Mediscope

Antimicrobial Susceptibility Pattern of Uropathogens Isolated at a Private Hospital in Khulna, Bangladesh

2024-02-24T04:13:27+00:00

Background & objectives: Urinary tract infection (UTI) is one of the most common infectious diseases affecting all age & sex groups, causing significant morbidity & mortality with a substantial economic burden. Due to the irrational empiric use of antibiotics, resistance is increasing at an alarming rate. Bacteria causing UTIs & their antimicrobial susceptibility pattern varies among different areas & changes frequently over time. This study aimed to identify microorganisms causing UTI at a private hospital in the southern part of Bangladesh & to determine their sensitivity pattern towards commonly used antibiotics. Methods: A cross-sectional study was conducted in the clinical pathology & microbiology laboratory at Islami Bank Hospital (IBH), Khulna during the period of January’2021 to July’2021. Clean catch midstream urine samples (MSU) from 221 clinically suspected UTI cases of all age & sex groups were included in the study. Uropathogens were isolated & identified by standard microbiological techniques & susceptibility was determined by Kirby Kirby-Bauer disc diffusion method. Results: Among 221 suspected UTI cases, 108 (48.8%) were positive for urine culture, of which 103 (95.37%) showed antimicrobial growth. The majority 75 (69.4%) of the culture-positive cases were female. E. coli 50(44.24%) was the most predominant bacterial isolate, followed by Klebsiella 18(15.92%) & Enterococcus 16(14.15%). All Isolated gram-positive cocci (GPC) showed very high sensitivity to Vancomycin (83.3% to 100%), Linezolid (87.5% to 100%) & moderate sensitivity to Meropenem (66.7% to 75%). However, they showed relatively lower sensitivity to Ciprofloxacin, Doxycycline, Gentamicin, and Amoxiclav & very poor sensitivity to Nitrofurantoin (31.3% to 50% only). Levofloxacin had relatively better sensitivity against GPC (S. aureus- 83.3% & CONS- 75%), except Enterococcus. All gram-negative bacilli (GNB) showed a very good sensitivity towards Amikacin & Meropenem, ranging from 77.8% to 100%. E. coli & Pseudomonas were highly sensitive to Piperacillin-Tazobactam (90% & 88.9% respectively). GNB were poorly sensitive to commonly used 3^rd generation cephalosporins, Azithromycin, Amoxiclav & Ciprofloxacin. Except for Pseudomonas & Klebsiella, Levofloxacin showed relatively good sensitivity against other GNB. Nitrofurantoin showed lower sensitivity against GNB, except for Pseudomonas (66.7%) & Enterobacter (75%). Conclusion: E. coli remains the most predominant uropathogen. Vancomycin, linezolid, Levofloxacin & Meropenem were very effective against GPC whereas Amikacin, Piperacillin- tazobactam & Meropenem showed good responses against GNB. Empiric antibiotics must be selected based on the current antibiogram of uropathogens in a particular area to prevent the increasing trends of antimicrobial resistance.

Mediscope 2024;11(1): 01-12

Current Pharmaco-therapeutic Approach on COVID-19 Admitted Patients in a Corona-dedicated Hospital in Khulna

2024-02-24T04:22:59+00:00

Background: The COVID-19 pandemic has been demanding possible pharmaco-therapeutic options to reduce the mortality associated with the disease by trying out the clinical efficacy of various therapeutic agents. Objective: Our purpose of the study was to explore the current pharmaco-therapeutic approaches to COVID-19 patients in different clinical categories. Methods: This is a descriptive observational study where 300 clinically diagnosed COVID-19-positive patients were included following inclusion & exclusion criteria at the study center. Patients’ demographic profiles and treatment plans were obtained using a specially designed form. The data were collated and analyzed using a Microsoft Excel spreadsheet and results were expressed in percentages. Results: Remdesivir, moxifloxacin, dexamethasone, meropenem, enoxaparin and other supportive drugs with different percentages in mild, moderate, severe & critical cases were frequently prescribed. Besides non-invasive oxygen therapy has been given in almost all patients. Conclusion: Antiviral, LMWH, broad-spectrum antibiotics, corticosteroids and other symptomatic drugs are the major treatment options for different clinical categories of COVID-19 patients.

Mediscope 2024;11(1): 13-21

Efficacy of Oral Prednisolone in the Management of Idiopathic Granulomatous Mastitis

2024-02-24T04:44:47+00:00

Background: Idiopathic granulomatous mastitis (IGM) is a benign inflammatory lesion of the mammary gland. Globally it possesses a major diagnostic and therapeutic problem. To date, there is no universally agreed treatment for this condition. Many treatment modalities have been attempted from conservative therapy to mastectomy but none of them has shown satisfactory results. Recent studies have shown promising results of corticosteroids on idiopathic granulomatous mastitis, so steroid therapy can be an effective treatment for idiopathic granulomatous mastitis. The goal of the study is to provide a therapeutic strategy in the future for idiopathic granulomatous mastitis. Methods: Our study included all patients with idiopathic granulomatous mastitis confirmed histologically by core needle/incisional biopsy at the general surgery unit of Chittagong Medical College Hospital and the private hospitals in the Chittagong Metropolitan City for a period of one year from October 2016 to September 2017. A total of seventy patients were included in the study provided they fulfilled predetermined criteria. All of them were included in this study by purposive sampling. After diagnosis oral prednisolone (1mg/kg/day) was given and the cases were observed by personal interview and through telephone interview. The patients were on follow-up for 06 months. Age, size of the breast lump, breast pain, nipple discharge, and skin changes were recorded in all cases. Results were analyzed using mean, percentage, and proportion as appropriate. Results: The mean age was 26.35±13.5 years ranging from 19 to 40 years. Out of 70 patients, Core cut biopsy was done in 55 patients (78.58%), and incisional biopsy with abscess drainage was performed in 15 patients (21.42%). 59 patients (84.28%) had complete recovery after a single cycle of steroid treatment, remaining 11 patients (15.72%) had recurrence, among them 6 patients were cured after 2^nd cycle of steroids but unfortunately, 5 patients did not respond. Though complications were found in 50 patients, all of them made good progress in the short term. Conclusion: We recommend steroid therapy as the first-line treatment in our study. However, prospective, randomized clinical trials are needed to determine the treatment algorithm.

Mediscope 2024;11(1): 22-26

Evaluation of Prognostic Significance of Serum Magnesium Level in Patients with Acute Myocardial Infarction

2024-02-24T05:01:32+00:00

Background: Magnesium has been considered an important factor in the pathogenesis of acute myocardial infarction and its complications. Magnesium ions are essential for the maintenance of the functional integrity of the myocardium. It also improves vascular tone, afterload and cardiac output, and decreases peripheral vascular resistance and cardiac arrhythmias. Serum magnesium concentration has great significance in the prognosis of acute myocardial infarction (MI). Aim and objective: This study aimed to assess the relation of low serum magnesium levels with post-infarction complications of acute MI. Methods: This cross-sectional descriptive study was conducted in the Department of Pharmacology & Therapeutics, Rajshahi Medical College in collaboration with the Cardiology department between July 2019 to June 2020. Assessment and comparison of the serum magnesium level of the patients on the 5^th day of post-infarction with the 1^st day of admission in 50 patients of acute MI was done in this study. Results: The mean magnesium level was 2.25 ± 0.15 mg/dl in patients without any complications which was significantly higher than the patients who had multiple complications. The level of magnesium was 1.79 ± 0.37 mg/dl in complicated cases. (P˂0.001). These observations suggest that in acute myocardial infarction, patients with low magnesium levels are more prone to develop complications. Conclusion: So it can be concluded that measurement of serum magnesium levels has prognostic significance and magnesium treatment can be implicated in patients of acute myocardial infarction with low magnesium levels.

Mediscope 2024;11(1): 27-33

Characteristics of Patients with Hypertension Admitted for COVID-19 Treatment in Khulna: Single-Centre Cross-Sectional Study

2024-02-24T05:11:09+00:00

Background: The outbreak of coronavirus disease 2019 (COVID-19) has become a large threat to global health due to its high contagious nature and varied mortality. Arterial hypertension represents one of the most common comorbidities in patients with COVID-19. Close connections between inflammation and blood pressure (BP) have been described, and inflammation plays a key role in the outcome for patients with COVID-19.

Objective: This study aims to investigate the clinical characteristics of patients with hypertension admitted for COVID-19 treatment in Gazi Medical College Hospital (GMCH), Khulna, Bangladesh.

Methods: This was a cross-sectional type of observational study on patients with hypertension who were diagnosed with COVID-19 based on laboratory and/or radiological findings and admitted to Gazi Medical College Hospital, Khulna, Bangladesh, from July 1 to July 31, 2021. In that timeframe, overall, 215 patients with COVID-19 were admitted. Among them, 37 patients having hypertension fulfilled the inclusion criteria for the study. Demographic, clinical, laboratory and radiological data of those 37 patients were recorded and analyzed.

Results: Among 37 study subjects, 54.1% were female. The mean age of the patients was 59.6±13.9 years. Among the study subjects, diabetes (56.8%) was the most common comorbidity. Regarding laboratory parameters, the mean Hb of the patients was 11.4±1.9 g/dl. In addition, the mean random blood sugar (RBS) level was 11.6±2.9 mmol/l. Neutrophilia and lymphocytopenia were observed in 86.5% and 83.8% cases, respectively. The mean D-dimer (2.4 mg/l) and CRP (72.5 mg/l) levels were well above their normal limits. In high resolution CT scan of the chest (HRCT chest), bilateral lung involvement was present in 89.2% cases. Ground-glass appearance was the most frequent (91.9%) radiologic pattern. Among antihypertensive drugs, losartan potassium was the most frequently used category (29.7%). Total 7 (18.9%) patients were severely affected with COVID-19 and admitted to the ICU, requiring mechanical ventilation. During our study, 2 patients (5.4%) died either due to multiple organ dysfunction syndrome or cardio-respiratory failure.

Conclusion: The study provides key information to better understand the clinical characteristics of patients with hypertension admitted for COVID-19 treatment, which may help physicians to identify the factors associated with adverse outcomes in this disease.

Mediscope 2024;11(1): 34-40

Effectiveness of combination use of intralesional steroid with 5-fluorouracil in the treatment of keloid patients

2024-02-24T05:19:48+00:00

Background: Keloids are a common problem with significant recurrence rates despite intralesional steroid treatment and 5-fluorouracil in combination with triamcinolone may be superior to triamcinolone alone. Objectives: To evaluate the effectiveness of the combination use of intralesional steroids with 5-fluorouracil in the treatment of keloid. Methods: The study was a descriptive cross-sectional study and was conducted at the Department of Dermatology and Venereology, Khwaja Yunus Ali Medical College (KYAMC), Enayetpur, Sirajganj, from July 2020 to June 2021. A total of 100 patients with keloid were included in this study. These patients were subjected to history, clinical examination, and investigations. In all cases, informed written consent was taken from the Participants and a separate case record form was used during data collection. Collected data were analyzed by the statistical software IBM SPSS 25. Results: This study shows that the majority (68%) of patients belonged to the age group of 21-30 years. The mean age was 26.43±7.77 years. Regarding sex, 56% were females and 44% were males with a male-female ratio of 1.3:1. 52% of patients had a duration of lesion up to 1 year, 22% of patients had 1-2 years and 26% of patients had >2 years. The most common site of keloid was the chest (38%), then face (32%), upper extremity (16%), shoulder (6%), back (4%). The most common presenting symptoms were pruritis (56%), then 38% were cosmetic disfigurement, 32% were skin discoloration, 28% were pain and 18% were restriction of movement. Trauma was the commonest factor seen in 34% of the patients followed by ear piercing (22%) and infection (20%). Other causes were spontaneous (10%), acne (6%), burns (6%), and post-surgical keloid (2%). 16 had a positive family history of the keloid disease. The majority (70%) had good outcomes followed by excellent outcomes in 22% and 8% had average outcomes. It was observed that most patients (88%) did not have any adverse effects. Only 12% had adverse effects seen as skin ulceration (6%), skin atrophy (4%) and telangiectasia (2%). Conclusion: This study revealed that the combination use of intralesional steroids with 5-fluorouracil in the treatment of keloid seems to offer the balanced benefit of faster and more efficacious response with fewer adverse effects. Treatment has to be individualized and can be combined with one or more modalities to aim for better efficacy and safety.

Mediscope 2024;11(1): 41-47