Author: dhaka-admin

An estimated 200 million people have COPD Globally, of which about 3.2 million die each year, making it the third-leading cause of death worldwide. The damage to the airways & lungs caused by COPD is permanent, but treatment can help slow down the progression of the condition.

The GOLD international COPD guidelines1, advise spirometry as the gold standard for accurate and repeatable measurement of lung function. Evidence is emerging that when spirometry confirms a COPD diagnosis, doctors initiate more appropriate treatment.

Treatments include:

Stopping smoking – if you have COPD and you smoke, this is the most important thing you can do.

Inhalers and medicines – to help make breathing easier.

For most people with COPD, short-acting bronchodilator inhalers are the first treatment used. Bronchodilators are medicines that make breathing easier by relaxing and widening your airways. There are 2 types of short-acting bronchodilator inhaler: Examples of short-acting bronchodilators are albuterol /Salbutamol/ levalbuterol and ipratropium.

A current recommendation of treatment in COPD is that two “fixed triple” combinations of an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) in a single inhaler have become available for patients with COPD.

The indication of using ICS in COPD is stronger if the patient has concomitant asthma and or blood-increased -Eosinophil levels. Apart from reducing the risk of exacerbations, there is also data indicating t

hat ICS has a small but significant positive effect on lung function decline and mortality

Stem cell therapy:

There is some evidence that stem cell therapy for lungs may be effective in improving lung function and reducing inflammation in people with COPD. However, the effectiveness of stem cell therapy for COPD is still being studied, and more research is needed to determine its long-term effectiveness.

Author:

Dr. SM Abdullah Al Mamun

MBBS(DMC), MD (Chest), MCPS(Med), FRCP(Edin)

Senior Consultant

Respiratory Medicine

Evercare Hospital Dhaka

Sudden Cardiac Death: A Major Cause of Death in Dialysis Patients

Cardiac disease is the major cause of death among dialysis patients. In the United States Renal Data System (USRDS) database, the single, largest, specific cause of death is attributed to arrhythmic mechanisms or sudden cardiac death (SCD). The overall best estimate is that SCD is responsible for approximately 29 percent of all-cause mortality in dialysis patients.

In the general as well as the dialysis population, most SCA events are believed to be due to ventricular arrhythmias; that is, ventricular tachycardia (VT) or ventricular fibrillation (VF). A minority may have been attributed to bradyarrhythmia’s.

The increased risk associated with low-potassium dialysate was greatest at lower levels of pre dialysis serum potassium. Increased ultrafiltration volume and low-calcium dialysate were also linked to SCA in this study. Compared with dialysate potassium ≥3 mEq/L, dialysate potassium concentrations ≤1.5 and ≤2 to 2.5 mEq/L were associated with increased risk of SCD.

Evercare Hospital’s Low Mortality Rate for Dialysis Patients

In Evercare Hospital for the first time in Bangladesh we have modified our dialysis potassium and calcium bath to reduced mortality, intradialytic hypertension, and cardiac events. We are offering high potassium low calcium bath dialysate specially for patients who are having intradialytic hypertension and cardiac arrhythmia.

Our dialysis mortality rate (21%) is lower than the international standard mortality rate in developed countries. We are continuously improving our standards and currently doing CRRT with online dialysate fluid which is a cheaper and more effective option for critical patients then with prepared dialysate bags.

Dr. Ebadur Rahman
MRCP(UK), FRCP(UK), FRCPI, FASN, MMEDSCI (UK) DM(UK), Sren nephrology (UK).
Senior Consultant
Department of Nephrology
Evercare Hospital Dhaka
Vice President of IRTA
E-MAIL: ebadurmr@gmail.com, ebadur.rahman@evercarebd.com

What is a Pediatric ICU?

A Paediatric ICU or Paediatric intensive care unit is a hospital department which is especially made to provide intensive care to children who are critically ill. Although children, in this regard, are categorized as being within 0 to 18 years of age, the maximum age limit for Paediatric ICU patients is determined as per the respective hospital’s protocol.

Pediatric Intensive Care Unit (PICU)

Critically ill infants, who are usually one month of age and older, receive medical care in Paediatric ICU. On the other hand, Neonatal ICU (NICU) is for babies who are less than one month-old. In the Paediatric ICU, the presence or use of various types of equipment along with trained doctors and nurses play a significant role in providing timely and accurate treatment.

Various critical illnesses of children, such as severe pneumonia, asthma-related breathing problems, heart failure, heart rhythm abnormalities, risk of heart failure, complications from kidney failure, age-related changes in blood pressure, brain infections (meningitis, encephalitis), prolonged seizures, and complications from diabetes (diabetic ketoacidosis) increase the risk of death.

In these conditions, breathing, blood pressure, heart rate, body salt, water, oxygen, and carbon dioxide all lose their equilibrium. In such cases, timely and need-based treatment is required, which is not possible without close monitoring. Artificial respiration or life support is sometimes required, which can only be seen in the ICU. Moreover, there are some life-saving drugs, which require intensive care units for implementation.

In the last few years, there has been an increase in the severity of dengue (dengue shock syndrome) and Multisystem Inflammatory Syndrome (MISC), which is a post-pandemic COVID infection complication. In this case, heart vein swelling and heart failure can occur. The treatment of these children requires close monitoring and care, which is possible only in the ICU.

Paediatric intensive care units/Paediatric ICUs are of immense importance in instances when the patient needs proper post-treatment monitoring and medical care after bone marrow transplants in Paediatric cancer treatments, kidney transplant in patients with long-term renal failure, and post-complex surgery.

Moreover, in order to reach the milestone of Sustainable Development Goals (SDG) by the year 2030, it is very important to establish child emergency and child intensive care centers, which will be especially helpful in reducing child mortality. The number of Paediatric ICU/Child Intensive Care Centers in Bangladesh is insufficient in both public and private sectors.

Besides, there are also very few experienced doctors and nurses in this department. Evercare Hospital is one of the private hospitals in the country that have doctors, nurses, advanced medical equipment and modern medical systems in their Paediatric ICUs. Paediatric ICUs are crucial in providing comprehensive care and emergency treatments by experienced physicians and skilled health workers who can save the lives of children.

Writer:

Dr. Nurun Nahar

Consultant-Paediatric ICU

Evercare Hospital Dhaka

How to Boost Your Immune System

A lot of research has been conducted around the world on how people can stay healthy and increase the strength of immunity in their bodies. According to doctors and nutritionists, if the body’s immune system is not strong, people will easily become weak and vulnerable to the attack of the diseases. Therefore, it is very important to maintain the immunity or the body’s immune system intact to stay healthy.

Fatigue, lethargy, anxiety, lack of sleep, consumption of tobacco products, lack of nutritious food and uncontrolled lifestyle are some of the main factors that reduce the immune system of the body. A strong immune system of the body is very important for the body to protect itself from various infectious organisms (bacteria, viruses, fungi, parasites) present in the environment.

In this case, the doctors strongly advise people to follow the right way of eating and living. Let’s take a look at healthy food or drinks that are particularly effective in increasing the immune system of the human body:

1. Dairy foods: Dairy foods are scientifically known as ‘probiotics’, among which yogurt, chickpeas, cheese, etc. are notable. Dairy foods are very effective in boosting the immune system of the body.
2. Food containing vitamins B and C: Foods containing vitamins ‘B’ and ‘C’ are water-soluble, which is why they do not accumulate in the body. These two vitamins work to control the functioning of the body’s nerves.
3. Green tea: Green tea is a very beneficial drink for the body. It contains a substance called ‘catechin’, which is known as ‘EGCG’. It is a powerful antioxidant that helps to boost immunity.
4. Natural foods: Honey, coconut water, black cumin, almonds, sugar cane, fruit syrup, and such other foods are very beneficial for the body.

Suicide: A Silent Killer!

Suicide…the last act of a depressed, dejected and despondent being, which they choose as a last resort to solve their life’s problems. But is suicide really a solution? Although the body can be freed from worldly pain through suicide, can the soul?

The Rise of Suicide Rates in Bangladesh

According to statistics from the WHO, there is an average of 1 suicide every 40 seconds all over the world. This means while you’re taking a sip of your cup of tea, , somewhere in the world someone is voluntarily taking a vacation from life. Even Bangladeshi statistics for suicide are quite alarming.

According to sources, a total of 14,436 people died due to suicide in Bangladesh last year alone, which is 70% more than the total number of deaths due to corona in the first year of the country’s corona epidemic. But as much as we have been able to stay aware and take precautions for the corona epidemic and other physical problems, have we been equally aware and prepared to resist this silent killer called suicide?

Signs of Suicide

The first important step in preventing suicide is to find out the reasons why a person chooses this path. Suicide is usually the ultimate manifestation of some mental disorder, one of which is depression. Sufferers of depression, often failing to achieve any dreams or goals, feel that their lives are meaningless at some point; as a result, they seek salvation through suicide. People may also choose this extreme approach due to stress, relationship problems, fear of loss of respect, family problems, physical pain, drug addiction and psychological abuse.

According to WHO statistics, suicide rates are higher among people under the age of 30. Men are more vulnerable than women. On the other hand, apart from these regular reasons, the financial crisis caused due to the ongoing coronavirus epidemic, tension in relationships and depression caused by loneliness, the tendency of people to commit suicide has increased significantly.

How to Help Someone at Risk of Suicide

There are several signs shown by a person at risk of suicide, which can largely help in predicting their decision. This is because suicidal tendencies don’t develop overnight. On the contrary, after a long period of time, the person loses his will to live when depression and shame accumulate in their mind. During this time, various negative thoughts are seen in the speech and activities of the person. Self-hatred, guilt, feeling like a burden to others etc. emerge in their conversations.

Such people tend to be restless, get easily irritated by everything and distance themselves from friends and family. They even start searching online for various suicide execution plans.

Preventing Suicide: The Role of Family and Friends

A suicidal person’s thoughts usually go round and round in circles, and at some point, they unknowingly push themselves towards suicide. Therefore, a person at risk of suicide can mostly be helped by family members and close friends. In many cases, a suicidal person has communicated his or her thoughts directly or indirectly to those close to them through social media.

Therefore, it is important to discuss with loved ones as soon as any such symptoms are seen. They need to be convinced that suicide is not a solution to the problem and that it is possible to find alternative ways to solve it. In addition, any deadly and dangerous material should be kept out of the reach of these vulnerable people. Above all, the person at risk should be referred to psychiatrists and psychologists as soon as possible. This is because proper care and counselling can help turn a suicidal person away from this path.

The Power of Awareness

Loving yourself and those you love, and a little attention and care from your loved ones can prevent this silent killer called suicide. Negative thoughts like suicide can be eradicated only by making life meaningful and enjoyable through social values, mutual harmony and understanding. This requires education, discussion and above all, awareness. So let us be aware and help others to be aware. Let awareness be the key to prevent suicide.

Fabia Alam

Counselor

Evercare Hospital Dhaka

Heart Disease: A Leading Cause of Death

In today’s world, heart disease, cardiac arrest or heart attack is considered to be one of the leading causes of death. At one time, it was thought that only the elderly were at risk of heart attacks. That notion is now deemed irrelevant due to the current situation, where young and middle-aged people are now suffering from heart attacks.

Heart Attacks in Young People

Around 20 million people worldwide die from cardiovascular disease each year, accounting for about 32% of global deaths. 60% of these deaths are due to heart attacks; coronary heart disease accounts for three-quarters of deaths in low- and middle-income countries in South Asia. In developing countries like Bangladesh, the risk of death due to heart disease is about 14.31%.

In the last 10 years, the death rate due to heart attacks has increased 35 times for men and 48 times for women in Bangladesh. What is most alarming, however, is that incidents of heart attacks are gradually increasing among the younger generation.

Although common, many people may not know what a heart attack is or why it happens. For their convenience, I would like to convey the information that Myocardial Infarction, heart attack or whatever you may call it, is a medical complication when blood flow to the heart suddenly stops due to an obstruction. Plaque, also known as a block, is usually formed by the accumulation of fat and cholesterol in blood vessels. It is one of the main causes of a heart attack.

Simply put, a blocked artery blocks the flow of oxygenated blood to a part of the heart, which results in a heart attack. If the blocked artery cannot be reopened quickly, the part of the heart that was supplied blood by that artery stops working, leading to death.

What is a Heart Attack?

Symptoms usually appear days or weeks before a heart attack. If a doctor is consulted, the risk of death decreases with proper treatment; but in case of a sudden heart attack, the risk of death is quite high. A sudden heart attack is undoubtedly a large shock for the body and there is no specific age at which it occurs.

Rather, the risk increases when there are inconsistencies in your lifestyle, consumption of unhealthy food, genetic problems, stress etc. But to think that it is asymptomatic because it occurs suddenly is the wrong assumption to make. Some of the symptoms of a sudden heart attack are constant pain or pressure in the chest, which lasts for a few minutes and can happen intermittently; you may feel pain while working, and then feel better while taking a rest.

Besides this, nausea, indigestion, excessive sweating, fatigue etc. are some common symptoms of a sudden heart attack; but it is not the same case for everyone. On the other hand, another possible cause of death due to heart attack is post-Covid heart problems. Many who have recovered from Covid-19 have experienced blood clotting problems, which increases the risk of heart attacks.

Risk Factors for Heart Attacks

It is true that the risk of heart attack increases as you get older. It also goes without saying that the risk skyrockets if there are problems with the heart and blood vessels.

Except nowadays, incidents of heart attacks are increasing at a significant rate even at a young age. The last 10 years of Global statistics show that heart attack rates among young and middle-aged adults have increased by 2% per year. According to doctors, inconsistent changes in modern lifestyles and physical inactivity are the two major reasons for increased problems in the heart and blood vessels.

Incidents of heart attacks among young people are increasing day by day due to excessive smoking, lack of physical activity, not enough sleep, weight gain, excessive anxiety, eating unhealthy food, especially fat and cholesterol-rich food, diabetes, unhealthy lifestyle, hereditary causes etc. – but what is the best way to cure it?

How to Prevent Heart Attacks

The answer is very simple. Young or old, a heart attack can be life-threatening for anyone. Even if it doesn’t result in death, it can cause serious damage to your health. So, you need to get used to a lifestyle that does not increase the risk of heart problems.

Eat food that does not clog blood vessels. Do things that keep your body active. The steps you can take to maintain this are to keep heart-friendly healthy food in your diet, exercise daily, avoid drugs and tobacco products, keep yourself cheerful, and if there is a history of a heart attack in your family, get screened from a young age. Even if not immediately, the risk of heart attack will decrease gradually.

Every living being must taste death; but a premature death is something no one desires. Heart attacks have become one of the leading causes of premature deaths among young people in recent times. So, everyone must be aware, and become interested in living a healthy life to prevent deaths due to heart attacks.

Prof. Dr. A.Q.M. Reza
Coordinator & Senior Consultant- Cardiology
Evercare Hospital Dhaka

41-year-old Piara Begum, a resident of Bhola. She was suffering from a tumour, situated in her uterus, for 9 years. It was initially small in size, so she did not consider it a major problem; but slowly the tumour started to grow in size, increasing her problems. At one point, her condition worsened and abnormal bleeding started. When Piara Begum did not receive any solutions from her local doctor in Bhola, she was moved to Evercare Hospital in Dhaka.

Her treatment started under Dr. Monowara Begum, Senior Consultant and Coordinator of the Department of Obstetrics and Gynaecology at Evercare Hospital Dhaka. Diagnoses revealed that Piara Begum had endometrial polyps in her uterus, due to which she was bleeding continuously. Anaemia was also diagnosed due to this bleeding. This was temporarily solved by supplying her with two bags of blood. Dr. Monowara Begum decided to remove the patient’s tumour through an immediate laparoscopic hysterectomy.

Piara Begum’s tumour removal was successful. Dr. Monowara Begum sent the patient’s removed tumour for a biopsy. As everything had been done properly, and there were no complications after the surgery after one day of observation, the patient was discharged.

A few days later, when Dr. Monowara Begum received the patient’s biopsy report, she found that the tumour had turned into cancer because it had been in the patient’s body for such a long time. Piara Begum’s grade-3 stage-2 endometrioid cancer had infected more than 50% of her uterus. So, to save the patient at this stage, the doctor decided to perform lymphadenectomy again through laparoscopy and then radiotherapy.

The patient underwent lymphadenectomy followed by the removal of her ovaries along with the affected part of the pelvic lymph nodes, and radiotherapy for further treatment of the cancer. For this purpose, Piara Begum was taken to the operation table for the second time and was operated on successfully.

Laparoscopic surgery is now well known to everyone. Today many surgeries are done this way. Surgery through laparoscopy is less painful as minimal or small cuts are made in the patient’s body and the wound heals faster. Therefore, the patient does not require any long post-operative observation. The patient can soon return to a normal life.

Although laparoscopy is used to treat cancer surgery in foreign countries, it was not common in Bangladesh until now. Recently, cancer surgery is being carried out through laparoscopy in Evercare Hospital Dhaka. If the patient’s cancer is in the early stage, then it is possible to treat it with this method of surgery. Evercare Hospital Dhaka is always ready to provide better and more effective treatments to patients through new technologies.

Due to the skillful hands of Dr. Monowara Begum, Senior Consultant and Coordinator of the Department of Obstetrics and Gynaecology at Evercare Hospital Dhaka, Bhola resident Piara Begum is now clear of danger. After two such major surgeries, the patient had no complications and is slowly recovering. She also expressed her gratitude for the sincere support she received from everyone after being admitted to Evercare Hospital Dhaka.

Radiotherapy or radiation therapy is the use of high-energy X-rays, protons, or other particles to eliminate cancer cells. Fast-growing cells such as cancer cells are more sensitive to the effects of radiation therapy than normal cells.

Breast cancer can be treated through radiation therapy in different ways

• EBRT — External Beam Radiotherapy or external radiation:

A device delivers radiation from outside the patient’s body to the breast. This is the most common type of radiation therapy used for breast cancer.

• Internal Radiotherapy or internal radiation (brachytherapy):

An object that delivers temporary radiation to the patient’s breast is placed in the place where the cancer was, after surgery to remove the cancer.

Radiation therapy can be used to treat breast cancer at almost every stage. Radiation therapy is an effective way to reduce the risk of breast cancer recurrence after surgery. Additionally, it is also commonly used to ease symptoms caused by cancer that has spread to other parts of the body (metastatic breast cancer).

Radiation after Lumpectomy:

If there is any breast tissue left after breast cancer surgery, it is called a Lumpectomy or Breast Conservation Surgery or Breast-conserving. After this surgery, radiation is recommended to eliminate the cancer cells. Adding radiation after a lumpectomy greatly reduces the risk of cancer returning to the affected breast. Lumpectomy combined with radiation therapy is often referred to as Breast Conservative Therapy. This type of treatment is just as effective as the removal of all breast tissue or a mastectomy.

Radiation after mastectomy:

Radiation may also be used after mastectomy. In this case, the decision is made based on the patient’s pre-operative cancer status and the post-mastectomy biopsy report.

In the past, radiation therapy or radiotherapy was given for a long time – for almost 5 to 6 weeks, but now there are also options for giving radiotherapy for 3 weeks or even just 1 week.

If the breast cancer has spread to other parts of the body, which we call metastasis, radiation therapy may be recommended to help reduce the cancer and control symptoms such as pain.

Side effects from radiation therapy can manifest in a variety of ways depending on the type of treatment and which tissues are being irradiated. Side effects are usually most noticeable from the third week or towards the end of radiation treatment. Some side effects of radiation treatment for breast cancer are:

• Mild to moderate fatigue
• Skin irritation, such as itching, redness, peeling or blistering
• Swelling of the breast
• Swelling of the arm (lymphedema) etc. if the lymph nodes under the arm are treated.

However, most of the side effects go away or subside after a few days, and advanced treatments are likely to reduce the side effects.

The Role of the Radiation Oncologist

A radiation oncologist is a doctor who specializes in treating cancer with radiation. The radiation oncologist prescribes the appropriate therapy for the patient, monitors the progress of the treatment and provides necessary treatment for side effects if necessary. Radiation oncology medical physicists and dosimetrists also perform calculations and measurements related to radiation dose and delivery.

The Role of the Radiation Technologist

A radiation technologist administers treatment to a patient using a radiation therapy machine. A radiation oncology nurse or physician’s assistant answers questions about treatments and side effects and helps manage the patient’s health during treatment. Therefore, it is “teamwork” and with the participation of all the people mentioned above, radiation therapy is successfully completed.

How Tumor Boards Work

Currently in our country, many hospitals organize tumour boards before starting any cancer treatment. A tumour board is a very important topic in cancer treatment. This is because a tumour board includes an operation doctor, a radiotherapy doctor, a medical oncologist i.e. chemotherapy doctor, a histopathologist i.e. who reports on biopsies, a radiologist i.e. who reports CT scan-MRI and other members.

Their objective is to prescribe an international standard treatment pathway for the patient. After that, according to the advice of the doctors on the tumour board, neoadjuvant therapy is sometimes used to reduce the size of the tumour during the treatment of breast cancer and then proceed to surgery. In many cases the operation is done before everything else. Sometimes treatment is started through Hormone Therapy Treatment.

Evercare Hospital Dhaka: A Leader in Cancer Care

However, before starting treatment with Hormone Therapy, it is necessary to know the status of hormone receptors by immunohistochemistry along with a biopsy. This is how a patient is treated for cancer through surgery, chemotherapy, radiotherapy, hormone therapy and sometimes immunotherapy. Due to unprecedented advancements in medical science, now our country has all kinds of treatment options for breast cancer patients. Evercare Hospital Dhaka always provides better and more effective treatments to patients through new technologies.

Dr. Arman Reza Chowdhury

Cancer specialist

Consultant – Department of Radiation Oncology

Evercare Hospital Dhaka.

The Dangers of Dehydration in Summer

The weather in Bangladesh is always hot during the month of April and May. However, this year, the heat is extremely high. Due to the intensity of summer heat, many suffer from dehydration, which is not a good sign for the body. Dry throat, urination problems, tiredness, constipation, weakness, nausea, headache, and dry skin are some of the major symptoms of dehydration. Besides, dehydration negatively affects many organs like kidneys, brain, liver, stomach, and lungs.

How to Stay Hydrated During Summer

Water is one of the essential parts of life, which stands second only after oxygen in terms of body requirements. Experts advise drinking at least 2.7 liters or 8-10 glasses of water per day. Drinking enough water helps us to maintain a proper balance of electrolytes in the body. Our bodies are relatively more active when we go outside.

This is why we lose a lot of water as sweat from our bodies when we go out in hot and humid weather conditions. Dehydration occurs when the body sweats continuously, thus leading to a decrease in water and salt levels from the body. The best way to know whether your body really is hydrated is to observe the color of your urine. If the color of urine is yellow, then your body is dehydrated. In this case, drinking water after frequent intervals is necessary.

The Importance of Drinking Water

We should drink water even before we feel thirsty. This is because of the fact that we feel thirst only after our body has already lost about 2 cups of water. When the body is dehydrated, the cells send a signal to the hypothalamus, which releases a hormone called vasopressin. Moreover, the body needs fluids to make blood as well. When the body lacks water, the blood volume decreases. As a result of this, problems such as low blood pressure, weakness, etc. may occur.

The Effects of Dehydration on the Body

To prevent dehydration, we should avoid soft drinks, tea and coffee as much as possible. This is because ingredients such sugar and sodium which are present in such drinks absorb water from body tissues. To properly hydrate ourselves, we should choose food items that are able to fulfill the water shortage in our bodies.

Vegetables such as cucumber, tomato, cabbage, cauliflower, lettuce and fruits such as sugarcane, watermelon, coconut water, strawberry, apple, orange, /malta etc. are very effective in filling up water deficiency in the body. Additionally, juices from various fruits also help to keep us hydrated.