Author: dhaka-admin

A high-risk pregnancy can be a daunting experience for expectant mothers, as it requires specialized care and attention due to potential complications that could arise both for the mother and the fetus.

In such cases, the expertise of feto-maternal medicine comes into play, offering comprehensive care to ensure the best possible outcomes for both mother and upcoming baby. In this blog post, we will explore the significance of feto-maternal medicine in managing high-risk pregnancies and its impact on maternal and fetal health.

Understanding High-Risk Pregnancy:

High-risk pregnancies are those that involve factors that may increase the likelihood of complications during pregnancy or childbirth. These factors can vary and may include maternal age (either too young or advanced), pre-existing health conditions like diabetes or hypertension, multiple pregnancies (twins, triplets), genetic disorders, and certain lifestyle choices, such as smoking or substance abuse.

The Role of Feto-Maternal Medicine:

Feto-maternal medicine, also known as maternal-fetal medicine, is a subspecialty of obstetrics that focuses on providing specialized care for pregnant women facing high-risk conditions. These specialists work collaboratively with obstetricians, neonatologists, and other healthcare professionals to monitor, diagnose, and manage high-risk pregnancies.

Diagnosis and Risk Assessment:

One of the essential aspects of feto-maternal medicine is risk assessment and diagnosis. Advanced prenatal screenings and diagnostic tests help identify potential complications early on, enabling the healthcare team to tailor a personalized care plan for each patient. Regular monitoring and follow-ups throughout the pregnancy ensure that any emerging issues are addressed promptly.

Management and Treatment:

Feto-maternal medicine specialists are equipped with the knowledge and skills to manage a wide range of high-risk conditions during pregnancy. Depending on the specific case, management may involve medical interventions, lifestyle modifications, or even surgical procedures. The ultimate goal is to optimize the health of both the mother and the fetus, reducing the risk of adverse outcomes.

Communication and Emotional Support:

High-risk pregnancies can take an emotional toll on expectant mothers and their families. Feto-maternal medicine specialists understand the importance of clear communication and emotional support throughout the journey. They provide guidance, answer questions, and address concerns, helping the expectant mother feel empowered and informed about her health and the health of her baby.

The Impact on Maternal and Fetal Health:

The interventions provided by feto-maternal medicine specialists have a significant impact on the health of both the mother and the baby. Timely detection and management of complications can lead to better pregnancy outcomes, reduced risks of preterm birth, improved neonatal health, and a lower likelihood of long-term health issues for the baby.

In conclusion, high-risk pregnancies require specialized care and attention to ensure the well-being of both the mother and the baby. Feto-maternal medicine plays a crucial role in managing these pregnancies, providing expert diagnosis, management, and emotional support.

By understanding the significance of feto-maternal medicine, expectant mothers can approach their pregnancy with confidence, knowing that they have a team of dedicated specialists working to ensure the best possible outcome for their little one.

Author:

Lt. Col. (Dr.) Nargis Nahar

Senior Consultant

Obstetrics and Gynaecology

Evercare Hospital Dhaka

In the ever-evolving landscape of healthcare, the “Golden Hour” has emerged as a critical time frame in acute heart attack cases. This vital sixty-minute window, following the onset of a heart attack, represents a race against time to provide immediate medical intervention.

In this article, we explore the profound importance of the Golden Hour in acute heart attack cases and how it continues to revolutionize emergency cardiac care, saving countless lives in the process.

Understanding Acute Heart Attacks:

An acute heart attack, or myocardial infarction, occurs when a coronary artery becomes blocked, leading to a sudden disruption of blood flow to a portion of the heart muscle.

The heart muscle, deprived of oxygen and nutrients, starts to suffer irreversible damage. The severity of the damage depends on the duration of the ischemic period before the artery is reopened.

The Golden Hour – A Race Against Time:

The term “Golden Hour” emphasizes the critical need for prompt action in acute heart attack cases. During this crucial hour, rapid medical intervention can significantly impact the patient’s prognosis, minimize complications, and improve long-term outcomes.

The sooner appropriate treatments are initiated, the greater the chances of preserving heart muscle function and saving lives.

Early Recognition and Response:

Early recognition of heart attack symptoms and immediate response are key to optimizing patient outcomes. Public awareness campaigns and education on heart attack symptoms play a crucial role in empowering individuals to identify warning signs promptly.

Common symptoms include chest pain or discomfort, shortness of breath, nausea, cold sweats, and pain radiating to the arms, back, neck, or jaw.

Role of Emergency Medical Services (EMS):

Emergency Medical Services (EMS) play a pivotal role in the Golden Hour by providing timely and efficient pre-hospital care.

EMS responders are trained to quickly assess and stabilize heart attack patients, initiate oxygen therapy, administer medications, and transport the patient to a specialized cardiac facility for further treatment.

Importance of Rapid Reperfusion:

Restoring blood flow to the affected heart muscle is the primary objective during the Golden Hour. Two main reperfusion strategies are employed: thrombolytic therapy and primary percutaneous coronary intervention (PCI).

Thrombolytic therapy involves administering clot-busting medications to dissolve the obstructing blood clot. PCI, on the other hand, involves mechanically reopening the blocked artery using a catheter and stent.

Primary Percutaneous Coronary Intervention (PCI):

Out of the two reperfusion strategies, the superior mode of delivering the treatment is doing a primary angioplasty of the blocked artery. Thrombolytic therapy has a high failure rate.

But urgent coronary angiography and primary angioplasty within six hours of chest pain, carries much better outcome and preservation of cardiac function.

The procedure can be extended up to twelve hours in certain circumstances. Therefore, primary angioplasty is the treatment of choice, if onsite facilities are available.

Impact on Patient Outcomes:

Studies consistently demonstrate that the time from symptom onset to reperfusion is directly correlated with patient outcomes. Those who receive correct treatment within the Golden Hour have higher survival rates and experience fewer complications.

Prompt medical intervention reduces the extent of heart muscle damage, lowers the risk of heart failure, and improves the patient’s overall quality of life.

In acute heart attack cases, the Golden Hour represents a race against time, where every minute counts. Rapid recognition of symptoms, prompt activation of emergency services, and swift access to appropriate medical care are crucial for saving lives and minimizing long-term complications.

Public education on heart attack symptoms and the importance of early intervention is vital to ensuring more individuals receive timely treatment during this critical window.

Emphasizing the significance of the Golden Hour in acute heart attack cases will continue to be instrumental in reshaping emergency cardiac care and fostering better patient outcomes.

Author:

Dr. Shams Munwar

Senior Consultant

Clinical & Interventional Cardiology

Evercare Hospital Dhaka

NCDs in Bangladesh: A Growing Public Health Crisis

In Bangladesh, non-communicable diseases (NCDs) are increasing rapidly and account for approximately 68% of mortality and 64% of disease burden – namely heart attacks, strokes, chronic respiratory disease, cancers & diabetes. Additionally, around 20% of the population suffer from hypertension, 10% from diabetes, and as much as 2 million people suffer from cancer each year in the country, with around 50,000 new patients joining the list annually.

NCD Risk Factors Worsen in Bangladesh

A study conducted by NCD Control unit at the Directorate General of Health Services (DGHS), published in June this year, stated that the NCDs risk factors have further worsened in the country compared to 2018 – with 44.9% of the population using tobacco products (smoke and smokeless), one of the leading risk factors for NCDs.

With close to 6.2 million adult smokers in the country, it is essential to embrace innovative measures and harm reduction alternatives rooted in science, to transform and save lives.

Harm reduction alternatives reduce the level of harmful toxins while providing the user with Nicotine. In the recent years, there has been a growing debate surrounding nicotine and its potential health risks. Misinformation and lack of awareness have clouded the understanding of nicotine’s true nature and its relationship with combustion, leading to misconceptions about its effects on human health. Contrary to popular belief, nicotine itself while addictive, does not cause diseases, and is present in various everyday products we use. The primary health risks associated with smoking, stem from the combustion of tobacco.

Nicotine vs. Combustion: What’s the Difference?

Understanding the distinction between nicotine and the combustion process is of particular importance. Research conducted by the U.S. Department of Health and Human Services reveals that the majority of toxic substances released during smoking are a direct result of the combustion process, including carbon monoxide, tar, and carcinogens. Nicotine, while it is highly addictive, it does not cause the myriad of health issues commonly associated with smoking.

Decades of research have led to the introduction of safer and better alternatives like heated tobacco products (HTPs)- that offer a way for those battling addiction and those who do not quit. HTPs have gained recognition as a promising safer alternative to traditional cigarettes. These devices operate by heating tobacco instead of burning it. Since the tobacco is not burned, the levels of harmful chemicals released are significantly reduced compared to cigarette smoke – hence provide a safer option for those seeking nicotine with significantly reduced detrimental health effects compared to smoking.

The Future of Smoking: Will HTPs Replace Cigarettes?

In conventional cigarettes, the combustion of tobacco at high temperatures not only releases nicotine, but also produces harmful byproducts that damage the respiratory system and contribute to various diseases, including lung cancer and cardiovascular ailments. In contrast, HTPs heat the tobacco at lower temperatures, reducing or eliminating the release of specific chemicals, thus providing a safer alternative, resulting in a more satisfying experience for smokers. 

Transition from conventional cigarettes to safer alternatives has the potential to reduce the risk substantially at both the individual and societal levels. This is best evidenced by the case of Japan. In recent years, Japan has experienced a significant decline in smoking rates as more individuals switch to HTPs.

The future of HTPs in public health

However, the introduction of these alternatives to the market has sparked discussions among public health experts, policymakers, and the tobacco industry. Some argue that promoting HTPs might inadvertently encourage smoking or deter current smokers from quitting altogether. It is critical for the government and the regulatory bodies to carefully consider the scientific evidence when formulating policies for harm reduction. Striking a balance and ensuring access to safer alternatives for current smokers and preventing non-smokers from initiating cigarette and nicotine consumption is important.

By educating consumers about safer and better alternatives, we can empower them to make informed choices and ultimately contribute to a healthier society. Encouraging further research into better alternatives and implementing science and evidence-based policies will be essential in tackling the global tobacco epidemic.

It is quite clear that the old “quit or die” approach to smoking control is no longer good enough on its own, as millions of lives are at stake.  We can work towards a future where the adverse health effects of smoking become a thing of the past, and individuals are empowered to make choices that contribute to their wellbeing. By providing consumers access to credible, evidence-based information, and science-based products we have an opportunity to benefit society at large. 

Author:

Dr. Ziaul Huq

Senior Consultant

Respiratory Medicine Department

Evercare Hospital Dhaka

The Importance of Breastfeeding in Bangladesh

In a world grappling with numerous health challenges, breastfeeding emerges as a simple yet powerful solution that can significantly impact the well-being of individuals and entire communities. As of 2023, Bangladesh stands at a critical juncture where promoting and supporting breastfeeding can foster a healthier, more resilient society. The evidence-backed benefits of breastfeeding extend far beyond infancy, making it a lifelong investment in health.

Need for Better Education and Support for Mothers in Bangladesh

In 2023, Bangladesh faces challenges in improving breastfeeding rates. According to recent data from the Bangladesh Demographic and Health Survey (BDHS), exclusive breastfeeding rates for infants under six months remain suboptimal, with only 35.9% of babies being exclusively breastfed. Furthermore, the initiation of breastfeeding within the first hour after birth stands at a mere 36%, indicating a need for better education and support for mothers.

Breastfeeding provides a myriad of immediate and long-term health advantages, both for the infant and the mother. In the short term, breast milk is a complete and easily digestible source of nutrition, protecting infants from infections, diarrhea, and respiratory illnesses. Longer-term benefits include a reduced risk of obesity, type 2 diabetes, and certain childhood cancers.

For mothers, breastfeeding lowers the risk of breast and ovarian cancer and contributes to postpartum weight loss. Investing in breastfeeding can alleviate the strain on Bangladesh’s healthcare system by reducing the burden of preventable diseases and minimizing healthcare costs.

Bangladesh faces significant challenges concerning malnutrition, especially among its young population. In 2023, stunting and wasting rates stand at approximately 12.5% and 27.5%, respectively, among children under five. Breastfeeding plays a crucial role in combatting malnutrition, as breast milk provides essential nutrients and immunological factors that promote healthy growth and development.

Research indicates that breastfeeding is linked to improved cognitive development in children. A study conducted in Bangladesh by the International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B), revealed that children who were breastfed for more extended periods showed higher scores in cognitive tests. Such findings underscore how breastfeeding can contribute to the nation’s human capital development and long-term economic prosperity.

Supporting breastfeeding extends beyond the home, with a pressing need for breastfeeding-friendly workplaces. Encouraging employers to provide lactation rooms and flexible break times for breastfeeding can enhance mothers’ ability to continue breastfeeding after returning to work. The benefits of this investment extend to the economy as well, with healthier, more productive workers and reduced absenteeism due to child illnesses.

In 2023, Bangladesh has the opportunity to embrace breastfeeding as a potent tool for improving the health and well-being of its population. By focusing on increasing exclusive breastfeeding rates, promoting early initiation of breastfeeding, and creating a breastfeeding-friendly environment, Bangladesh can pave the way for a healthier future.

Investing in breastfeeding is not just a short-term strategy but a lifelong commitment to building a resilient, prosperous nation. It is a collective responsibility of policymakers, healthcare providers, communities, and families to support breastfeeding and unlock its full potential for the health and development of every Bangladeshi citizen. By doing so, Bangladesh can create a legacy of lifelong health, prosperity, and success for generations to come.

Author:

Dr. Nusrat Farooq

Senior Consultant

Paediatrics & Neonatology

Evercare Hospital Dhaka

References:

https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-018-1076-0

https://www.sciencedirect.com/science/article/pii/S0899900723000266

Overcoming the Challenges of Cancer Care in Bangladesh

As a physician on the front lines of cancer care in Bangladesh, I have witnessed the immense challenges faced by patients and healthcare providers in the battle against this formidable disease. I firmly believe that with the power of technology we can overcome these obstacles and usher in a new era of hope and progress in cancer diagnosis, treatment, and support.

Technology plays an immense role for cancer care in terms of the innovative solutions it brings. But it is undeniable that there are challenges we must address in order to maximize the treatment potential in Bangladesh.

The advent of technology has given us remarkable tools to enhance cancer diagnosis and screening. For example, timely consultations and accurate diagnoses can be conducted through the implementation of telemedicine and telepathology to bridge the gap between patients in remote areas and expert oncologists.

Almost everyone has a smartphone nowadays and the power of the internet in their palms. What’s amazing is that there are specific mobile applications which can provide educational resources to empower individuals, help them recognize early warning signs and seek medical attention promptly. More investment is these technological advancements can help us with the early detection of cancer and save countless lives.

With tele-oncology services, patients can connect with expert oncologists, receive cancer diagnosis, get treatment and follow-up care to ensure that every individual, regardless of their location, has access to specialized care. By embracing these innovative approaches, we can raise the standards of cancer treatment throughout Bangladesh.

Technology and Cancer Treatment

Additionally, technology has revolutionized cancer treatment options in a way that empowers us to provide effective and personalized care to our patients. Advanced radiation therapy techniques, such as IMRT, SBRT and IGRT, precisely target tumors with minimal healthy tissues and side effects, to improve treatment outcomes.

Cancer care extends far beyond medical interventions, as there is a great need for emotional and psychological support for patients and their families. To this extent, there are virtual support groups that can facilitate patients with teleconferencing platforms where they can get a sense of community and emotional support even from remote locations.

Furthermore, mobile health applications can equip patients with tools to manage symptoms, track medications, and access mental health resources. By integrating such technological innovations, we can enhance the overall well-being and quality of life for individuals afflicted with cancer.

While talking about the huge possibilities of positive impact for the greater good of patient care, it is wise to keep an eye out for the challenges we might face in the widespread implementation of cancer treatment in Bangladesh. Firstly, there is very limited healthcare infrastructure for cancer treatment in rural areas.

This issue must be addressed through the establishment of specialized cancer centers and the training of healthcare professionals in Bangladesh. Secondly, enhancing digital literacy and ensuring affordable access to the internet is imperative to ensure that all individuals can benefit from technology-enabled solutions.

Lastly, the privacy and security of patient data must be safeguarded, while awareness and educational initiatives should be launched to familiarize healthcare providers and the general public with these advancements.

To fully harness the benefits of technology, we must confront the challenges head-on through collaborative efforts between the government, healthcare organizations, technology providers, and the society at large.

Technology’s Role in Revolutionizing Cancer Care in Bangladesh:

It is undeniable that the role of technology in cancer care has the potential to revolutionize the landscape of cancer diagnosis, treatment, and support in Bangladesh. By embracing telemedicine, mobile applications, and other technological innovations, we can overcome barriers of distance and limited resources to deliver high-quality cancer care to every corner of our nation. Together, we can empower our patients, save lives, and build a brighter future for cancer care in Bangladesh.

Author:

Dr. Ferdous Shahriar Sayed

Senior Consultant & Coordinator

Medical Oncology

Evercare Hospital Dhaka

2023 Heatwave: A National Crisis

In 2023, summer brought on a series of unexpected heatwaves in Bangladesh, affecting people’s general well-being and worsening pre-existing medical conditions to cause widespread suffering and distress throughout the country.

Just a few weeks ago, one thought was running through the minds of all Bangladeshis – “How much hotter can it get? How do we tackle the extreme heat? Is it possible to die as a result of sweating so much? Well, it turns out the answer is yes.

Heatwaves: A Major Public Health Threat

A Harvard report says nearly an average of 1500 people died between 2003 and 2007 in Bangladesh. This year, about 1000 to 1200 patients were admitted to hospitals every day due to illnesses exacerbated by the heatwaves. So how can we protect ourselves during such heat waves?

Heatwaves are not only unbearable to live in, they are also extremely distressing to our health and well-being. It is important to take measures to tackle the heatwave as they can affect people’s general well-being and worsen pre-existing medical conditions.

Heat Stroke Symptoms and Risk Factors

Heat strokes can occur when body temperature rises to 40 degrees Celsius. At this temperature, people experience exhaustion, lethargy, tightness in the chest, headaches, and restlessness with no perspiration.

Some people are more vulnerable to heat strokes than others. The vulnerable segments of the population are infants, older adults, outdoor workers (including bike riders), athletes, low-income families, and those with pre-existing health issues like diabetes, obesity, cardiovascular disease, pulmonary disease, kidney disease, and mental health issues such as psychiatric disorders and depression.

Some more implications of heatwaves on our health includes dehydration, heat exhaustion, feared heat stroke, edema, syncope and general worsening of existing medical conditions. Extreme heat can also result in serious dehydration, stroke, and the development of clots.

A lot of care and caution is needed when temperatures rise to extremes like 40 °C. There are several measures that should be taken during a heatwave to provide adequate protection against sudden health collapses.

Tips for Staying Cool in Hot Weather

Spend as much time as possible indoors, and do not get out of the house unless it is absolutely necessary. If you are outside, try to be around plants and trees where you can get some natural shade from the sun. Stay as cool as you can, take multiple short showers throughout the day, or splash some water on your face periodically.

Choose your outfits carefully, opt for loose-fit, light-colored and lightweight clothes. Avoid getting involved in high-energy activities like running, jumping and playing sports in the afternoon. Last but not the least, keep yourself hydrated with lots of water and fluids. Keep a water bottle or electrolyte drink with you at all times.

As heatwaves came to us a surprise, we all witnessed for two months how people were falling ill, productivity was decreasing, and hospitals were filling up with patients experiencing ailments brought on by heatwaves sweeping the nation. Temperatures rose as high as 40.4 degrees Celsius in Dhaka, while it was 42.2 degrees in the mid-western side of the country, and similarly hot in other regions as well.

Heatwaves in Bangladesh: A recurring problem

But in fact, heatwaves are not new in Bangladesh. The people of the country experienced their first recorded heat wave in 1972 when the temperature went up to 45.1 degrees Celsius. Again in 1960, the temperature rose to 42.3 degrees Celsius, in 1965 it was 42 degrees Celsius, and so on. There is all the more possibility that we will be facing more heatwaves in the future.

By employing proper measures as stated above, we will be able to save ourselves and our loved ones from a lot of heat exhaustion and suffering. Let’s spread the news against health implications of seasonal heatwaves for a secure and health-positive future.

Author:

Dr. K.F.M. Ayaz

Senior Consultant

Internal Medicine

Evercare Hospital Dhaka

Glioblastoma multiforme (GBM): An aggressive brain cancer

Glioblastoma multiforme (GBM) is a type of brain cancer that is characterized by its aggressive nature and poor prognosis. Unfortunately, there is limited information available on the incidence of GBM in Bangladesh. However, it is estimated that the incidence of brain tumors in general is around 2-3 cases per 100,000 individuals in Bangladesh.

The clinical presentation of GBM can vary depending on the location of the tumor in the brain. Common symptoms of GBM include headache, nausea, vomiting, seizures, cognitive impairment, weakness, and changes in vision or speech.

Magnetic resonance imaging (MRI) is the gold standard imaging modality for the diagnosis of GBM. The typical MRI sequences used for the diagnosis of GBM include T1-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR), and gadolinium-enhanced T1-weighted images.

After radiological diagnosis, post-surgery histopathology and molecular testing of the biopsy sample can help to identify specific genetic mutations or biomarkers that may guide treatment decisions. GBM is classified as a grade IV Astrocytoma, which is the most aggressive type of brain tumor. GBM can also be further classified based on specific genetic mutations or biomarkers, such as IDH status.

Available Treatment Facilities for GBM in Bangladesh

The treatment of GBM typically involves a combination of surgery, radiation therapy, and chemotherapy. Surgery is typically the first-line treatment and aims to remove as much of the tumor as possible. Radiation therapy is typically administered after surgery. Radiation therapy is being administered using external beam radiation. Chemotherapy may also be used in conjunction with radiation therapy. Usually oral chemotherapeutic agent is used.

The prognosis for GBM is poor, with a median survival of approximately 15 months. The use of radiation therapy and chemotherapy can improve outcomes. Currently almost all sort of treatment facilities of GMB is readily available in many centers in Bangladesh. Proper quality assurance in radiotherapy is the key concern for outcome.

Dr. Arman Reza Chowdhury

Consultant – Radiation Oncology

Evercare Hospital Dhaka

Email: rezadrarman@gmail.com

During extreme heat it is easy to become dehydrated or for your body to overheat. If this happens, you may develop heat cramps, heat exhaustion or even heatstroke. Extreme heat can also make existing medical conditions worse.
To minimize the impact during the heat wave and to prevent serious ailment or death because of heat stroke, you can take the following measures:
 Avoid going out in the sun, especially between 11.00 a.m. and 3.00 p.m.
 Drink sufficient water and as often as possible, even if not thirsty. If your doctor normally limits your fluids, check with your doctor how much to drink during hot weather.
 Wear lightweight, light-colored, loose, and porous cotton clothes. Use protective goggles, sunscreen, umbrella/hat, shoes while going out in sun.
 Avoid strenuous activities when the outside temperature is high. Avoid working outside between 11.00 a.m. and 3 p.m.
 Cancel or postpone outings. If you absolutely must go out, stay in the shade and take plenty of water with you.
 Avoid alcohol, tea, coffee and carbonated soft drinks, which dehydrates the body.
 Avoid high-protein food and do not eat stale food.
 If you work outside, use a hat or an umbrella and use a damp cloth on your head, neck, face and limbs.
 Keep yourself cool by using damp towels containing ice, putting your feet in cool water and taking cool (not cold) showers.
 Do not leave children or pets in parked vehicles.
 If you feel faint or ill, see a doctor immediately.
 Use ORS, homemade drinks like lassi, lemon water, buttermilk, etc. which helps to re-hydrate the body.
 Keep animals in shade and give them plenty of water to drink.
 Keep your home cool, use fans, curtains, shutters or sunshade and open windows at night.
 Monitor those at high risk- infants and young children, people 65 years of age or older, people who are overweight, people who overexert during work or exercise.

Tips For Treatment Of A Person Affected By A Heatstroke:

 Lay the person in a cool place, under a shade. Wipe her/him with a wet cloth/wash the body frequently. Pour normal temperature water on the head. The main thing is to bring down the body temperature.
 Give the person ORS to drink or lemonade or whatever is useful to rehydrate the body.
 Take the person immediately to the nearest health care centre. The patient needs immediate hospitalization, as heat strokes could be fatal.

Acclimatization:

People at risk are those who have come from a cooler climate to a hot climate. You may have such a person(s) visiting your family during the heat wave season. They should not move about in open field for a period of one week till the body is acclimatized to heat and should drink plenty of water. Acclimatization is achieved by gradual exposure to the hot environment during heat wave.

Article by:
Dr. Nikhat Shahla Afsar
Senior Consultant, Internal Medicine
Evercare Hospital Dhaka