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Evans B, Ellsmere J, Hossain I, Ennis M, O'Brien E, Bacque L, Ge M, Brodie J, Harnett J, Borgaonkar M, Pace D. Colonoscopy skills improvement training improves patient comfort during colonoscopy. Surg Endosc 2022; 36:4588-4592. [PMID: 34622297 DOI: 10.1007/s00464-021-08753-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION We aimed to assess the effect of Colonoscopy Skills Improvement (CSI) training on patient comfort and sedation-related complications during colonoscopy. METHODS This retrospective cohort study was performed on 19 endoscopists practicing in a Canadian tertiary care center who completed CSI training between October 2014 and May 2016. Data from 50 procedures immediately prior to, immediately after, and eight months following CSI training were included for each endoscopist. The primary outcome variable was intraprocedural comfort, and secondary outcomes included intraprocedural hypotension and hypoxia. Data were extracted from an electronic medical record and analyzed using SPSS version 20.0. Univariate analysis and stepwise multivariable logistic regression were performed to determine if there was an association between patient comfort and CSI training. Predictors of these outcomes including patient age, gender, sedation use and dosing, procedure completion, quality of bowel preparation, endoscopist experience, and specialty were included in the analysis. RESULTS 2533 colonoscopies were included in the study. The mean dose of sedatives was reduced immediately following CSI training and at 8 months for both Fentanyl (75.4 mcg v. 67.8 mcg v. 65.9 mcg, p < 0.001) and Midazolam (2.57 mg v. 2.27 mg v. 2.19 mg, p < 0.001). The percentage of patients deemed to have a comfortable exam improved following endoscopist participation in CSI training and remained improved at 8 months (55.1% v. 70.2% v. 69.8%, p < 0.001). No significant change in rates of intraprocedural hypoxia or hypotension were noted following CSI training. CONCLUSION CSI training is associated with improved patient comfort and reduced sedation requirements during colonoscopy.
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Affiliation(s)
- B Evans
- Department of Surgery, Dalhousie University, Halifax, NS, Canada. .,Department of Surgery, Memorial University, St. John's, NL, Canada.
| | - J Ellsmere
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - I Hossain
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - M Ennis
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - E O'Brien
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - L Bacque
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - M Ge
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - J Brodie
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - J Harnett
- Department of Medicine, Memorial University, St. John's, NL, Canada
| | - M Borgaonkar
- Department of Medicine, Memorial University, St. John's, NL, Canada
| | - D Pace
- Department of Surgery, Memorial University, St. John's, NL, Canada
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Bhattacharjee M, Hossain I, Roy S, Kamrul-Hasan AB, Ahmed F, Banerjee S, Bhuya SI, Losy SA, Biswas R, Mondal D. Post-Acute Covid Neurological Symptoms among Doctors and Nurses in A Tertiary Care Hospital: An Observational Study from Bangladesh. Mymensingh Med J 2022; 31:379-384. [PMID: 35383754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A good number of patients experience post-Covid complications. Doctors and nurses are the front liners who are at greater risk of having this disease. Neurological symptoms are frequent in patients with post-COVID-19 infection. The study aims to observe the post-acute neurological symptoms among doctors and nurses of Mymensingh Medical College Hospital, a tertiary care hospital in Bangladesh, after they recover from initial infection or among the asymptomatic cases. It was a retrospective observational study among the doctors and nurses who became RT PCR positive from late April to mid-September 2020. A total of 100 subjects were interviewed over the phone for the presence or absence of neurological symptoms four weeks post Covid-19 infection. Total 54 doctors and 46 nurses were evaluated; the male-female ratio was 1:1.77, the mean age was 35.6±7.6 years. Post-acute COVID neurological symptoms (PACNS) were present in 60% of respondents. Fatigue (51%) was the most common symptom, followed by sleep disturbance, headache, myalgia, loss of taste and smell. PACNS were more in symptomatic patients at the initial Covid infection than asymptomatic cases.
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Affiliation(s)
- M Bhattacharjee
- Dr Manabendra Bhattacharjee, Associate Professor, Department of Neurology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
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Iaccarino C, Kolias A, Adelson PD, Rubiano AM, Viaroli E, Buki A, Cinalli G, Fountas K, Khan T, Signoretti S, Waran V, Adeleye AO, Amorim R, Bertuccio A, Cama A, Chesnut RM, De Bonis P, Estraneo A, Figaji A, Florian SI, Formisano R, Frassanito P, Gatos C, Germanò A, Giussani C, Hossain I, Kasprzak P, La Porta F, Lindner D, Maas AIR, Paiva W, Palma P, Park KB, Peretta P, Pompucci A, Posti J, Sengupta SK, Sinha A, Sinha V, Stefini R, Talamonti G, Tasiou A, Zona G, Zucchelli M, Hutchinson PJ, Servadei F. Consensus statement from the international consensus meeting on post-traumatic cranioplasty. Acta Neurochir (Wien) 2021; 163:423-440. [PMID: 33354733 PMCID: PMC7815592 DOI: 10.1007/s00701-020-04663-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022]
Abstract
Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
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Yussuf NM, Saeed MA, Wagiran H, Hossain I. Soil-to-Plant Transfers Factor of Natural Radionuclides in Groundnut Crops Grown on Soils with Different Levels of Background Radioactivity. Proc Natl Acad Sci , India, Sect A Phys Sci 2020. [DOI: 10.1007/s40010-018-0580-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hamzah SA, Saeed MA, Hossain I, Wagiran H. Thermoluminescence of Dysprosium Doped Strontium Borate Glass for (NA, LI, CA) Modifiers Irradiated to High Dose 60CO. High Energy Chem 2019. [DOI: 10.1134/s0018143919030068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Goemans N, Wong B, Signorovitch J, Sajeev G, Jenkins M, Dieye I, Yao Z, Hossain I, Ward S. DUCHENNE MUSCULAR DYSTROPHY - PHYSIOTHERAPY. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hossain I, Jiang J, Matras M, Trociewitz UP, Lu J, Kametani F, Larbalestier D, Hellstrom E. Effect of sheath material and reaction overpressure on Ag extrusions into the TiO 2 insulation coating of Bi-2212 round wire. IOP Conf Ser Mater Sci Eng 2017; 279. [PMID: 30197666 DOI: 10.1088/1757-899x/279/1/012021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In order to develop a high current density in coils, Bi-2212 wires must be electrically discrete in tight winding packs. It is vital to use an insulating layer that is thin, fulfils the dielectric requirements, and can survive the heat treatment whose maximum temperature reaches 890 °C. A thin (20-30 µm) ceramic coating could be better as the insulating layer compared to alumino-silicate braided fiber insulation, which is about 100 μm thick and reacts with the Ag sheath during heat treatment, degrading the critical current density (Jc). At present, TiO2 seems to be the most viable ceramic material for such a thin insulation because it is chemically compatible with Ag and Bi-2212 and its sintering temperature is lower than the maximum temperature used for the Bi-2212 heat treatment. However, recent tests of a large Bi-2212 coil insulated only with TiO2 showed severe electrical shorting between the wires after over pressure heat treatment (OPHT). The origin of the shorting was frequent silver extrusions that penetrated the porous TiO2 layer and electrically connected adjacent Bi-2212 wires. To understand the mechanism of this unexpected behaviour, we investigated the effect of sheath material and hydrostatic pressure on the formation of Ag extrusions. We found that Ag extrusions occur only when TiO2-insulated Ag-0.2%Mg sheathed wire (Ag(Mg) wire) undergoes OPHT at 50 bar. No Ag extrusions were observed when the TiO2-insulated Ag(Mg) wire was processed at 1 bar. The TiO2-insulated wires sheathed with pure Ag that underwent 50 bar OPHT were also free from Ag extrusions. A key finding is that the Ag extrusions emanating from the Ag(Mg) sheath actually contain no MgO, suggesting that local depletion of MgO facilitates local, heterogeneous deformation of the sheath under hydrostatic overpressure. Our study also suggests that predensifying the Ag(Mg) wire before insulating it with TiO2 and doing the final OPHT can potentially prevent Ag extrusion.
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Affiliation(s)
- I Hossain
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA.,Materials Science and Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - J Jiang
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - M Matras
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA.,Materials Science and Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - U P Trociewitz
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - J Lu
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - F Kametani
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA.,Department of Mechanical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - D Larbalestier
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA.,Materials Science and Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA.,Department of Mechanical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - E Hellstrom
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA.,Materials Science and Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA.,Department of Mechanical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA
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Refaei A, Wagiran H, Saeed MA, Hossain I. Thermoluminescence characteristics of neodymium-doped silicon dioxide optical fibers subjected to X-ray. High Energy Chem 2016. [DOI: 10.1134/s0018143916040032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hossain I, H. Kassim H, I. Sharrad F, Ahmed A. Nuclear structure of yrast bands of 180Hf, 182W, and 184Os nuclei by means of interacting boson model-1. ScienceAsia 2016. [DOI: 10.2306/scienceasia1513-1874.2016.42.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Saeed MA, Abdul Pattah NF, Hossain I, Wagiran H. Thermoluminescence response of ytterbium-doped silicon dioxide fiber. High Energy Chem 2015. [DOI: 10.1134/s001814391504013x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Saeed MA, Hossain I, Nursyazwanie R, Wagiran H, Mubarak AA. Thermoluminescence response of multimode fluorine-doped SiO2 optical fibers and TLD 100 with 6 mega volt photon irradiation. High Energy Chem 2015. [DOI: 10.1134/s0018143915030133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nahar B, Hossain I, Hamadani JD, Ahmed T, Grantham-McGregor S, Persson LA. Effect of a food supplementation and psychosocial stimulation trial for severely malnourished children on the level of maternal depressive symptoms in Bangladesh. Child Care Health Dev 2015; 41:483-93. [PMID: 25040164 DOI: 10.1111/cch.12176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Maternal depression is associated with poor child development and growth in low-income countries. This paper evaluates the effect of a community-based trial providing psychosocial stimulation and food supplements to severely malnourished children on maternal depressive symptoms in Bangladesh. METHODS Severely underweight (weight-for-age Z-score < -3) hospitalized children aged 6-24 months (n = 507), were randomly assigned to: psychosocial stimulation (PS), food supplementation (FS), PS+FS, clinic control (CC) and hospital control (CH) at discharge. PS included play sessions with children and parental counselling to mothers during fortnightly follow-up visit at community clinics, conducted by trained play leaders for 6 months. FS involved cereal-based supplements (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplements and growth monitoring. We used Bayley scales, Home Observation for Measurement of Environment (HOME) inventory and a parenting questionnaire to assess child development, home stimulation and mothers' child-rearing practices, respectively. We assessed mothers' depressive symptoms using a modified version of Centre for Epidemiologic Studies Depression Scale at baseline and at 6 months post intervention. RESULTS Maternal depressive symptoms were significantly lower in the CH group at baseline (P = 0.014). After 6 months of intervention there was no significant effect of intervention after adjusting for baseline scores and all possible confounders. Maternal depressive symptoms were higher among poorer (P = 0.06), older (P = 0.057) and less educated (P = 0.019) mothers, who were housewives (P = 0.053), and whose husbands had more unstable jobs (P = 0.058). At 6 months post intervention, children's cognitive (P = 0.045) and motor (P = 0.075) development, HOME (P = 0.012) and mother's parenting score (P = 0.057) were higher among mothers with lower depressive symptoms. CONCLUSION The study did not show a significant effect of the intervention on the level of maternal depressive symptoms. Interventions with higher intensity and/or of longer duration focusing directly on maternal psychosocial functioning are probably needed to reduce maternal depressive symptoms.
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Affiliation(s)
- B Nahar
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Sahini MH, Hossain I, Wagiran H, Saeed MA, Ali H. Thermoluminescence responses of the Yb- and Yb-Tb-doped SiO2 optical fibers to 6-MV photons. Appl Radiat Isot 2014; 92:18-21. [PMID: 24973463 DOI: 10.1016/j.apradiso.2014.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/27/2014] [Accepted: 05/27/2014] [Indexed: 11/26/2022]
Abstract
Characteristics of the thermoluminescence (TL) responses of Yb- and Yb-Tb-doped optical fibers irradiated with 6MV photons are reported. The concentration of Yb in the Yb-doped optical fiber was 0.26mol%; the concentrations of Yb and Tb in the Yb-Tb-doped optical fiber were 0.62 and 0.2mol%, respectively. The TL dose responses are linear in the dose range 0.5-4Gy. The radiation sensitivity of the Yb-Tb material is almost two orders of magnitude higher than the sensitivity of the material doped with Yb alone.
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Affiliation(s)
- M H Sahini
- Department of Physics, Universiti Teknologi Malaysia, 81310 Skudai, Johor, Malaysia
| | - I Hossain
- Department of Physics, Rabigh College of Science & Arts, King Abdulaziz University, 21911 Rabigh, Saudi Arabia.
| | - H Wagiran
- Department of Physics, Universiti Teknologi Malaysia, 81310 Skudai, Johor, Malaysia
| | - M A Saeed
- Department of Physics, Universiti Teknologi Malaysia, 81310 Skudai, Johor, Malaysia
| | - H Ali
- Department of Oncology and Radiation Therapy, Hospital Sultan Ismail, Johor Barhu, Malaysia
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Hossain I, Hoque A. Factors influencing the success of home modification in paraplegic spinal cord injured individuals in Bangladesh. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hossain I, Hossain S. Post-rehabilitation participation restriction of spinal cord injured patient at Centre for the Rehabilitation of the Paralysed (CRP). Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Md Khudzari J, Wagiran H, Hossain I, Ibrahim N. Screening heavy metals levels in hair of sanitation workers by X-ray fluorescence analysis. J Environ Radioact 2013; 115:1-5. [PMID: 22846873 DOI: 10.1016/j.jenvrad.2012.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 05/06/2012] [Accepted: 05/14/2012] [Indexed: 06/01/2023]
Abstract
This work presents a study of human hair as a bio-indicator for detection of heavy metals as part of environmental health surveillance programs project to develop a subject of interest in the biomedical and environmental sciences. A total of 34 hair samples were analyzed that consisting of 29 samples from sanitation workers and five samples from students. The hair samples were prepared and treated in accordance to the International Atomic Energy Agency (IAEA) recommendations. The concentrations of heavy metals were analyzed using the energy dispersive X-ray fluorescence (EDXRF) technique by X-50 Mobile X-ray Fluorescence (XRF) at Oceanography Institute, Universiti Malaysia Terengganu. The performance of EDXRF analyzer was tested by Standard Reference Material (SRM 2711) Montana Soil which was in good agreement with certified value within 14% deviations except for Hg. While seven heavy metals: Mn, Fe, Ni, Cu, Zn, Se, and Sb were detected in both groups, three additional elements, i.e. As, Hg and Pb, were detected only in sanitation workers group. For sanitation workers group, the mean concentration of six elements, Mn, Fe, Cu, Zn, Se, and Sb, shows elevated concentration as compared to the control samples concentration. Results from both groups were compared and discussed in relation to their respective heavy metals concentrations.
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Affiliation(s)
- Jauharah Md Khudzari
- Department of Science and Mathematics, Faculty of Science, Technology and Human Development, Universiti Tun Hussein Onn Malaysia, 86400 Parit Raja, Batu Pahat, Johor, Malaysia
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Akhter MQ, Authoy F, Nabi J, Rahman MR, Hossain I, Hossain MM, Mamun AA, Chakrabarty P. Wandering spleen associated with β-Thalassemia: a case report. Mymensingh Med J 2013; 22:186-191. [PMID: 23416830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The clinical entity 'Wandering spleen' is an uncommon presentation and it is more often diagnosed in children than in adults, mostly women of reproductive age. Here is a case of a young woman who presented with generalized weakness and fever, and a painless mobile lump in her central abdomen. The laboratory evaluation revealed a haemolytic state and Haemoglobin electrophoresis showed β-Thalassemia trait (Hb A2 5.1%). Ultrasonography and Computerized Tomography (CT) scan confirmed that the mass is spleen and spleen is not present in its normal anatomical location. Abdominal CT described a well-defined, homogenous pediculated mass with echo texture comparable to spleen. Radioisotope scanning could be used as an alternative for confirmation of diagnosis of this rare condition, but was not done in our case. Colour Doppler sonography of the splenic circulation revealed no infarction and intact splenic vasculature. Wandering spleen should be considered in the differential diagnosis of idiopathic abdominal or pelvic lumps. The authoritative opinion for the treatment of such a case is splenectomy or splenopexy especially in children and here, in this case splenectomy was done.
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Affiliation(s)
- M Q Akhter
- Department of Surgery, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh
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King MT, Viney R, Smith DP, Hossain I, Street D, Savage E, Fowler S, Berry MP, Stockler M, Cozzi P, Stricker P, Ward J, Armstrong BK. Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer. Br J Cancer 2012; 106:638-45. [PMID: 22274410 PMCID: PMC3324299 DOI: 10.1038/bjc.2011.552] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Men diagnosed with localised prostate cancer (LPC) face difficult choices between treatment options that can cause persistent problems with sexual, urinary and bowel function. Controlled trial evidence about the survival benefits of the full range of treatment alternatives is limited, and patients' views on the survival gains that might justify these problems have not been quantified. Methods: A discrete choice experiment (DCE) was administered in a random subsample (n=357, stratified by treatment) of a population-based sample (n=1381) of men, recurrence-free 3 years after diagnosis of LPC, and 65 age-matched controls (without prostate cancer). Survival gains needed to justify persistent problems were estimated by substituting side effect and survival parameters from the DCE into an equation for compensating variation (adapted from welfare economics). Results: Median (2.5, 97.5 centiles) survival benefits needed to justify severe erectile dysfunction and severe loss of libido were 4.0 (3.4, 4.6) and 5.0 (4.9, 5.2) months. These problems were common, particularly after androgen deprivation therapy (ADT): 40 and 41% overall (n=1381) and 88 and 78% in the ADT group (n=33). Urinary leakage (most prevalent after radical prostatectomy (n=839, mild 41%, severe 18%)) needed 4.2 (4.1, 4.3) and 27.7 (26.9, 28.5) months survival benefit, respectively. Mild bowel problems (most prevalent (30%) after external beam radiotherapy (n=106)) needed 6.2 (6.1, 6.4) months survival benefit. Conclusion: Emerging evidence about survival benefits can be assessed against these patient-based benchmarks. Considerable variation in trade-offs among individuals underlines the need to inform patients of long-term consequences and incorporate patient preferences into treatment decisions.
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Affiliation(s)
- M T King
- Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Room 148, Transient Building (F12), Sydney, NSW 2006, Australia.
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Jinghua Ge, Hutanu A, Toole C, Kooima R, Hossain I, Allen G. An Experimental Distributed Visualization System for Petascale Computing. Comput Sci Eng 2010. [DOI: 10.1109/mcse.2010.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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King MT, Viney R, Hossain I, Smith D, Savage E, Stockler MR, Armstrong B. Survival gains needed to justify the side effects of treatment for localized prostate cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5119 Background: Men diagnosed with localized prostate cancer face difficult treatment decisions. Evidence about the relative survival benefit of treatment options is lacking or piecemeal. Side-effects can vary widely with treatment, affecting some fundamental aspects of quality of life (QOL). Little is known about patients’ views of the relative tolerability of these side-effects or the survival gains needed to justify them. Methods: QOL data were collected prospectively 3 years post-diagnosis in a population-based cohort of men treated for localized prostate cancer (n=1642); these data were used to identify common side-effect profiles. A patient preference survey was conducted in a subset (n=357, stratified by treatment); hypothetical treatment alternatives were described in terms of side-effects and survival. Random parameter logit models were estimated. We adapted the concept of compensating variation from welfare economics to derive a parameter function for the value of changes in QOL in terms of survival time; i.e., the survival gains needed to justify persistent side-effects. Bootstrap confidence intervals (CI) were constructed. Results: The table shows the survival gains needed for a range of common treatment profiles, relative to the base case of active surveillance (in which men typically experienced mild loss of libido and mild fatigue). For example, radical prostatectomy often resulted in severe impotence and mild urinary leakage; men required an extra 8.0 months (95% CI 7.4–8.7) of life to make this worthwhile. Generally, urinary dysfunction and bowel symptoms were considered the least tolerable, hormonal symptoms and fatigue came next, and sexual dysfunction was considered relatively benign. This pattern was relatively consistent across treatment groups. Conclusions: These results highlight the need for better evidence about the actual survival benefits of alternative treatments. They also help to target supportive care to optimize patient QOL after treatment for localized prostate cancer. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- M. T. King
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - R. Viney
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - I. Hossain
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - D. Smith
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - E. Savage
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - M. R. Stockler
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - B. Armstrong
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
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Hossain I, Moussavi Z. Finding the lung sound-flow relationship in normal and asthmatic subjects. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:3852-5. [PMID: 17271136 DOI: 10.1109/iembs.2004.1404078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To investigate the relationship between lung sound (LS) and flow, we studied LS signals from 5 healthy adults (group I), 10 healthy children (group II) and 7 asthmatic children (group III). The LS signals were recorded on right upper lung lobe at different flow rates varied from 0.4 to 3.0 L/s and the flow signals were measured at mouth. The LS and flow signals were parsed into segments of 1024 data points with 50% overlap between successive segments. The mean LS amplitude (mean AMP) and mean flow (flow) were calculated for each segment. The average power (Pave) of each segment was calculated from LS spectrum for different frequency bands between 20-600 Hz. Four different types of models, representing the relationship between mean AMP or Pave and flow, were investigated using different percentage of flow signal in each inspiratory phase. The model coefficients were derived from either linear regression analysis or polynomial curve fitting between the data and model variables. The correlation coefficients (r) between the experimental data and data estimated from the model coefficients were calculated for each subject in each model and averaged between the subjects. The results showed much stronger correlation between Pave and flow than mean AMP and flow for all groups. The best model to describe Pave relationship with flow was found to be power relationship in both healthy adults and children whereas a third-order polynomial curve best fitted the Pave and flow data in asthmatic group. The optimum frequency band to calculate Pave was found to be 150-450 Hz for healthy subjects and 300-600 Hz for asthmatic children. The diminution of heart sound (HS) from LS recordings showed no change in the selected model in all three groups. The results of this study suggest the difference in Pave- flow relationship in healthy and asthmatic subjects may be used as a diagnostic tool for asthma.
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Affiliation(s)
- I Hossain
- Department of Electrical and Computer Engineering, University of Manitoba, Winnipeg, MB.
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Aminuzzaman FM, Hossain I. Evaluation of plant activator and chemical fungicides on leaf blight (Bipolaris sorokiniana) development and yield of wheat. Pak J Biol Sci 2007; 10:1797-803. [PMID: 19086540 DOI: 10.3923/pjbs.2007.1797.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bion 50 WG (Benzothiodiazole), Tilt-250 EC (Propiconazole) and Amistar (Azoxystrobin) either alone and some of their combinations were evaluated against leaf blight/spot (Bipolaris sorokiniana) development and yield of wheat. All the treatments significantly reduced leaf spot reaction of wheat over untreated control. But Bion in combination with Amistar resulted significantly highest reduction of leaf spot reaction of wheat (p = 0.05) against all the tested pathotypes inoculated at flag leaf stage. In the field, Bion reduced leaf spot severity at heading and flowering stage in 2000-2001 and at hard dough stage in 2001-2002. Number of grains/ear not significantly increased by treating seeds with Bion though 1000-grain weight is significantly increased (p = 0.05) in 2000-2001 by Bion. Statistically higher grain yield was obtained from the experimental plot by treating seeds with Bion and Amistar. Bion resulted 53.33% higher grain yield in compare to untreated control.
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Affiliation(s)
- F M Aminuzzaman
- Department of Plant Pathology, Sher-e-Bangla Agricultural University, Dhaka-1207, Bangladesh
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Hollingsworth JW, Li Z, Brass DM, Garantziotis S, Timberlake SH, Kim A, Hossain I, Savani RC, Schwartz DA. CD44 regulates macrophage recruitment to the lung in lipopolysaccharide-induced airway disease. Am J Respir Cell Mol Biol 2007; 37:248-53. [PMID: 17446529 PMCID: PMC1976546 DOI: 10.1165/rcmb.2006-0363oc] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
LPS from bacteria is ubiquitous in the environment and can cause airway disease and modify allergic asthma. Identification of gene products that modulate the biologic response to inhaled LPS will improve our understanding of inflammatory airways disease. Previous work has identified quantitative trait loci for the response to inhaled LPS on chromosomes 2 and 11. In these regions, 28 genes had altered RNA expression after inhalation of LPS, including CD44, which was associated with differences in both TNF-alpha levels and neutrophil recruitment into the lung. It has previously been shown that CD44 can modulate macrophage recruitment in response to Mycobacterium tuberculosis, as well as clearance of neutrophils after lung injury with both bleomycin and live Escherichia coli bacteria. In this study, we demonstrate that the biologic response to inhaled LPS is modified by CD44. Macrophages failed to be recruited to the lungs of CD44-deficient animals at all time points after LPS exposure. CD44-deficient macrophages showed reduced motility in a Transwell migration assay, reduced ability to secrete the proinflammatory cytokine TNF-alpha, reduced in vivo migration in response to monocyte chemotactic protein-1, and diminished adhesion to vascular endothelia in the presence of TNF-alpha. In addition, CD44-deficient animals had 150% fewer neutrophils at 24 h and 50% greater neutrophils 48 h after LPS exposure. These results support the role of CD44 in modulating the biologic response to inhaled LPS.
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Affiliation(s)
- John W Hollingsworth
- Division of Pulmonary, Allergy, and Critical Care Medicine, DUMC 3136, Duke University Medical Center, Durham, NC 27710, USA.
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Brass DM, Hollingsworth JW, McElvania-Tekippe E, Garantziotis S, Hossain I, Schwartz DA. CD14 is an essential mediator of LPS-induced airway disease. Am J Physiol Lung Cell Mol Physiol 2007; 293:L77-83. [PMID: 17384086 DOI: 10.1152/ajplung.00282.2006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic lipopolysaccharide (LPS) inhalation in rodents recapitulates many classic features of chronic obstructive pulmonary disease seen in humans, including airways hyperresponsiveness, neutrophilic inflammation, cytokine production in the lung, and small airways remodeling. CD14-deficient mice (C57BL/6(CD14-/-)) have an altered response to systemic LPS, and yet the role of CD14 in the response to inhaled LPS has not been defined. We observed that C57BL/6(CD14-/-) mice demonstrate no discernable physiological or inflammatory response to a single LPS inhalation challenge. However, the physiological (airways hyperresponsiveness) and inflammatory (presence of neutrophils and TNF-alpha in whole lung lavage fluid) responsiveness to inhaled LPS in C57BL/6(CD14-/-) mice was restored by instilling soluble CD14 intratracheally. Intratracheal instillation of wild-type macrophages into C57BL/6(CD14-/-) mice restored neutrophilic inflammation only and failed to restore airways hyperresponsiveness or TNF-alpha protein in whole lung lavage. These findings demonstrate that CD14 is critical to LPS-induced airway disease and that macrophage CD14 is sufficient to initiate neutrophil recruitment into the airways but that CD14 may need to interact with other cell types as well for the development of airways hyperresponsiveness and for cytokine production.
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Affiliation(s)
- David M Brass
- National Institute of Environmental Health Sciences, Rall Bldg., Rm. C224, PO Box 12233 MD C2-15, 111 Alexander Dr., Research Triangle Park, NC 27709, USA.
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Ahsan S, Ahmed M, Islam T, Islam MS, Hossain I, Bashar A, Rahman SM. Bilateral giant angiomyolipoma of kidneys: a case report and review of literature. Bangladesh Med Res Counc Bull 2004; 30:125-7. [PMID: 16240983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Angiomyolipoma is uncommon benign tumor of the kidney. Bilateral and multiple lesions are associated with tuberous sclerosis. We report a case with bilateral giant angiomyolipomas in a patient who had no other features of tuberous sclerosis. In this case, the involvement of the kidneys was diffuse rather than usual well-circumscribed lesions.
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Affiliation(s)
- S Ahsan
- Deptt. of Radiology and Imaging, Bangabandhu Shiek Mujib Medical University (BSMMU), Dhaka
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Sarker SA, Casswall TH, Juneja LR, Hoq E, Hossain I, Fuchs GJ, Hammarström L. Randomized, placebo-controlled, clinical trial of hyperimmunized chicken egg yolk immunoglobulin in children with rotavirus diarrhea. J Pediatr Gastroenterol Nutr 2001; 32:19-25. [PMID: 11176319 DOI: 10.1097/00005176-200101000-00009] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hyperimmunized bovine colostrum containing antibodies has been shown to be effective in the treatment of rotavirus diarrhea. Antibodies derived from eggs of immunized hens may be a less expensive and more practical alternative. In this study, children with proven rotavirus diarrhea were treated with immunoglobulin extracted from eggs of chicken immunized with human rotavirus strains. METHODS In a randomized, double-blind study, 79 children with known rotavirus diarrhea were assigned to receive either 10 g hyperimmune egg yolk (HEY) daily in four equally divided doses for 4 days (HEY group) or a similar preparation obtained from nonimmunized chicken (placebo group). The daily stool frequency and amount, oral rehydration solution iORS) intake, and presence of rotavirus in the stool were monitored for 4 days. RESULTS In the HEY-treated group, there was significant reduction in stool output (in grams per kilogram per day; HEY vs. placebo; 87+/-59 vs. 120+/-75, P = 0.03), and significant reduction of ORS intake (in milliliters per kilogram per day) (HEY vs. placebo; 84+/-46 vs. 122+/-72, P = 0.008) on day 1 and clearance of virus on day 4 (HEY vs. placebo; 73% vs. 46%, P = 0.02). There was, however, no difference in diarrheal duration between the groups. CONCLUSIONS Treatment with HEY against four human rotavirus strains resulted in modest improvement of diarrhea associated with earlier clearance of rotavirus from stools. These results indicate an encouraging role of HEY in the treatment of rotavirus-induced diarrhea in children. Further studies are needed to optimize the dose and neutralization titer and thus improve the efficacy of egg yolk immunoglobulin IgY derived from immunized hens.
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Affiliation(s)
- S A Sarker
- Clinical Sciences Division, International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) Centre for Health and Population Research, Dhaka.
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Hynninen MS, Cheng DC, Hossain I, Carroll J, Aumbhagavan SS, Yue R, Karski JM. Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery. Can J Anaesth 2000; 47:1182-7. [PMID: 11132739 DOI: 10.1007/bf03019866] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Non-steroidal anti-inflammatory drugs (NSAIDs) are used as analgesic in postoperative pain to reduce opioid side effects, such as drowsiness and nausea. However, NSAIDs have not been used extensively in cardiac surgical patients due to the fear of untoward effects on gastric, renal, and coagulation parameters. This study will evaluate the efficacy and safety of three NSAIDs for pain control in CABG patients. METHODS One hundred and twenty patients scheduled for elective CABG surgery were enrolled in randomized, double blind, controlled study. Standardized fast track cardiac anesthesia was used. One dose of drug (75 mg diclofenac, 100 mg ketoprofen, 100 mg indomethacin, or placebo) was given pr one hour before tracheal extubation and a second dose 12 hr later. Pain was treated with morphine iv and acetaminophen po. Visual analogue pain scores were recorded at baseline, 3, 6, 12 and 24 hr after the first dose of drug. RESULTS There were no differences among the groups in pain scores. Only patients who received diclofenac required less morphine than patients in the control group (P < 0.05). When the total amounts of pain medications were computed to morphine equivalents, only patients in the diclofenac group received less pain medications than the placebo group (P < 0.05). Proportion of patients with postoperative increase of creatinine level (20% and over) did not differ between placebo and drug groups. CONCLUSION Non-steroidal anti-inflammatory drugs may be used for analgesia management post CABG surgery in selected patients. Diclofenac appears to have the best analgesic effects by reducing the morphine and other analgesic requirement postoperatively.
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Affiliation(s)
- M S Hynninen
- Division of Cardiac Anesthesia & Intensive Care, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada
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Ishii T, Asai M, Makishima A, Hossain I, Ogawa M, Hasegawa J, Matsuda M, Ichikawa S. Core-excited states in the doubly magic 68Ni and its neighbor 69Cu. Phys Rev Lett 2000; 84:39-42. [PMID: 11015829 DOI: 10.1103/physrevlett.84.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/1999] [Indexed: 05/23/2023]
Abstract
In deep-inelastic collisions of 8 MeV/nucleon 70Zn projectiles with 198Pt, we have found an 8(+) isomer with T(1/2) = 23(1) ns at 4208 keV in 68Ni; the nug(9/2) E2 effective charge was determined to be 1. 5(1)e. In 69Cu, a 19/2(-) isomer with T(1/2) = 22(1) ns at 3691 keV was identified and its decay data were calculated quite accurately by a parameter-free shell model calculation using empirical input parameters. Proton 2p- 1h excitation, fed by another T(1/2) = 39(6) ns isomer at 3827 keV, induces large collectivity in 69Cu.
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Affiliation(s)
- T Ishii
- Advanced Science Research Center, Japan Atomic Energy Research Institute, Tokai, Ibaraki 319-1195, Japan
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Arellano R, Jiang MT, O'Brien W, Hossain I, Boylen P, Demajo W, Cheng DC. Acute graded hypercapnia increases collateral coronary blood flow in a swine model of chronic coronary artery obstruction. Crit Care Med 1999; 27:2729-34. [PMID: 10628618 DOI: 10.1097/00003246-199912000-00021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effect of acute hypercapnia on regional myocardial blood flow in a swine model of chronic, single-vessel coronary artery obstruction. Permissive hypercapnia is being used frequently in critical care settings. One possible detrimental effect of hypercapnia is the initiation of coronary "steal" in patients with coronary artery disease. The effects of hypercapnia on collateral coronary blood flow in the setting of coronary obstruction have not been defined. DESIGN Prospective controlled experimental study. SETTING Institutional animal research facility. SUBJECTS Eight juvenile swine weighing 25-30 kg. INTERVENTIONS Collateral coronary circulation was induced in eight piglets by banding the proximal left anterior descending coronary artery for 8-10 wks followed by total ligation. Graded hypercapnia (mean Paco2, 81 torr [10.80 kPa; Paco2 = 81 torr] and 127 torr [16.93 kPa; Paco2 = 127 torr]) was induced by increasing inspiratory carbon dioxide under isoflurane anesthesia (1 minimum alveolar concentration). MEASUREMENTS AND MAIN RESULTS Animals were attached to instruments to measure pulmonary and systemic hemodynamics, regional myocardial blood flow, and cardiac output. Regional myocardial blood flow was determined using radiolabeled microspheres. Cardiac output, mean arterial pressure, and coronary perfusion pressure were unchanged at both levels of hypercapnia compared with baseline values. Heart rate was increased at Paco2 [HI] (p < .05). Regional blood flow was increased at both levels of hypercapnia in the collateral-dependent and normally perfused myocardium (p < .05; as high as 56% for subendocardium and as high as 106% for subepicardium at Paco2 [HI]). The intercoronary blood flow ratio remained unaltered. The transmural flow ratio was reduced at Paco2 [HI] (P < .05). During hypercapnia, regional lactate extraction remained unaltered, and regional oxygen extraction was unchanged or reduced despite the increase in oxygen consumption. CONCLUSIONS In this swine model of chronic single-vessel coronary artery obstruction, acute hypercapnia does not induce coronary steal from collateral-dependent myocardium, but it does increase global coronary blood flow.
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Affiliation(s)
- R Arellano
- Department of Anaesthesia, Toronto Hospital, University of Toronto, Ontario, Canada
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Perry H, Weierbach R, El-Arifeen S, Hossain I. A comprehensive assessment of the quality of immunization services in one major area of Dhaka City, Bangladesh. Trop Med Int Health 1998; 3:981-92. [PMID: 9892283 DOI: 10.1046/j.1365-3156.1998.00333.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This report assesses the quality of service inputs, service processes and service outcomes (with the exception of coverage and effectiveness) for immunization services in Zone 3 of Dhaka City. The results indicate that in general, the providers of immunization services are knowledgeable, friendly and give technically appropriate immunizations. Client ratings of the quality of services are quite good. Access is 90% for childhood immunizations and 89% for tetanus toxoid (TT) immunizations for women with a child < 1 year old. Three areas were identified as needing attention: frequently missed opportunities for the promotion or provision of immunizations; uneven distribution and utilization of immunization sites, and some fundamental weaknesses of the TT immunization programme (lack of awareness among women of reproductive age about the importance of TT immunization, low access to it among women of reproductive age who do not have a child < 1 year of age, and confusion among women and service providers about the purpose of TT immunization and the dosage schedule). Efforts to monitor and strengthen the quality of EPI activities will facilitate further decline in the numbers of deaths and illnesses from vaccine-preventable diseases. The approaches used in this study and the typology for quality assessment are widely applicable elsewhere.
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Affiliation(s)
- H Perry
- MCH-FP Extension Project (Urban), ICDDR, B, Dhaka, Bangladesh.
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Hynninen MS, Hossain I, Karski JM, Aumbhagavan S, Cheng DCH. NON-STEROIDAL ANTI-INFLAMMATORY AGENTS IN TREATMENT OF POSTOPERATIVE PAIN AFTER CARDIAC SURGERY. Anesth Analg 1998. [DOI: 10.1097/00000539-199804001-00106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perry H, Weierbach R, Hossain I, Islam R. Tetanus toxoid immunization coverage among women in zone 3 of Dhaka city: the challenge of reaching all women of reproductive age in urban Bangladesh. Bull World Health Organ 1998; 76:449-57. [PMID: 9868835 PMCID: PMC2305782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Neonatal tetanus is still an important public health problem in both urban and rural Bangladesh, with an estimated 41,000 cases occurring annually. This article analyses the coverage of tetanus toxoid (TT) immunizations among women of reproductive age in Zone 3 of Dhaka City in 1995. Although 85% of women with a child under 1 year of age had received two TT immunizations, only 11% of women of reproductive age had obtained the complete series of five TT immunizations and only 52% of women of reproductive age had received one or more TT immunizations. Access to TT immunization, as defined by having had at least one such immunization, was lower among women aged over 30 years and also among those aged under 20 years, especially those who were not yet married or who had not yet become pregnant. Characteristics associated with TT immunization status included the following: educational level of the woman, distance from the nearest immunization centre, and level of contact with family planning field workers. Additional characteristics that influenced women's TT immunization status included age, marital and working status, recency of migration from rural to urban area, and number of children. The relationships were complex and varied depending on the number of TT immunizations received (one or two) and on the type of analysis being carried out (bivariate or multivariate). The findings point to the need for a broad-based campaign to promote access to TT immunization as well as to promote the completion of all five TT doses in Bangladesh. Reducing missed opportunities for promotion of immunization as well as targeting home visitation of women in need of additional immunizations constitute further approaches to improving coverage. Although TT coverage rates were only marginally lower among women in slum households, such women were more likely than those in non-slum households to be pregnant and hence more likely to bear a baby at risk of neonatal tetanus. Furthermore, the environment of slum households, where deliveries normally take place, is more conducive to the development of neonatal tetanus among unprotected neonates; a strategy of focusing on slum households is therefore also needed.
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Affiliation(s)
- H Perry
- MCH-FP Extension Project (Urban), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Perry H, Weierbach R, Hossain I, Islam R. Childhood immunization coverage in zone 3 of Dhaka City: the challenge of reaching impoverished households in urban Bangladesh. Bull World Health Organ 1998; 76:565-73. [PMID: 10191552 PMCID: PMC2312496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
A household survey of 651 children aged 12-23 months in Zone 3 of Dhaka City carried out in 1995 revealed that 51% of them had fully completed the series of childhood immunizations. Immunization coverage in slum households was only half that in non-slum households. Apart from residence in a slum household, other characteristics strongly associated with the completion of the entire series of childhood immunizations included the following: educational level of the mother, number of children in the family household, mother's employment status, distance from the nearest immunization site, and number of home visits from family-planning field workers. The findings point to the need to improve childhood immunization promotion and service delivery among slum populations. Two promising strategies for improving coverage are to reduce the number of missed opportunities for immunization promotion during encounters between health workers and clients, and to identify through visits to households those children who need additional immunizations. In the long run, increasing the educational level of women will provide a strong stimulus for improving childhood immunization coverage in the population.
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Affiliation(s)
- H Perry
- MCH-FP Extension Project (Urban), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Simpson JI, Eide TR, Schiff GA, Newman SB, Clagnaz JF, Hossain I, Schulman SB, Gropper JE. Effect of nitroglycerin on spinal cord ischemia after thoracic aortic cross-clamping. Ann Thorac Surg 1996; 61:113-7. [PMID: 8561534 DOI: 10.1016/0003-4975(95)00829-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Thoracic aortic cross-clamping with the use of sodium nitroprusside (SNP) has been shown to cause a decrease in spinal cord perfusion pressure and an increased incidence of paraplegia. Nitroglycerin is frequently used in this setting. This study investigated the effects of nitroglycerin and SNP on spinal cord ischemia. METHODS Three-groups of 8 mongrel dogs underwent thoracic aortic cross-clamping for 45 minutes. Proximal pressure was maintained between 95 and 100 mm Hg with SNP, nitroglycerin, or phlebotomy. All animals were neurologically evaluated 24 hours later by a blinded observer, and the findings were confirmed by histopathologic study. Statistical analysis (p value of less than 0.05) of measured hemodynamic data was by analysis of variance and of Tarlov scores, the Mann-Whitney U test. RESULTS Distal aortic pressures (p < 0.001), Tarlov scores, and spinal cord perfusion pressures (p < 0.01 and p < 0.05 for SNP group and nitroglycerin group, respectively) were significantly higher in the phlebotomy group compared with the SNP and NTG groups. Cerebrospinal fluid pressures were significantly lower in the phlebotomy group compared with the SNP group (p < 0.001). CONCLUSIONS The use of either NTG or SNP was associated with a high incidence of paraplegia. Nitroglycerin appears to be no safer than SNP when used during thoracic aortic cross-clamping.
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Affiliation(s)
- J I Simpson
- Department of Anesthesiology, Long Island Jewish Medical Center, New Hyde Park, New York 11042, USA
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Simpson JI, Eide TR, Schiff GA, Clagnaz JF, Zisbrod Z, Newman SB, Hossain I. Isoflurane versus sodium nitroprusside for the control of proximal hypertension during thoracic aortic cross-clamping: effects on spinal cord ischemia. J Cardiothorac Vasc Anesth 1995; 9:491-6. [PMID: 8547547 DOI: 10.1016/s1053-0770(05)80129-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This study was designed to compare the effects of isoflurane and nitroprusside on spinal cord ischemia when they are used to control proximal hypertension during thoracic aortic cross-clamping (TACC). DESIGN Prospective, randomized, blinded experimental study. SETTING Laboratory and animal research facility. PARTICIPANTS Adult mongrel dogs. INTERVENTIONS Two groups of eight dogs had TACC for 45 minutes. Proximal aortic, distal aortic, and cerebrospinal pressure was calculated as the distal mean pressure minus the CSF pressure. Group 1 received nitroprusside and group 2 received isoflurane to control proximal hypertension during cross-clamping. The dogs were neurologically evaluated 24 and 48 hours later by an observer blinded as to the study group. Spinal cord segments were obtained for histopathologic examination. MEASUREMENTS AND MAIN RESULTS Distal perfusion pressure and spinal cord perfusion pressure were significantly higher in the isoflurane group (p < .005). At 24 hours, seven of eight dogs in group 1 had severe neurologic injury (ie, paraplegia), with the eight having mild neurologic injury. This is in contrast to group 2, where 6 of 8 dogs had either minimal or no injury, one had mild injury, and one had severe injury. Similar results were observed at 48 hours (p < .005). CONCLUSIONS Isoflurane, when used to control proximal hypertension during TACC, produces a higher spinal cord perfusion pressure and is associated with a lower incidence of neurologic injury than nitroprusside in this canine model.
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Affiliation(s)
- J I Simpson
- Department of Anesthesiology, Long Island Jewish Medical Center, New Hyde Park, NY 11042, USA
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Simpson JI, Eide TR, Schiff GA, Clagnaz JF, Hossain I, Tverskoy A, Koski G. Intrathecal magnesium sulfate protects the spinal cord from ischemic injury during thoracic aortic cross-clamping. Anesthesiology 1994; 81:1493-9; discussion 26A-27A. [PMID: 7992919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Paraplegia is a known complication after surgery on the descending thoracic aorta. Thoracic aortic cross-clamping causes an increase in proximal aortic and cerebrospinal fluid pressures. Sodium nitroprusside, though effectively decreasing proximal aortic pressure, has been implicated in worsening the incidence of paraplegia by further increasing cerebrospinal fluid pressure and decreasing distal blood pressure, thereby reducing spinal cord perfusion pressure. Intravenous administration of magnesium sulfate has been shown to offer some spinal cord protection when used with mild hypothermia. This study investigated the effect of intrathecal magnesium on the prevention of paraplegia when sodium nitroprusside is used to control proximal hypertension during thoracic aortic cross-clamping in a dog model of spinal cord ischemia. METHODS Two groups of eight dogs underwent thoracic aortic cross-clamping via a small thoracotomy incision for 45 min. Proximal, distal, and central venous pressures and cerebrospinal fluid pressures were monitored. Temperature was maintained at 36 degrees C. Sodium nitroprusside was used to control proximal hypertension. The control group received no magnesium sulfate, and a second group received 3 mg/kg intrathecal magnesium sulfate before thoracic aortic cross-clamping. The dogs were neurologically evaluated 24 h later by an observer blinded to the dogs' group. Spinal cord segments were obtained for histologic examination. RESULTS Proximal mean arterial pressure, cerebrospinal fluid pressure, spinal cord perfusion pressure, and central venous pressure were not statistically different between the two groups. Neurologic outcome, however, was statistically different between the groups. None of the eight dogs in the magnesium group had any measurable neurologic injury, in contrast to the control group, in which seven of the eight dogs had severe neurologic injury (P < 0.005). Post mortem histologic data supported these findings. CONCLUSIONS Intrathecal magnesium can prevent spinal cord injury despite markedly negative spinal cord perfusion pressure during thoracic aortic cross-clamping in a canine model of spinal cord ischemia.
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Affiliation(s)
- J I Simpson
- Department of Anesthesiology, Long Island Jewish Medical Center, New Hyde Park, New York 11402
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