Structured Training to the Patients of Chronic Obstructive Pulmonary Disease Reduces Frequency of Hospital Readmission

Background: Patient education after treatment of acute exacerbation in patients with chronic obstructive pulmonary disease (COPD) prevents frequent hospital readmission and improve quality of life.Objectives: To observe the impact of providing structured training to patients of COPD on repeated hospital admission.Materials and method: This prospective comparative study was carried out in the inpatient department of Medicine and Pulmonology Unit, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from January 2010 to June 2011. A total of 144 admitted patients with COPD with an attack of acute exacerbation were included in this study without having any significant or chronic comorbidity. Of the 144 patients, 72 were randomly allocated for receiving structured training (cases; Group-A) and the rest 72 patients did not receive the training (controls; Group-B).Results: The pertinent demographic characteristics, smoking status, and knowledge about different aspects of COPD, and medications used during acute exacerbation of COPD before intervention were almost similar between the groups. Over 30% of the patients who received structured training needed no hospital admission, 58.3% needed only one and 11.1% needed 2 or more admissions, while the other group required two or more admissions during the same period (p < 0.001). The duration of hospital stay was significantly less in case group. Number of > 2 consultations with physicians was significantly higher in the former group (26.4% vs. 6.9%) (p = 0.002), indicating an increased awareness on the part of that group.Conclusion: Structured training to COPD patients significantly reduced hospitalization and hospital stay for an acute exacerbation in this study.Delta Med Col J. Jan 2018 6(1): 35-44

Treatment outcome of national guideline based antitubercular chemotherapy in tubercular ascites patients

Adenosine De Aminase (ADA) is increased in tuberculous ascitic fluid due to the stimulation of T-cells by mycobacterial antigens. The treatment for abdominal tuberculosis including ascites as a presentation is a matter of controversy around the world. The study is aim at to see the outcome of antitubercular chemotherapy in selected tubercular ascites patients. This hospital based prospective study was done in 24 cases of adult (>13 years) tubercular ascites admitted in a tertiary hospital Dhaka, over one year. Increased ADA level (>37iu/L) in ascitic fluid evaluated after the colorimetric method of Galanti and Giusti and other supportive investigations were done for diagnosing tuberculosis. Patients were under treatment of ATT cat-1 for six months as per national guide line. Outcome was seen as predefined criteria as treatment completed, cured, improved and not improved. Total number of patient is 24. Of which range of age is 13-70 years and mean±SD (33.2±14.77) with male female ratio is 0.85:1. Ninety six percent patients presented with abdominal pain, 23(96%) with fever, 22 (91%) with anorexia. Abdominal tenderness in 22(91%), ascites on 24(100%), hepatomegaly on 2(8%). Hundred percent patients were evaluated after completion of treatment. Twenty three (96%) patients improved and 1(4%) not improved. There is effectiveness of standard chemotherapy suggested by national guideline. Outcome of the patients were highly satisfactory with short regimen of antitubercular chemotherapy.

Prevalence and chemo-therapeutical investigations of gastrointestinal nematodes in domestic pigeons in Lahore, Pakistan

The prevalence of gastrointestinal nematodes was studied in 143 (80 male and 63 female) domestic pigeons. Faecal samples were collected to determine the gastrointestinal nematodes of domestic pigeons through qualitative and quantitative faecal examinations. A total of 48 (male 33 and 25 female) naturally infected domestic pigeons were divided into G1 (albendzdole) and G2 (fenbendazole) treatment-groups along with one control group (C). The overall prevalence of gastrointestinal nematodes was 40.5% (58/143) in domestic pigeons. Likewise, the prevalence of gastrointestinal nematodes in males and females was found 41.3% (33/58) and 39.7% (25/58) respectively. The overall prevalence of Capillaria obsignata and Ascaridia columbae was found to be 67.2% and 32.8%, respectively. The prevalence of C. obsignata and A. columbae in males was 72.7% (24/33) and 27.8% (9/33) and in females was 60% (15/25) and 40% (10/25), respectively. There was no significant sex related difference seen in the prevalence of C. obsignata (p>0.56) and A. columbae (p>0.40) in domestic pigeons, respectively. The overall efficacy of albendazole and fenbendazole was calculated to be 66% and 71%. A remarkable significant difference (p<0.05) was observed in eggs per gram before and after treatment in both G1 and G2 treated-groups. The efficacy of fenbendazole was found to be more significant (p<0.02) than albendazole.

Deaths in visceral leishmaniasis (Kala-azar) during treatment

Twenty-seven out of five hundred and fifty three patients hospitalized for visceral leishmaniasis (Kala-azar) died during treatment with sodium antimony gluconate. Data from these patients were evaluated to find out the cause of death. Eight patients had associated diseases such as pulmonary tuberculosis (3), severe malnutrition (1), acute gastroenteritis (1), spleenic infarction (1), acute renal failure (1) and atrial septal defect (1) which could be attributed to death. Twelve patients developed spontaneous haemorrhages from nose, gums and gastrointestinal tract and died, despite of adequate supportive measures. Seven other patients who were improving slowly with antimony therapy died unexpectedly. Though, cause of death could be explained in some patients with associated disease conditions, it could not be explained in others as significant clinical manifestations, haematological, biochemical and electrocardiographic alterations were not evident prior to death. Our impression is that mortality in Kala-azar patients during standard antimonial therapy is more related to the drug rather than the disease process.

Copper sulphate poisoning

A number of cases of copper sulphate poisoning from the southern region of Bangladesh are presented. There was a high mortality (24.9%) in comparison to other forms of poisoning. Hepatotoxicity, acute renal failure and gastrointestinal bleeding were the main complications. This degree of copper sulphate poisoning in one particular area is cause for alarm.