Effect of Rehabilitation Team Meeting on the Patient’s Disability in the Department of Physical Medicine and Rehabilitation (PMR) in a Tertiary Care Hospital in Dhaka

Background: Teamwork is one of the most fundamental factors in rehabilitation medicine. Although isolated physicians and therapists are working with rehabilitation services in Bangladesh, there is limited data for understanding the effects of a team effort. Objective: To evaluate the effect of rehabilitation team meeting on the patients’ disability in the Department of Physical Medicine and Rehabilitation (PMR) in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Methods: This was a randomized controlled trial conducted in the Department of Physical Medicine and Rehabilitation (PMR) in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from September 2018 to October 2019. Two hundred and thirty nine patients attending the PMR department for comprehensive management of disability (such as disability in mobility, speech, self-care, sphincter control etc.) were purposively selected for the study. Patients were randomly allocated by lottery in two groupsgroup A (received Rehabilitation Team Meeting service) and group B (received conventional Rehabilitation treatment). The meeting comprised physiotherapist, occupational therapist, rehabilitation nurse, speech and language therapists, social worker, nutritionist, psychologists under the team leader guidance by physiatrist. Respondents of both groups were assessed to see the effects of treatment at 6th weeks, 12th weeks and 24th weeks. Among 239 patients, 77 patients in group A and 71 patients in group B had completed 24th week follow up. Outcomes were measured by FIM (Functional independence Measure) scores. Results: The mean age of the patients in group A and B were 42.2 (±17.5) years and 45.7 (±14.6) years respectively. In both groups, majority of the patents were male and came from urban areas. Main cause of disability was stroke while others had traumatic brain injury, spinal cord injury, spinal cord compression, rheumatoid disease and others. At baseline and after 6th week of treatment, there were no significant statistical differences between the two groups (p>0.05) regarding FIM scores. In 12th week, FIM significantly increased in group A (p=0.009) compared to group B which persisted till 24th week (p<0.001). Conclusion: Rehabilitation team meeting significantly reduce disability of the patient. It needs to work continuously to build up the rehabilitation team to improve physical rehabilitation in Bangladesh to ensure total care of the disabled. Bangladesh Med Res Counc Bull 2020; 46(3): 228-232

Diagnostic Accuracy of Magnetic Resonance Imaging in Infective Vertebral Lesions

Background: Infective vertebral lesions usually involve the vertebral column, including the bone, intervertebral disk and paravertebral soft tissues. Variable imaging characteristics in conjunction with clinical findings can facilitate early diagnosis and treatment. MRI is a powerful imaging tool that can be help to evaluate spinal pathology specially infection. Typical MRI findings of infective vertebral disease are vertebral endplate destruction, bone marrow and intervertebral disc signal intensity changes and para vertebral soft tissue involvement. Objective: This study was aimed to assess whether the MRI can different the in differentiate the invective vertebral lesions from benign or malignant Tumors. Methods: This cross-sectional study was conducted on a total of 52 clinically suspected patients of infective vertebral lesions to establish diagnostic accuracy of MRI. The validity of MRI diagnosis for infective vertebral lesion was compared against CT-guided fine needle aspiration cytological (FNAC) diagnosis. Results: The sensitivity, specificity, positive and negative predictive values (PPVs and NPVs) and finally diagnostic accuracy of MRI were calculated by comparing the MRI diagnoses with those of fine needle aspiration cytological diagnosis of vertebral lesions. Finally the sensitivity, specificity, PPV and NPV of MRI diagnosis for infective vertebral lesion were 95.6%, 85.7%, 97.7% and 75.0% respectively. The overall diagnostic accuracy was 94.2%. Conclusion: Finding of this study suggested that MRI should be considered as the imaging modality of choice for patients with suspected infective vertebral lesions. Bangladesh Med Res Counc Bull 2020; 46(3): 233-239

Symptom Burden of Patients with Haematological Malignancy

Background: Haematological malignancy and its treatment produce multiple symptoms that significantly distress patients and impair function. Symptoms caused by treatment may delay treatment or lead to premature treatment termination and residual treatment-related symptoms often complicate post treatment rehabilitation. When treatment is no longer possible, symptom control becomes the focus of cancer care. Objectives: The study was aimed to determine the symptom burden of the haematological malignancy patients. Methods: A cross sectional study was conducted from July 2015 to June 2016 among the haematological malignancy patients. A total of 316 haematological malignancy adult (age ≥18 years) patients were purposively selected from haematology department of two tertiary level of hospitals in Dhaka city. Face to face interviews were taken from the diagnosed haematological malignancy patients admitted in the hospital and attending outdoor using questionnaire based on symptom distress scale (SDS). Results: Mean age was 39 years and most of the patients suffering from Acute Leukemia 162(51.3%). Mean monthly family income was around 22235 taka and 120(37.9%) patients were unemployed. Patients with haematological malignancy had a considerable physical and psychological symptom burden which ranged from 94.3% for fatigue to 8.5% for difficulty in concentration. Physical symptoms such as fatigue 127 (40.2%), change in appetite 86 (27.2%), pain1 81 (25.6%), insomnia44 (13.9%) caused severedistress and psychological symptoms include change in appearance 37 (11.7%) and outlook 33 (10.4%) were sever distressing. Significant association (p<0.001) was to be found between occupation and symptom distress where 82 (68.4%) unemployed and 51 (66.3%) housewife had moderate/sever symptom distress. Respondents who managed their treatment expenditure by loan and asset sell 11 (84.6%) had significant(p=0.004) moderate/sever distress. Patients having less than one month of diagnosis 47(72.3%) and admitted in inpatient 114 (66.6%) had significant higher moderate/sever symptom distress(p=0.03) and (p<0.001) respectively. Conclusion: Patients with haematological malignancy were likely to have multiple symptoms and comprehensive symptom assessment was suggested throughout. The introduction of supportiveor palliative care services during times of increased symptom burden may assist haematologists and other careers in the management of their patient’s distress and quality of life. Bangladesh Med Res Counc Bull 2020; 46(3): 196-203

Echocardiographic Evaluation of Cardiac Status in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a global health burden having systemic and extrapulmonary manifestations. Among them cardiovascular changes are the major comorbidity associated with COPD, responsible for significant morbidity and mortality. Echocardiography is one of the simplest and noninvasive tools in assessing these changes. Objective: To evaluate the echocardiographic changes in patients with chronic obstruction palmonary disease. Methods: A cross sectional observational study was carried out in Department of Cardiology and Department of Respiratory Medicine, Dhaka Medical College Hospital from July, 2018 to June, 2019. Total 98 COPD patients were included in the study. They underwent spirometry in Department of Respiratory Medicine and echocardiography in Department of Cardiology. Data was collected from the patients and recorded in a structured report form. Results: Significant echocardiographic abnormalities were present in 51.02% patients. Most common echocardiographic change was pulmonary hypertension (43.9%). Other echocardiographic findings were dilated RA & RV (36.7%), RVH (35.7%), LV diastolic dysfunction (30.6%) and RV systolic dysfunction (9.2%). Echocardiographic signs of pulmonary hypertension, dilated RA & RV, RVH, RV systolic dysfunction and LV diastolic dysfunction were correlated with the severity of the disease. Though echocardiographic change of pulmonary hypertension was uncommon in COPD stage 1 & 2, but it was very common in stage 3(45.7%) & stage 4(92.9%). Conclusion: This study showed that echocardiographic changes were very common among the COPD GOLD stage 3 & 4 patients. Though these changes were infrequent among mild COPD patients but their severity increased with increasing stage of COPD. Bangladesh Med Res Counc Bull 2020; 46(3): 204-210

Patients’ Consent in Dental Practices

not available Bangladesh Med Res Counc Bull 2020; 46(3): 248

Assessment of the Ability to Perform Activities of Daily Living: A Study Among Freedom Fighters in Bangladesh

Background: Bangladesh got its glorious victory of independence in 1971 from Pakistan after nine months of the liberation war. After 47 years, freedom fighters are in geriatric age. Objective: The study was aimed to assess the ability to perform daily living activities among the Freedom fighters of Bangladesh. Methods: It was a cross-sectional study and a mixed-method qualitative and quantitative. It was conducted from December 2017 to May 2018. A total of 153 freedom fighters who actively participated in the Liberation War were randomly selected from eight Bangladesh divisions. The Sami-structure questionnaire was collected in quantitative data. Qualitative data was collected by key informant interviews (KII) Physical functional status was determined by Activity of Daily Living Scales (ADLS) and Instrumental Activity of Daily Living Scales (IADLS). Freedom fighters who actively participated in the Liberation War and gladly participated were included in the study. Results: Among the 153 respondents, 92.8% were Muslim and mean age 68.50±5.808 years. Their monthly family income was a minimum of 6000 BDT and a maximum of 500000 BDT, and 92.2% received the freedom fighter allowance. Most of them lived with their family members and about half of them took care of themselves. Activities of the daily living scale showed that two-third of them had difficulties in one or more activities. The Instrumental Activities of daily living scale revealed that most of them had problems in one or more instrumental activities. Conclusion: This study revealed that the ability to perform daily living activities was so difficult for Freedom fighters at their old ages. Further large-scale studies involving all living freedom fighters could show a more complex scenario. Bangladesh Med Res Counc Bull 2020; 46(3): 184-188

Noise Exposure and Noise Induced Hearing Loss Among the Traffic Police in Dhaka Metropolitan City

Background: Occupational noise is considered as a global problem with social and physiological impacts, causing noise-induced hearing loss (NIHL). High levels of occupational noise is a problem in all regions of the world. Road traffic produces high noise levels that can cause damage to the traffic police hearing. Hence, occupational hearing loss is a well-known outcome of noise exposure at work. Objectives: The study aimed to measure the noise exposure level at different traffic points and determine the occurrence rate and severity of hearing loss among the traffic police of Dhaka Metropolitan City. Methods: This cross-sectional study was conducted during 2017-2019 in 28 selected traffic points of Dhaka Metropolitan City under four traffic zone (East, West, North, and South) and among 100 traffic police who were working there and met the inclusion and exclusion criteria. Noise exposure level was measured from all selected traffic points with a digital sound level meter. Data were collected by face to face interview with a pretested semi-structured questionnaire followed by an otoscopic examination, tuning fork tests, and a baseline audiogram. To see the association, Chi-square tests or Pearson’s correlation coefficient (r) tests were performed. Results: This study revealed that the average noise exposure level at East, West, North, and South zones are respectively 125.6 dB, 112.9 dB, 121.3 dB, and 119.4 dB. At every point, the noise exposure level was more than the acceptable limit set by the Occupational Safety and Health Administration (OSHA). In the audiometry report of 100 traffic police, 64% had sensorineural hearing loss. Of them 85% had mild, 9% had moderate and 6% with severe hearing loss. Notch in 4 kHz in an audiogram was present in the right ear of 46% of respondents and left ear of 52% respondents. It was observed that hearing loss was significantly associated with increasing age and job duration. Conclusion: Traffic police of Dhaka Metropolitan City is in constant risk of noise induced hearing loss as the ambient noise of this city is very high. Regular assessment and hearing screening is recommended for all the traffic police who are exposed to noise. Bangladesh Med Res Counc Bull 2020; 46(3): 219-227

Chronic Obstructive Pulmonary Disease Among the Users of Improved Cooking Stove and Traditional Cooking Stove

Background: Use of Improved Cooking Stove (ICS) is increasing in Bangladesh. It is expected that the use of ICS will decrease the occurrence of respiratory diseases, which remains to be explored. Objective:The current study was an attempt to find out the occurrence of respiratory illnesses, particularly the Chronic Obstructive Pulmonary Disease (COPD) among the ICS users and comparing such illness among Traditional Cooking Stove (TCS) users. Methods: This was a cross-sectional comparative study carried out among the women who were using ICS and TCS for cooking purposes. Women aged 35 years and above and cooking for more than 3 years were the study population. A total of 674 respondents were selected from a selected rural area, of which 232 were ICS users and 442 were TCS users. The study participants of both groups were age-matched (±2 years). Questionnaire on respiratory illness, COPD Population Screener (CPS) and COPD Assessment Test (CAT) questionnaires were used to collect necessary data from the respondents. Results: The average age of the respondents was 43.96±7.632 years. Significantly (p=.000) a higher proportion of the TCS users had no formal education (46.4%). None of the respondents had smoking habits, but 16.8% of them had the habits of chewing tobacco. Overall, 85.5% of the respondents used biomass fuel. The average cooking year of the respondents was 26.9±8.59 and the daily average cooking duration was 3.09 hours. Among the TCS users, COPD (23.6%) and other respiratory illnesses (49.5%) were significantly (p=.001 and p=0.014 respectively) higher than those of the ICS users. Logistic regression analysis revealed that biomass fuel had the strongest ability (3.8 times) to predict COPD followed by the ability (1.8 times) of TCS use. Conclusion: The study revealed that TCS users significantly suffered more from COPD than that of ICS users. Respondents having poor socio-economic conditions, a lower proportion of them were found to use ICS; not affordable was a reason. Along with TCS use, biomass fuel should also be discouraged. Bangladesh Med Res Counc Bull 2020; 46(3): 211-218

Telemedicine Services of ‘Shasthyo Batayon 16263’ During COVID-19 Pandemic: Opportunities and Challenges

not available Bangladesh Med Res Counc Bull 2020; 46(3): 240-244

Pattern of Household Activities and its Effects on Low Back Pain Among Bangladeshi Housewives

Background: Housework is traditionally an unpaid labour performed by women. It involves routine and compulsory household maintenance tasks can create musculoskeletal disorder like Law back pain (LBP). Objective: The main objective of the study was to identify the effects of household activities on LBP among Bangladeshi housewives. Methods: A descriptive cross-sectional study was carried out among 255 respondents. At the Musculoskeletal department of Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka. The questionnaire was designed according to Bangladesh perspectives regarding household activities that housewife do at home. Severity of pain was assessed using Visual Analogue Scale (VAS) and data ware collected using face to face interview. Results: Study found that household activities like cooking and chopping (p<.0001), washing dish and cloth (p<.0001), sweeping floor/cleaning toilet (p<.0001) were significantly associated with LBP. The results from regression analysis showed that having LBP compare with the time duration of cooking (OR=11.2; CI=2.62-47.73), chopping (OR=2.67; CI=1.44-4.93), washing dish (OR=3.33; CI=1.50-7.39), washing cloth (OR=5.71; CI=2.94-11.10), sweeping floor (OR=4.71; CI=2.33-9.53) was significantly higher among housewife than who don’t do this activity at home. Conclusion: This study revealed that all of married women had to do their household activities for a long period in awkward posture. Elderly housewives suffer more, as the duration of married life and duration of doing household activities are high among them. Among the activities coking, chopping, washing dish, washing cloth, lift heavy objects and sweeping the floor/cleaning toilet were done by maximum housewives. Bangladesh Med Res Counc Bull 2020; 46(3): 189-195