Evidence-based protocols, investigating tools, public health concerns, effectiveness of existing protocols are minutely studied and improvised with time. Investigations related to diseases now explore other factors that were previously deemed unrelated.
A woman’s pregnancy journey leaves physical impact lasting her a lifetime. Hormonal changes throughout this period raises complications with gestational diabetes being the most common endocrine disorder. The other hormonal condition that is overlooked but women commonly suffer while being pregnant is thyroid disease. Subclinical hypothyroidism is more common than overt hypothyroidism. It is essential to monitor thyroid hormones in pregnant women as the neurocognitive development of fetus is dependent on that. Some studies elucidate that gestational diabetes are associated with hypothyroidism.
Stroke in children? Yes, it happens and happens mostly from trivial head injury from fall. Although minor head injuries are common in childhood and resolves on its own, sometimes it may lead to infarcts causing hemiparesis. The injury affects the lenticulostriate arteries which are deep perforating end arteries. The broad understanding is, children’s brains are underdeveloped, and trauma mechanically shifts the brain which may stretch the arteries, causing vasospasm that disrupts the flow between the fixed intracerebral and mobile extracerebral parts of the deep perforating vessels. The spasm leads to intimal lesion and thrombus formation. CT scans and diffusion weighted MRI can detect the lesion, the former is mainly done to exclude hematoma and the latter is the main investigation to visualize the infarct.
Sexualized drug use (SDU) is a public health concern for raising addiction and spreading sexually transmitted diseases like HIV, syphilis, gonorrhea, and chlamydia. Stress, emotional agony, peer pressure, need for social inclusion especially among youths and adolescents, and partners’ pressure are cited to be the cause of drug abuse. Sadly, SDU use among women is mostly a product of gender-based oppression, rather than a phenomenon where women choose to partake in drug use to increase their sexual performance for a better income. East, Southeast Asian regions, and North America constitutes almost 90% of the global methamphetamine seizures between 2017-2021. Awareness needs to be spread for curbing this to become a full-fledged public health alarm.
Bite injuries are seldom given importance, yet human and animal bite injuries are a serious global health concern. Upper and lower limbs followed by face are the commonest site of dog bite injury. Younger children are more likely to get bitten in the face and adults on the limbs. The most affected areas of the face are the lips and nose which causes the detrimental mental strain to the affected and the family. Surprisingly, human bites after a vicious fight are not uncommon and leads to serious avulsion type injury. Reconstructive surgeries are now common in Bangladesh, and it may take more than two surgeries to correct the deformities. When primary reconstructive surgery is performed soon after the injury happens, it not only boosts the confidence of the affected but the outcome is better with less chances of infection, and less cost from shorter hospital stays.
Intra articular distal humerus fractures are one of the most difficult injuries to manage. Double plate osteosynthesis is the standard treatment method, yet controversy exists concerning the plate positions in terms of providing optimal stability of these kind of fractures. Flexion arc, MEPS, and DASH scores are the standards used to compare the orthogonal and the parallel plating groups. A quasi-experimental study of 36 patients, conducted in the department of Orthopedics and Traumatology of Chittagong medical college hospital, Chattogram, for a period of fifteen month showed that, from a clinical perspective, a parallel plating method appears to provide better rigid fixation that is adequate for obtaining bone union.
Even though advanced minimal invasive techniques of crushing stones have gained popularity, cost-effective surgical removal of large urinary stones is still a management protocol in Bangladesh. Post-operative urinary leakage is a complication in such cases for both patient and clinician. The use of D-J stent has shown to prevent urinary leakage. A study compiled of 100 patients on whom D-J stents were implanted during surgical procedure of removing the stones in Central medical college of Cumilla, Bangladesh showed success in preventing the leakage but also showed unexpected complications. The complications mainly arose when patients forgot to come at their scheduled time for the removal of stents. Complications like encrustation, stone formation, fragmentation, infection, stent displacement occurred due to delay coming for follow ups.
Mental health was for the longest time a stigma in our society. More and more awareness is being generated to acknowledge and seek medical help for mental health challenges. The stigmatization is prevalent worldwide, but it is more predominant in low to middle-income countries. Not only do the patients suffer from social exclusion, but in some parts of the society even the caregivers are not given the respect that is their due. Considering the new epidemic of ADHD mostly related to social media addiction, mental health stigmatization should become a thing of the past. The global connectivity is such, it does not take long for advanced global protocol to come to our shores. Worldwide, the main challenge is not having enough healthcare workers. Any new protocol requires training and continuous medical education of the clinicians. In Bangladesh, the burden on healthcare worker creates so much pressure that often it becomes impossible for specialists to update their skills. Hospital management and healthcare system needs to become compliant as per international accreditation. Regulatory framework will bring about accountability of the whole system which will enhance the quality of care and patient safety.