A Comparative Cross-Sectional Study to compare the Isolated Organism and their Antibiotic Sensitivity Pattern Between Community-Acquired Pneumonia (CAP) and Ventilator-Associated Pneumonia (VAP) in Intensive Care Unit (ICU).

Background: The moment most common cause of in-hospital infection is pneumonia. Pneumonia is prevalent within the ICU (Intensive Care Unit) setting and can be deadly. The Incidence of pneumonia is approximately 17% in the therapeutic ICU2 but can be 6 to 20 times increased in mechanically ventilated patients. The duration of hospital stay and expenditure are both expanded in patients who develop ventilator-associated pneumonia. This study aims to identify the causative microorganism responsible for CAP (Community-Acquired Pneumonia) and VAP (Ventilator-Associated Pneumonia) and their antibiotic sensitivity pattern. Methods: This was a comparative cross-sectional study that was carried out at two ICU in Sylhet city. The data was collected from the patient's medical information, the patient's file, and the hospital information system. Culture and sensitivity (C/S) were collected from the electronic medical information system (MIS). All data from January 2019 to December 2020, including patient's information, course of the disease (in terms of death or recovery-if available), clinical features, and investigation reports, was transferred to an electronic data collection sheet (Microsoft Excel). After completion of all data collection, analysis was conducted through a spreadsheet. Comparison between two disease groups was made by independent t-test. Within the group, the analysis was done by the Chi-Square test. Results: In this thesis study, it was found that the most common organism responsible for CAP was Streptococcus spp. (34.70%) and is sensitive to Meropenem (92.21%), Imipenem (88.16%), Amikacin (70.67%), Piperacillin (70.91%), Moxifloxacin (70.96%), Levofloxacin (67.95%), Amoxiclav (67.92%), and Ceftriaxone(63.95%). The most common causative organism responsible for VAP was Staphylococcus spp. (36.51%) and it was sensitive to Imipenem (100%), Moxifloxacin (100%), Meropenem (94.73%), Amikacin (85.71%), Ceftriaxone (60%), Amoxiclav (66.66%), Levofloxacin (57.14%), and Cefuroxime (50%). Conclusion: Pneumonia is still one of the most common reasons for hospitalization, particularly for those admitted to ICU. It has been observed in several studies that the majority of the cases are communityacquired pneumonia. Many mechanically ventilated patients often develop VAP, which is fatal if timely diagnosis and appropriate antibiotics administration are not made. Streptococcus spp. was the most common organism responsible for CAP, and Staphylococcus spp. mainly was responsible for VAP.

Epidemiology, risk factors and antimicrobial resistance of Escherichia coli bacteremia

Background: Escherichia coli is a common causative of blood stream infection having potentials to produce significant morbidity and mortality. This organism also has the ability to develop resistance against antimicrobial agents. Knowing its epidemiology, risk factors and antimicrobial resistance patterns can help preventing and managing bacteremia caused by this organism. Materials and methods: This was across sectional observational study carried out from February 2017 to February 2018 on 64 blood culture positive Escherichia coli infected patients admitted in Medicine inpatient of a medical college hospital. Age, sex, mode of acquisition of infection, history of prior empiric antibiotic treatment, duration of hospital stay, development of complication were observed and noted. Antibiotic susceptibility test for all isolates was performed by Kirby-Bauer disc diffusion method. Predesigned semi-structured data collection from was used and collected data were analyzed manually and expressed in descriptive statistical terms. Results: Of the 64 enrolled patients, 47(73.43%) were female. Average age of affection was 53.48±20.65 years and increased incidence rates (51.56%) was observed at age >60 years. Infection was communityacquired in 35.84% cases and urinary tract infection was the most frequent (46.3) risk factor. More than eighty seven percent of samples showed resistance to at least one antimicrobial agent and resistance to multiple drugs was associated with complications. Conclusion: Escherichia coli bacteremia has high incidence rates for antimicrobial resistance and mortality. Continuous surveillance and antibiotic susceptibility pattern monitoring is essential to develop regional antibiotic therapy protocols.

Shoulder Pain in an Elderly Smoker May be an Alarm: a Rare Case of Pancoast Tumor

Patients with shoulder pain commonly present to a general practitioner and/or in the orthopedic department. In some instances, pain in the shoulder region can indicate serious underlying pathology. This article describes an elderly smoker presenting with progressively worsening shoulder pain not conforming to musculoskeletal, neuropathic or mechanical type pain and with poor response to conventional pain management protocols. Evaluation with meticulous history, physical signs, chest imaging findings, and histopathology confirmed the diagnosis of a rare clinical condition the Pancoast tumor.

Frequency and Treatment Outcomes of Isolated Ventricular Hemorrhage Cases Among Traumatic Intracranial Hemorrhage Patients

Background: Bleeding into the ventricular system of brain is called intraventricular hemorrhage (IVH). It may be associated with brain parenchyma. Cases of isolated ventricular hemorrhages are found less. Ventricular hemorrhage due to trauma is more commonly seen in premature babies and infants than adults. Uncertainty in recovery is a important issue for such cases. Aim of the study: The aim of this study was to evaluate the frequency and the treatment outcomes of isolated ventricular hemorrhage cases among patients with traumatic intracranial hemorrhage. Methods: This prospective observational study was directed in the neurosurgery department of Sylhet MAG Osmani Medical College, Sylhet, Bangladesh from January 2015 to December 2020. In total 890 Admitted diagnosed cases of traumatic intracranial hemorrhage were chosen for this study as study population. Ultrasonography CT scan, MRI of the brain, MRA, MRV, and CSF were performed according to the patient’s status. Those were collected, processed, analyzed, and disseminated by using MS office and SPSS version 23 as per need. Results: According to this study, in total participants, the highest number was with parenchymal hemorrhage which was 34% (n=302). Besides these, cases with extradural hemorrhage were 33% (n=298), cases with subdural hemorrhage were 17% (n=149%), cases with subarachnoid hemorrhage were 14% (n=124) and cases with isolated ventricular hemorrhage (IVH) were 2% (n=17). So, in this study, the frequency of IVH was found only 2% among all types of traumatic intracranial hemorrhage cases. Among a total of 17 IVH patients, most of the cases were infants or baby which was 59%. And 41% of the IVH patients were adults. In analyzing the outcomes among the IVH patients we observed, early recovery was found in 1 child (5.88%) and in 2 adults (11.76%). Besides these, death was occurred in 6 children (35.29%) and in 3 adults (17.65%). Conclusion: Traumatic isolated ventricular hemorrhage (IVH) causes the worst prognosis in most cases. The survival rate with no residual effect is very minimum. In this study in 2 patients’ history of long coma, for more than 12 weeks was found. Besides these, moderate to severe morbidity was found in some cases.

Congenital Agenesis of Both Vertebro-Basilar Artery-A Rare Case Report

Vertebral and basilar arteries are the major blood suppliers of the brain. They supply nearly one-third of the brain. Congenital absence of these arteries is a rare condition. Usually, this condition presents with stroke like presentation. This is a case presentation of a 40-year-old lady who was diagnosed as congenital agenesis of vertebra-basilar arteries. This lady was presented with intraventricular hemorrhage. Subsequently the diagnosis was made by cerebral angiogram.

Changes of Proinflammatory Biomarkers of COVID-19 Patients and Its Relationship with HRCT Percentage- A Multi-Center Study in Tertiary Hospitals of Sylhet

Background and objectives- COVID-19 is a coronavirus disease declared pandemic by WHO. The commonly checked proinflammatory biomarkers are Neutrophil-Lymphocyte ratio (NLR), C - reactive protein (CRP), D-Dimer and Ferritin. High-Resolution Computed Tomography (HRCT) of chest is an important tool to evaluate the diagnosis and prognosis of COVID-19. The objective of this study was to evaluate the relationship between the biomarkers and HRCT findings. Materials and method- This was a multi-center cross-sectional study done in Sylhet Women’s Medical College Hospital (SWMCH), Sylhet Shahid Shamsuddin Ahmed Hospital (SSSAH), Northeast Medical College Hospital (NMCH) and Mount Adora Hospital, Sylhet. Data were collected from electronic medical record (EMR). Relationship test were done by independent t-test and one-way-ANOVA test. Results- Among the total 481 participant, 312 (65%) were male and rest 169 (35%) were female. The average age of the COVID-19 positive group participants was 60.72 year and it was 60.79 year in the COVID-19 negative group. The mean difference of D-Dimer between COVID-19 positive and negative patients was significant (p=0.0063). The mean differences of NLR (p=0.0012) and CRP (p=0.005) were significant between died and survived patients. Conclusion- All four biomarkers were raised in the higher HRCT percentage involved groups. NLR and DDimer were significantly (p<0.001) higher in the higher HRCT percentage groups.

Neutralizing Monoclonal Antibody: New Member of Therapeutic Armamentarium Against COVID-19

Many targeted treatment methods have focused on SARS-CoV-2's spike protein, along with neutralizing monoclonal antibodies (mAbs), which are recombinant proteins, may be employed as a kind of passive immunotherapy to reduce pathogenicity. While vaccines are still the best way to prevent COVID-19 infection, mAbs are an effective treatment for those who have already been infected, as well as having the potential to prevent infection in those who have already been exposed to SARS-CoV-2, which can be especially beneficial to certain high-risk groups. Due to the limited initial availability of these new treatments, it is essential to consider their larger potential and create methods for their optimal deployment in clinical practice. The objectives of this review is to answer the most commonly asked clinical questions from HCPs and patients about the target population, dose, interactions with other medicines and vaccines, duration of immunity, and variants.

Neonatal Candidaemia in Tertiary Care Hospitals in Dhaka- A Comparison of Different Carbohydrate Assimilation Methods and Chromagar Technique for Speciation

Background: Nosocomial candidiasis are becoming increasingly important worldwide. Candida is a major causative agent of health care associated bloodstream infections, and lately non-albican Candida species are increasingly isolated from blood samples. Some of the Candida species have intrinsic and acquired resistance to the limited arsenal of antifungals; therefore early speciation is essential for the timely initiation of effective antifungal therapy. Methods: A hospital based cross-sectional study was conducted to evaluate the performance of different carbohydrate assimilation tests and commercially available HiCrome Candida Differential Media (CHROMagar) for the identification of Candida in the four tertiary level hospitals in Dhaka. Results: A total of 58 yeasts samples was included in this study. Non-albicans Candida accounted for 100% of the isolates of which C. tropicalis was the predominant species (81.03%) followed by C. parapsilosis (12.07%), C. auris (5.17%) and C. dubliniensis (1.72%). Swab auxanographic technique and microtitre plate based miniaturized CHO assimilation methods were equally effective in identification of Candida sp. in comparison to CHO impregnated YNB plate method (98.28% and 100% vs 89.66%). Conclusion: By using Chromogenic agar 75.86% yeasts were identified but it could not give the conclusive differentiating color between the species of C. parapsilosis and C. auris.

Bacteriological Profile and Antimicrobial Sensitivity Pattern of Neonatal Sepsis

Introduction: Neonatal sepsis (NS) is one of the important causesof neonatal morbidity anddeath in neonatal ward and neonatal medical care unit,especiallyin emergent nations. Frequent monitoring on pathogens with recent updates and their antimicrobial sensitivity pattern is compulsory for more satisfactory management. Methods: This cross sectionalstudy was outlined to evaluate the bacteriological profile and antimicrobialsensitivity pattern of NS in neonatal ward and neonatal intensive care unit (NICU)of Sylhet Women’s Medical College and Hospital, Sylhet, Bangladeshfrom October 2019 to December 2020. Blood samples from 90 clinically suspected neonatal sepsis cases were accumulated and processed in the microbiological protocol and their antimicrobial sensitivity pattern were determined. Results: Among the90 cases, two third (61, 67.78%) showed positive blood culture. Among the positive blood culture, 38(62.29%) were gram positive isolates and gram negative isolates were 23(37.7%). This study showed Staphylococcus aureuswas the most common organism (59.01%) followed by Escherichia coli (E. Coli)(27.87%), Klebsiella pneumonia (9.87%) and Streptococcus pneumonia (3.28%) among the isolates. Gram positive isolates were highly reactive to Amikacin and Amoxicillin and Clavulenic acid whereas gram negative isolates were highly reactive to Gentamicin and Meropenem. Conclusion: Gram positive organism are the predominant source of NS which was highlighted in our study,though gram negative organism also plays an important role in the mortality cause by neonatal sepsis.

Factors determining the Knowledge of Nurses Towards COVID-19 at Tertiary Hospital, Sylhet

Introduction: COVID-19 virus has become a highly contagious disease as pandemic in the current situation over the world. As a communicable disease, COVID-19 can be transmitted so rapidly from nurse to nurse, patient to nurse and nurse to other group of people. Health care workers should know knowledge about this communicable disease. This is why we have done this study. Methods: The cross sectional study was conducted in Sylhet Women’s Medical College Hospital, Sylhet, Bangladesh; from January to June 2021. Face to face data was collected. Data was collected by researcher themselves. Collected data were checked, coded and transferred into the SPSS V22.0 for analyzing data. Frequency, percentages, mean and t-test statistics were calculated. Results: Among the participants, the age mean of senior staff nurse and junior staff nurse is 24.34 year and 33.66 year. The result shows that among senior staff nurse 25.74% was male and 74.26% was female, on the other hand among junior staff nurse, there was 100% female and no male junior staff nurse in this study. Among 134 participants of SSN, 86.77% and 96.32% were answered “yes” against “COVID-19 is communicable disease” and “COVID-19 is virus” where among 64 participants of JSN, 59.38% and 89.06% were answered “yes” against same questions. In case of “Yes” result, SSN is answer better than JSN which is statistically significant (p value is 0.006366). Conclusion: There is comparably better knowledge about COVID-19 disease to SSN than JSN. Health care workers must gain knowledge about such pandemic disease. By gaining well knowledge; everybody can stop spreading infection of COVID-19 disease.