oxygen therapy). She had a critical course of illness, having continued fever, cough, breathlessness, desaturation along with thrombocytopenia & plasma leakage. However, to our great satisfaction, the patient was ultimately improved & could be discharged in a happy face. Bangladesh J Medicine July 2022; 33(1) : 104-108

Impact of Donor Inflow in COVID 19 Pandemic: A Tertiary Care Hospitals Blood Service Experience

Background: The severe acute respiratory syndrome (SARS) causing the COVID 19 pandemic infection has affected one and all across the world and halting mosthuman activities. During the disease outbreak and country lockdown, Blood Transfusion Services faced numerous challenges to maintain the sustainability in service provision. We intend to identify the challenges faced during COVID-19 outbreak and the following imposed national lockdown. Methods: This retrospective study was done during the lockdown period from26/03/2020 to 30/05/2020 comprising 66 days to detect donor inflow declination and to compare the donor inflow with pre lockdown and post lockdown period of same duration. The periods were divided into six equal intervals to compare donor distribution patterns in lockdown, pre lockdown and post lockdown period. Mean and standard deviation was calculated for continuous variables and chi square test was done for categorical variables. Results: The donations collected during the lockdown period and post lockdown period were almost 71.37% and 62.82% less respectively when compared with the pre lockdown collection (211and 274 versus 737).While in interval periods, donor inflow was declined substantially in lockdown period and in post lockdown period, inflow was declined as of lockdown period initially but it increases as time passed. But the increment was not as such of pre lockdown period. Donor inflow in age group and time interval of donation frequency were statistically significant (p <0.00005 and p< 0.0037 respectively). Conclusion: Concerns of being infected through hospital contact, lack of public transport facilities, travel restrictions imposed by the police department, and no availability of medical student donors in the hospital setting were the main attributing factors for donor inflow. Bangladesh J Medicine July 2022; 33(1) : 70-75

Outcomes of Dialysis in low Income Country – An Experience in a Tertiary Care Center of Bangladesh

Background: The widespread use of hemodialysis to prolong life of end-stage renal disease (ESRD) patients has been a remarkable achievement, preventing death from uremia in these patients. The aim of the study was to find out the outcomes of haemodialysis patients with end-stage renal disease (ESRD) in low Income County. Methods: A hospital based prospective observational study was performed in the of Department of Nephrology, Shaheed Suhrawardy Medical College. Total 189 patients who stated dialysis during study period were included. All patients were monthly followed up and appropriate investigation done. All data recorded in a case record form. Study protocol approved by Ethical committeeof institute. Data analyzed in SPSS software version 25. Results: Among 189 ESRD patients on MHD selected with mean age 49.16 years (15-82), male was 60.3% and female 39.7%.Eighty eight 46.5% patient died and 39.15%(74) patient discontinue dialysis due to lack of financial support or helping assistant or social support. Three (1.6%) patients underwent renal transplantation and five patients (2.6%) transfer to other dialysis center. Average life span in dialysis 256 day (16-786 days). Most of the paints was on twice weekly dialysis 84%. Vascular access of stating dialysis was 73.8% by catheter and only 32.2% stated with AV fistula. Conclusion: A large group of patients leave dialysis due to financial or helping personal or social supportwithin 3-4 months of stating dialysis. A significant number of patients died due to multiple risk factors within 8-9 months. Identification of risk factors for early mortalityis essential and appropriatemeasure should take to prevent discontinuation at community and national level. Bangladesh J Medicine July 2022; 33(1) : 52-56

Echocardiographic Evaluation of Systolic Left Ventricular function in Acute Myocardial Infarction in 1st Week of Hospitalization

Objectives: To assess systolic left ventricular function determined by left ventricular ejection fraction (LVEF) with the help of Echocardiography and correlate with ECG findings in patients of AMI. Methods: One hundred (100) cases of acute myocardial infarction were studied in the Department of Cardiology, DMCH from July 2015 to December 2015. It was an observational study. All selected patients were interviewed with a preformed questionnaire and were observed up to 7 days in hospital. Echocardiography was done to assess left ventricular ejection fraction (LVEF) by applying Teichholz (cube) formula. Results: 83% of them were males and 17% of them were females. Mean age (±SD) was 52.24±11.59 years (range 34-82 years). The important risk factors among the study subjects, was hypertension (45%) (Male 40.96%; Female 64.7%) followed by Diabetes mellitus (33%) (Male 31.32%; Female 41.17%). Most of the admitted patients could reach in hospital within 4-12 hours of onset of symptoms and most of the patients of acute myocardial infarction had anterior wall involvement (37%). Mild systolic LV dysfunction (52.87%) was revealed in echocardiography among the survivors. Conclusion: The incidence of AMI was seen common among farmers who were mostly hypertensive. Systolic LV dysfunction was common in most patients where anterior wall involvement was present. Bangladesh J Medicine July 2022; 33(1) : 12-18

Tale of a Teenager: A Case Report of Tuberous Sclerosis

Tuberous sclerosis complex is an unusual neurocutaneous syndrome with autosomal-dominant inheritance. It is characterized by the development of benign tumors involving the brain, skin, retina, heart, kidneys, lungs, and liver. The classic triad of clinical features comprises learning disability, epilepsy and skin lesions but there is marked heterogeneity in clinical features. Here, we present a case report of a 17-old-year male with characteristic clinical and radiological features of tuberous sclerosis complex. Bangladesh J Medicine July 2022; 33(1) : 99-103

A Perplexing Case of Pituitary Apoplexy Masquerading as Meningoencephalitis

Pituitary apoplexy (PA) is extremely rare in children and adolescents. It is a life-threatening condition usually results from sudden hemorrhage or infarction induced swelling in a pituitary adenoma. The clinical manifestations of PA include severe headaches, impaired consciousness, fever, visual disturbance, and variable ocular paresis. Therefore, the presence of meningeal irritation may lead to misdiagnosis as a case of meningoencephalitis or spontaneous subarachnoid hemorrhage, and delay in the proper management of the disease. We report a case of 17-year-old pubertal boy who developed sudden severe headache, vomiting, slurring of speech and abnormal behaviour followed by impaired sensorium with fever. The patient who was initially diagnosed with meningoencephalitis (ME) based on clinical presentation and cerebrospinal fluid (CSF) analysis, which was consistent with bacterial meningitis. MRI of brain was performed, confirming a pituitary macroadenoma with hemorrhage and ischemic changes in both basal ganglia and pons. A complete analysis of the pituitary hormones revealed decreased cortisol and thyroid hormone level and hyperprolactinemia and he was subsequently started on placement corticosteroid and L-thyroxine therapy and cabergoline. After 14/ days of antimicrobial therapy with ceftriaxone and ampicillin, the patient improved and was discharged on hormone replacement therapy and surgical advised. Hereby, we report our case with a review of literatures. Bangladesh J Medicine July 2022; 33(1) : 85-88

Answer to Medical Quiz: Image (Vol 33)

not available Bangladesh J Medicine July 2022; 33(1) : 124-125

Evaluation of the Changes in Mental Health State at the Beginning of COVID-19 in Hospital Personnel

Objective: In the present study, it was aimed to determine the changes in the mental states of hospital personnel at the beginning of COVID-19 pandemic, and the factors affecting these changes. Methods: The research sample consisted of 299 hospital personnel in Turkey, who could be reached with the online method. The data were collected using the “Information Form”, which was prepared in line with the literature and the pandemic process, “The Impact of Event Scale (IES)” and the “Depression-Anxiety-Stress Scale (DAS-21)”. Results: It was found that the sociodemographic characteristics, medical history, and the characteristics related to COVID-19 were effective on the participants in terms of their mental states and the way they perceived traumatic experiences. According to the multiple linear regression analyses, it was found that hyper arousal and reexperiencing predicted stress, anxiety, and depression with a rate of 58.5%, 59.0% and 60.6%, respectively. Conclusion: At the beginning of the pandemic, it was observed that the responses of frontline hospital employees to traumatic experiences affected their mental states. Psychiatric nurses should take an active role in the development and implementation of psychosocial support programs for hospital personnel. Bangladesh J Medicine July 2022; 33(1) : 19-26