The non-communicable disease prevalence in Bangladesh is now in epidemic proportions. While the government health system was traditionally focused on managing infectious diseases and acute conditions, NCDs like diabetes, stroke, cancer, chronic respiratory diseases, hypertension, and heart diseases have surpassed all else and are responsible for almost 70% of all deaths in the country. These co-morbidities complicate simple infections and raises the need for critical care more often than before.
It has been observed that patients only in their 30s and 40s with underlying diabetes or hypertension are succumbing to septicemia or all system failure. For long-term solution, it will require a concerted effort to change nutrition, lifestyle, culture, and environment to reverse this scenario. Meanwhile innovations have not stopped- newer drugs, devices, and interventions are becoming readily available to absolve patients from critical conditions. One such drug, Cytosorb is being used widely in the urban critical care unit. A 48-year-old woman presented with sepsis, acute kidney injury, deep jaundice had underlying diabetes mellitus, hypertension, polycystic ovarian syndrome. Her self-treatment of jaundice led to multiple complications, and she had to be brought to BIRDEM where she finally received hemodialysis and Cytosorb at critical care which reduced her bilirubin level and stabilized her condition. Cytosorb is steadily gaining popularity for use in very critical care. It has proven to be effective in removing toxic substances from chronic inflammation.
Parenteral nutrition (PN) is a vital intervention for patients unable to receive nutrition orally or patients required to remain nothing per oral for a specific duration. Essential nutrients are replenished in critically ill, malnourished, dehydrated, and post-surgical patients parenterally. Advancements like three-chamber bags has improved safety and efficiency in PN. However, risk assessment must always be calculated with long-term use as it is associated with infections, liver dysfunction, and complications like dyslipidaemia. To ensure PN remains beneficial, optimizing PN protocols, incorporating alternative lipid formulations when needed, and prioritizing enteral nutrition when feasible will enhance patient outcomes and reduce complications.
Chemotherapy-induced anemia (CIA) significantly affects cancer patients, with fatigue being the most debilitating, yet overlooked symptom. Traditional management with red blood cell (RBC) transfusions and iron supplementation is now enhanced with erythropoiesis-stimulating agents (ESAs) like epoetin beta which transformed the excessive RBC transfusion dependency. Epoetin beta mimics endogenous erythropoietin, stimulating erythropoiesis and improving hemoglobin levels, ultimately enhancing patient’s quality of life. Despite its benefits, concerns regarding its safety persist. Studies show that while epoetin beta alleviates anemia and reduces fatigue, it does not improve survival rates and may increase the risk of thromboembolic events, particularly when given at a hemoglobin range of 11.5 g/dL or more. Moreover, ESA-induced erythropoietin receptor (EpoR) activation in endothelial cells may promote angiogenesis, tumor proliferation, and drug resistance in certain cancers. Current guidelines recommend epoetin beta for CIA patients with hemoglobin between 10–11.5 g/dL. However, further large-scale trials are needed to assess long-term survival outcomes and refine its safety profile.
Although intensive care units are essential to saving lives of critical patients, Bangladesh not only faces challenge in having inadequate number of ICUs but even the spread of the ICU beds are mostly concentrated in Dhaka, leaving a large section of the population without any access to critical care. A study in Bangladesh Specialized Hospital highlighted that the patients ending up in critical care have comorbidities like hypertension, diabetes, and ishcaemic heart diseases which makes healing complicated and time consuming. The study also underscores the alarming rate of pneumonia, sepsis, and multi-organ failure among ICU patients, reinforcing the need for stringent infection control and better management of underlying co-morbidities. With a mortality rate of 20%, tailored interventions, including early sepsis detection and aggressive glucose control, are imperative. A geriatric-focused critical care strategy needs to be designed. Strengthening Bangladesh’s critical care landscape will be a step toward reducing preventable mortality and improving patient survival.
Vitamin K2 plays an essential role in optimizing calcium transport for bone and cardiovascular health. While vitamin D3 facilitates calcium absorption, vitamin K2 activates osteocalcin and matrix Gla-protein (MGP) to ensure calcium is directed to bones rather than arteries, reducing the risk of osteoporosis and vascular calcification. This synergy among calcium, vitamin D3, and vitamin K2 is increasingly recognized as a first-line treatment for osteoporosis. Bangladesh follows the international guideline on the recommended daily doses of calcium and vitamin D3, but awareness of vitamin K2 remains low. Ensuring a dose specific intake of all three nutrients under the guidance of healthcare providers will ensure strong bones and healthy heart and at the same time avoid hypercalcemia and soft tissue calcification.
Oral contraceptives increase blood coagulability and combined used of it with NSAIDs, especially non-aspirin and COX-2 inhibitors—significantly raises the risk of venous thromboembolism (VTE). A Danish cohort study of 2 million women (15-49 years) investigated and confirmed this link. VTE, which includes deep vein thrombosis and pulmonary embolism, can be life-threatening but is preventable with early diagnosis. NSAIDs inhibit prostacyclin (a vasodilator and anti-thrombotic agent) while allowing thromboxane A2 (a clot promoter) to remain active, increasing thrombosis risk. The study found that NSAID use alone raised VTE risk, and combined use with high-risk contraceptives increased risk by 58%. Ibuprofen (60%), diclofenac (20%), and naproxen (6%) were the most commonly used NSAIDs. Given the widespread use of hormonal contraceptives and NSAIDs, this study highlights a critical public health concern. Women on hormonal therapy should use NSAIDs cautiously to minimize thrombotic risks.
Hepatocellular carcinoma (HCC), the most common primary liver cancer, is increasingly linked to non-alcoholic fatty liver disease (NAFLD) and its advanced form, non-alcoholic steatohepatitis (NASH). In Bangladesh, 17.51% of HCC cases are associated with NAFLD, highlighting a growing concern. A study of 1,028 Bangladeshi patients found that 46.50% had HBV, 5.45% had HCV, 61.48% had chronic liver disease (CLD), and only 4.46% had a family history of malignancy. NAFLD, characterized by excess fat storage in liver cells, can progress to NASH when inflammation and cellular damage occur. NAFLD-related HCC can develop even without cirrhosis, and its risk is elevated by metabolic disorders such as obesity, diabetes, hypertension, and dyslipidemia. Lifestyle factors, including alcohol consumption and smoking, further increase HCC risk, while dietary modifications like the Mediterranean diet, regular exercise, and coffee consumption can offer protective benefits. A multifaceted prevention strategy is crucial, involving weight loss, metabolic management, and chemoprevention with agents like aspirin, anti-diabetic drugs, and statins. Future research into disease mechanisms may enhance targeted interventions to curb HCC prevalence.
A holistic, multi-sectoral approach is necessary to combat the rising burden of the NCD epidemic in Bangladesh. These conditions not only drive mortality but also complicate infections, increasing the demand for critical care. Lifestyle modifications, including diet, exercise, and metabolic control, are vital in reducing risks. Policy interventions, improved healthcare access, strengthen critical care infrastructure throughout the country, and enhanced preventive strategies will be key in mitigating disease burden. By fostering awareness, early detection, and treatment innovations, Bangladesh can move toward a healthier future with reduced critical care dependency and improved survival rates.