jahidul hasan

Introduction Critically ill patients in intensive care units are at high risk of dying not only from the severity of their illness but also from secondary causes such as hospital-acquired infections. USA national medical record-data show that approximately 10% of patients on mechanical ventilation in an intensive care unit developed ventilator-associated pneumonia. Polymyxin B has been used intravenously in the treatment of multi-drug resistant gram-negative infections, either as a monotherapy or with other potentially effective antibiotics, and the recent international guidelines have emphasised the use of nebulised polymyxin B together with intravenous polymyxin B to gain the optimum clinical outcome in ventilator-associated pneumonia cases caused by multi-drug resistant gram-negative infections. Methods One hundred and seventy-eight patients with ventilator-associated pneumonia due to multi-drug resistant K. pneumoniae were identified during the study period. Following the inclus...

Polypharmacy prescriptions increase the risk of drug-drug interactions (DIs) including potential drug-drug interactions (PDI) leading to alteration of drugs' therapeutic responses and occurrence of adverse drug reactions (ADRs). Critical care pharmacists (CCP) are the key responsible persons for monitoring DIs and PDIs, and drug-interaction checker mobile apps (DICMA) are the most useful tool. The main objective of this study was to evaluate the outcomes of CCP interventions in monitoring the DIs/PDIs in ICU-patients of a resource limited setup by using free DICMA.   This retrospective study was conducted in a hospital in Dhaka, Bangladesh. Without having any paid DICMA, CCP of that ICU used the free DICMA: 'Medscape' and 'Epocrates' to check DIs frequently in every prescription, CCP suggested to doctors and prescriptions were modified, accordingly. Those suggestions were collected from the hospital data archive and the satisfaction level of CCP to DICMA was measured.   CCP worked on 2,967 critical patients, 11,128 DIs were detected, 3,932 PDIs were identified and suggested to doctors. In every patient, 1.77 (on average) PDIs were calculated. Prescriptions containing 6 to 10 medications and above 10 medications, the number of available DIs were 3.28 and 7.53, respectively; and the number of PDIs were 1.42 and 4.7, respectively. Doctors accepted 95.85% of total PDIs suggestions (n= 3,932) and 30.41% of those PDIs suggestions yielded immediate positive responses in patients. The satisfaction level of CCP in using free DICMA was 4 (on a scale of 5). Most of the resource limited setups are unable to provide a paid DICMA to its CCP for monitoring DIs. Free DICMA can be an alternative solution for CCP to safe the critical patients from serious DIs, PDIs and ADRs through frequently screening the prescriptions, easily and cost-effectively. Funding Statement: The authors state: "No external funding source for this study." Declaration of Interests: The authors declare: "No conflicts of interest." Ethics Approval Statement:  The ethical approval for this study was taken on March, 2017 from the hospital ethical committee.

Background and Aim: Urinary tract infection (UTI) can lead to adverse renal outcomes in the form of renal scarring and its consequences in children. Underlying congenital abnormalities of the kidney and urinary tract (CAKUT) play a crucial role in UTI recurrence and its outcome.  Methods: This study was conducted to evaluate children aged 1 month to 18 years with bacteriuria retrospectively to assess recent trends of antimicrobial resistance, underlying structural abnormalities of the urinary tract, and severity of symptoms associated with it. Ultrasonography was done in children under 2 years with a history of recurrent UTI to exclude associated structural abnormalities of the urinary tract. Results: Of 255 studied children, 58% were female. Ultrasonography of the kidney and bladder was performed in 116 children, which revealed CAKUT in 38% (n=44). Children with CAKUT commonly presented with fever (36%) alone or in combination with other features. The most common pathogen was E col...

Fulminant hepatic failure (FHF) is a serious complication of dapsone syndrome. In our case, the young male patient took dapsone for the treatment of his dermatitis herpetiformis. After 18 days of taking dapsone therapy orally, he developed dapsone syndrome including FHF, also known as acute hepatic failure. He admitted in our intensive care unit (ICU) with low Glasgow Coma Scale (GCS) score (E3 V2 M4), elevated serum bilirubin (2.3 mg/dL) and alanine amino transferase (ALT) (261 U/L) level. Finally, he was diagnosed as dapsone-induced hepatic encephalopathy with high level of serum bilirubin (12.9 mg/dL), ALT (2372 U/L) and ammonia (>500 μg/dL). After completing five sessions of plasma exchange, abnormalities of the liver biomarkers reduced, significantly, but GCS not improved. His brain death was declared and then he died. Dapsone syndromeassociated death is a very rare incidence and in our case, patient died from FHF-associated brain death.

Acute localized bullous lesions (ALBL) characterized by fluid-filled blisters due to extravasation injury associated with hyperosmolar total parenteral nutrition (TPN) is a painful event especially for neonates and elderly patients. Here, the case of hyperosmolar TPN-induced ALBL was progressed through an extravasation injury while administrating through peripheral venous access catheter. Immediate discontinuation of the TPN administration and proper localized supportive cares helped the bullous lesions to heal within a week. Peripheral administration of hyperosmolar TPN increases the risk of extravasation injury which may lead to acute bullous lesions, and immediate care and withdrawn of the TPN solution may be effective to recover the associated harm shortly.

Background. Acute respiratory distress syndrome (ARDS) in severe COVID-19 pneumonia is mostly responsible for high mortality rate. Tocilizumab, an interleukin-6 (IL-6) inhibitors, down-regulates the progression of cytokine storm leading to ARDS. Objectives. The study aimed to assess the clinical outcomes of three consecutive intravenous doses of tocilizumab in patients with severe COVID-19 pneumonia. Methods. This retrospective observational study was conducted on severe COVID-19 pneumonia patients in a single-center who were treated with three intravenous dose of tocilizumab (8 mg/Kg of body weight, max 800 mg per dose × 3) along with intravenous dexamethasone. Three doses of tocilizumab-associated changes in respiratory function, clinical outcomes and mortality rate were analyzed. Results. Seventy-four patients (N) received intravenous tocilizumab therapy. After third intravenous dose of tocilizumab (48-72 h apart from the second dose), SpO2 (blood oxygen saturation) was increased...

The increasing emphasis on the pharmacists' role as the medication expert has created a global movement towards the implementation of clinical pharmacy practice, defined as any pharmacist in any setting who provides patient care. Although the pharmacy profession in Bangladesh has traditionally been oriented towards the pharmaceutical industry sector, direct patient care roles of pharmacists in both community and hospital practice settings are slowly beginning to emerge. The MEDLINE, Cochrane, Web of Science, and Scopus databases were searched for relevant reference articles for this study. This article presents a narrative review on the current state of pharmacy education and practice in Bangladesh, including a case study highlighting the successful implementation of the country's first clinical pharmacy team‐based care model at a private, tertiary‐care hospital in Dhaka, Bangladesh. Challenges and lessons learned initiating advanced hospital pharmacy practice and a decentra...

Drug-induced serious adverse reaction is an unpleasant event with high rate of mortality. Stevens–Johnson Syndrome and toxic epidermal necrolysis are most common among the serious adverse drug reactions. There is no selective drug therapy for the management of serious adverse drug reactions-associated mucocutaneous blisters. The use of N-acetylcysteine in the treatment of mucocutaneous blisters has limited evidence worldwide. Three cases of toxic epidermal necrolysis or Stevens–Johnson Syndrome-associated mucocutaneous blisters are presented in this study where intravenous N-acetylcysteine (600 mg, every 8 h) was given in early hospitalization hours for the treatment of mucocutaneous fluid-filled blisters. Here, one patient with toxic epidermal necrolysis received intravenous immunoglobulin along with intravenous N-acetylcysteine and the other two patients (toxic epidermal necrolysis/Stevens–Johnson Syndrome) received only N-acetylcysteine intravenously. In response, mucocutaneous f...

Background: Multi-drug Resistant (MDR) pathogen Carbapenem-Resistance Klebsiella pneumonia (CR-Kp) associated Ventilator-Associated Pneumonia (VAP) is a serious infectious disease and tigecycline with high or conventional dose, is one of the last resort potential antibiotics for its treatment. Objective: The major objective of this study was to evaluate the key role of adverse events in preferring the better dosing option of tigecycline. Methods: Total 45 middle-aged MDR-CR-Kp associated VAP patients and treated with high (200 mg/day) and conventional dose (100 mg/day) of tigecycline (intravenous) distributed into two groups. Group-wise microbiological eradication rate, secondary infection rate, 30 days mortality rate and dose-related adverse events were analyzed and compared, accordingly. Result: After 5 days, highest microbiological eradication was observed in HD-group (79.17%) than CD-group (47.62%) with low rate of secondary infections (8.33% versus 33.33%). The 30 days mortalit...

Results: To treat uncontrolled diarrhea at home, antibiotic therapy was initiated in 36.7% of patients in the DH group without any valid prescription, whereas only 7.5% of patients in the EH group received antibiotics (P<0.05). In the DH group, 67.1% of children received different antibiotic therapies for treating their diarrhea with or without other hospital-acquired infections during their extended hospital-stay period, resulting in Antibiotic-Associated Adverse Events (AAAEs) in 17.7% of the patients. At the same time, 21.1% of the patients in the EH group received antibiotics that caused AAAEs in 2.2% of them (P=0.001). The EH group, who received doctors’ consultations and hospitalized within 2 days of the onset of diarrhea, stayed in the hospital for a maximum of 4 days. It was less than half a time that of the children in the DH group (P<0.05) (stayed for a maximum of 10 days), who visited doctors and admitted to hospitals at a later stage of diarrheal-onset.

Background: COVID-19 patients with preexisting comorbidities are at increased risk of exacerbated symptoms. Objectives: The current study aimed to firstly assess the impact of predisposed comorbidities on the severity of COVID-19, and secondly investigating the associated clinical outcome of patients with COVID-19 infection in Bangladesh. Methods: In this single-center retrospective study, the medical data of 157 hospitalized COVID-19 patients, including their preexisting comorbidities, from April 30, 2020, to June 15, 2020, are analyzed. Patients’ clinical outcomes in moderate-to-critical COVID-19 infections need for Intensive Care Unit (ICU) and mechanical ventilation support, and mortality were evaluated, with emphasis on predisposed chronic diseases. Results: Approximately 40.1 and 7.6% of patients (n = 157) presented severe and critical COVID-19 symptoms, respectively (P = 0.001). The most common comorbidity was diabeties (24.8%), followed by hypertension (23.2). Patients with ...

Purpose Hyperinflammation in severe COVID-19 infection increases the risk of respiratory failure and one of the cogent reasons of mortality associated with COVID-19. Baricitinib, a janus kinases inhibitor, can potentially suppress inflammatory cascades in severe COVID-19 pneumonia. Methods The objective of this study was to compare the clinical outcomes of high dose of baricitinib with its usual dose in patients with severe COVID-19 pneumonia. This prospective cohort study was conducted on 238 adult patients with severe COVID-19 pneumonia. Eight milligram and 4 mg of baricitinib was given orally to 122 patients in the high dose (HD) group and 116 patients the usual dose (UD) group, respectively daily for 14 days, and clinical outcomes were compared among the groups. Results Blood oxygen saturation level was stabilized (≥94% on room air) earlier in the HD group compared to the UD group [5 (IQR: 4–5)/8 (IQR: 6–9), P  0.05; N = 116/122, respectively]. The 30-day mortality and 60-day re...

Pneumonia associated with coronavirus disease 2019 (COVID-19) has been accounted for high mortality rate in severe COVID-19 worldwide, and additional serious scarcity of standard and effective anti-inflammatory drug in COVID-19 pneumonia management is a big challenge. Baricitinib, a Janus kinase (JAK) inhibitor, is a promising drug in COVID-19 pneumonia. This study aims to compare the clinical outcome of moderate-to-severe COVID-19 pneumonia treated with baricitinib with or without a loading dose. This prospective case-control study enrolled 37 adult patients where 17 patients (control) received baricitinib at 4 mg oral daily dose and 20 patients (case) received an additional single 8 mg oral loading dose. The median day to gain blood oxygen saturation level ≥95% (in room air) and return in normal breathing function were lower in case group than the control group. The requirement of intensive care unit and mechanical ventilation support was higher in the control group than in the ca...

Background: Critical care pharmacists (CCPs) have a key role in ensuring medication safety by screening drug-drug interactions (DIs) in polypharmacy prescriptions, mostly in critically ill patients. The drug-interaction checker mobile apps (DICMA) are freely available for smartphones. Objectives: The current study aimed to assess the utilization of smartphone-based free mobile apps by CCPs for ensuring drug-drug interaction-free polypharmacy prescriptions in critically ill patients. Methods: This observational study was conducted in an intensive care unit. Critical care pharmacists (CCPs) checked the medications of polypharmacy prescriptions to detect DIs or potential drug-drug interactions (PDIs) using free DICMA installed on their smartphones. DIs/PDIs were sent to physicians as suggestions, and the prescriptions were modified accordingly. Results: CCPs screened 2,967 prescriptions, where 11,128 and 3,932 DIs and PDIs were identified, respectively. Prescriptions with 6 to 10 medic...

Background: Ventilator-associated pneumonia (VAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) is a serious infection in an intensive care unit (ICU). Ventilator-associated MRSA pneumonia (VAMP) in critically ill patients causes a high rate of mortality. Objectives: This study mainly aimed to compare the clinical outcomes and associated drug safety perspective of linezolid and teicoplanin in VAMP treatment. Methods: This retrospective study included 98 adult ICU patients with VAMP, where 42 patients (LZD group) and 56 patients (TPN group) received a standard dose of linezolid and teicoplanin, respectively, for their VAMP treatment. Adverse reactions associated with linezolid and teicoplanin were considered. Clinical outcomes and 30-day mortality rates were compared in both groups. Results: The LZD group showed a higher MRSA eradication rate (97%, n = 34) than the TPN group (94.3%, n = 53) (P = 0.034). The linezolid and teicoplanin therapy was suddenly discontinued in...

The frontline pharmacists during this pandemic COVID-19 (coronavirus disease 2019) situation are potentially contributing to saving human lives worldwide. The objective of this study was to demonstrate the current contributions of pharmacists among the frontline healthcare professionals in the management of the COVID-19 crisis across the world. MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Web of Science, and Scopus databases were searched for this study from March 20, 2020 to May 20, 2020. The basic keyword “pharmacist and COVID-19” was used to select studies. Relevant English-language studies, guidelines, articles, relevant published reports in different online news portals and official web pages of different organizations were searched. Pharmacists in the United States and United Kingdom are testing patients for COVID-19 and providing medical advice to patients. Community pharmacists in European countries are focused on the smooth supply of essential medicines, and working to build awareness regarding the community transmission of COVID-19. Hospital and clinical pharmacists are working to facilitate the effective medication therapy management for improving the clinical outcomes of COVID-19 patients. Pharmacists in low-and middle-income countries around the world have focused their efforts mainly on awareness-building activities regarding the community transmission of COVID-19, and the mass production of alcohol-based hand-sanitizer. Several resources are globally available for pharmacists to improve their competency and self-protection from COVID-19. Frontline pharmacists are enthusiastically contributing in the prevention and treatment of COVID-19 from a community-to-clinical level worldwide. Their active participation as a member of the frontline healthcare team is crucial in order to address and overcome the challenges that this pandemic has created, and to tackle this global healthcare crisis efficiently.

An elderly man presented with the history of diphenhydramine hydrochloride overdose as a suicidal attempt. At presentation, he was in an acute confusional state with several anticholinergic features and had to be managed in intensive care unit. As an antidote for diphenhydramine hydrochloride, donepezil was used instead of physostigmine due to the unavailability of physostigmine in Bangladesh. The patient improved within the next 24 hours; his level of consciousness improved and the anticholinergic features regressed.

Polymyxins are the last line potential antibiotics against multi-drug resistant gram-negative bacteria and consist of two sister antibiotics: Polymyxin B and colistin (polymyxin E). Intravenous use of polymyxins was started from a long ago in the treatment of serious gram-negative infections and once their uses were restricted due to potential adverse drug reactions, such as nephrotoxicity and neurotoxicity. Lack of in vivo clinical studies on polymyxins mostly, in human body makes the pharmacokinetics and pharmacodynamics of polymyxin B and colistin unclear in many aspects, such as the distribution of polymyxins in different compartments of lung. The nebulization of polymyxins is practicing very limitedly and lack of clinical evidence has not justified this administration technique yet properly to date. The main objective of this review study was to evaluate the pharmacokinetic and pharmacodynamic properties of intravenous and nebulized polymyxins and the related therapeutic potent...

Pneumocephalus is a life-threatening event associated with different infectious diseases and trauma. Klebsiella pneumoniae is a gas-forming organism that can cause pneumocephalus. A 56-year-old woman presented with a history of septic shock and community-acquired pneumonia. She was supported by mechanical ventilation in intensive care unit. Multidrug-resistant K. pneumoniae was detected in her blood and tracheal aspirate. Her level of consciousness reduced and clinical condition was deteriorating. The computed tomography scan of brain revealed abundant pneumocephalus entities. Multidrug-resistant K. pneumoniae was found in her cerebrospinal fluid while on appropriate antibiotic therapy. She died from acute stroke during her treatment.

Background Electrocution is a common cause of mild to severe multisystem injuries leading to high rate of mortality and morbidity. Low to high-voltage injury may be clinically manifested from a simple unpleasant sensation to multiple soft tissue injury which may cause instant death. The severity of injury depends on intensity of the electrical current, voltage of the source, resistance in the victims' body and the duration of the contact. Case presentation A 20-year-old young male experienced with an accidental high-voltage electrocution injury from a blasted electrical transformer while passing across the road. He lost his consciousness and immediately hospitalized. Bilateral pulmonary infiltrates and right cerebellar hemorrhage with fractures in anterior and posterior arch of the first cervical vertebrae (C1) were diagnosed, and there was no history of electrical burn. He stayed in hospital for three days and completely treated with initial oxygen supplementation and immobilization of his head and neck with a Philadelphia collar for 6 weeks. Electrocution is a serious public health concern and reported worldwide with few fatal ending. Accidental high-voltage electrocution injury is a serious type of unfortunate accidental injuries which in most of times, ends with immediate or delayed sequelae or even death. In this case, the victim with high-voltage-associated electrical injuries in his lungs and brain was completely recovered because of early hospitalization. Conclusions Electrocution injury is an accidental event with high mortality and morbidity rate. Mild to severe electrical current-induced injuries including burn can be treated successfully in most of the cases, but early hospitalization is highly required.

Teicoplanin is a drug of choice for treating infections by gram positive microorganisms. Teicoplanininduced thrombocytopenia is an adverse drug reaction found in critically ill patients receiving teicoplanin. The aim of this observational study was to analyze the increased risk of occurring teicoplanin-induced thrombocytopenia in patients with severe hypoalbuminemia than the patients having normal blood-albumin level. A 5-month long study was conducted in an adult-ICU department on 42 critically ill adult patients. In this study, 17 (40.48%, n=42) patients developed teicoplanin-induced thrombocytopenia and among them, 14 patients (60.87%, n=23) were suffering from severe hypoalbuminemia during the initiation of teicoplanin therapy. All the events were normalized within 48 hours after discontinuing the teicoplanin. In this study, we found that teicoplanin-induced thrombocytopenia is one of the most common adverse drug reaction developed in critically ill adult patients and concurrent...

Polymyxins are the last resort antibiotics for treating carbapenem-resistance Klebsiella pneumoniae (CR-Kp)-associated bacteremia. The main aim of this study was to demonstrate the therapeutic effectiveness of polymyxin B versus colistin in the treatment of CR-Kp-associated Bacteremia. This 12-month long cross-sectional study was conducted on 54 and 47 patients suffering from CR-Kp-associated Bacteremia, and residing into two separate groups, they were treated with polymyxin B and colistin, respectively. After 5 day-treatment, the microbiological eradication rate was found 96.30% (52; n=54) in polymyxin B group and 87.23% (41; n=47) in colistin group. In the 30-day mortality rate-comparison, 51.03% more death was found in colistin group (34.04 %, n= 47) than the polymyxin B group (16.67 %, n= 54). In this study, Polymyxin B showed superior therapeutic potentiality with less number of secondary infections and 30-day mortality rate in CR-Kp-associated bacteremia than colistin. Dhaka U...

Introduction Sepsis is a life-threatening condition, and sepsis-associated thrombocytopenia (SAT) is a common consequence of the disease where platelet count falls drastically within a very short time. Multiple key factors may cause platelet over-activation, destruction and reduction in platelet production during the sepsis. Eltrombopag is a thrombopoietin receptor agonist and is the second-line drug of choice in the treatment of chronic immune thrombocytopenia (ITP). Aim of the study The objective of this study was to observe the therapeutic outcome of high dose eltrombopag in SAT management in critically ill patients. Material and Methods This 6-month-long single group, observational study was conducted on seventeen ICU patients with SAT. Eltrombopag 100 mg/day in two divided doses was given to each patient. Platelet counts were monitored. A low platelet blood count returning to 150 K/μL or above, is taken as indicative of a successful reversal of a thrombocytopenia event. Results...

Background: Along with several significant factors in chemotherapy treatment management’s nurses plays the pivotal role. The objective of this study was to evaluate the knowledge of nurses in relation to handling chemotherapy and the current practice of cancer centers in different hospitals in Bangladesh.Methods: The cross-sectional study was designed based on anonymous self-administered questionnaire. The questionnaire was developed from literature and expert input and validated by subject experts.Results: A total of 96 nurses were the respondents in this study. Around half of them already exposed directly with chemotherapy agents. Some 72.9% of nurses had not any training and 58.3% of respondents were not aware about use of closed system transfer devise in chemotherapy. A greater proportion 58.3% of nurses did not know the same health hazard of both oral and parenteral drugs. One third (33.3%) respondents used biological safety cabinet for doing preparation. Nurses’ did not use es...

The capital Dhaka city of Bangladesh is one of the world’s most crowded cities where about 45,000 people live per square Km area and an estimated 14.4 million people have made this city over populated.1 The rapid spread of the infection from one person to another is very common here because of the tropical climate, congested living patterns, lack of active infection control activities in most of the healthcare setups, inadequate pure drinking water supply, lack of proper sewerage and draining system, illiteracy of the peoples and inadequate public as well as healthcare professionals knowledge on occupational hygiene and infection control.2 Rate of infections among the hospitalized patients and in the community is very high, and still to date, antibiotics are sold more frequently without having a legal prescription and uses of antibiotics are found irrational in many cases.3 Antimicrobial resistance (AMR) is a major concern not only for the local population of Dhaka city but also for the global public health due to the resistance-emergence. Inappropriate use, overuse and unjustified use of antibiotics are considered as the major causes of antibiotics becoming resistant to antibiotics.3,4

Critically ill patients at ICU are treated with poly pharmacy and conservative drug management is necessary for ensuring drugs’ safety and accuracy. The objective of this study was to analyze the qualitative intervention of critical care pharmacists (CCP) in critically ill patients’ effective medication management. This was a 6 months long observational study. All the provided suggestions of CCP were categorized into- A (drug-drug interaction), B (addition of new drug therapies), C (rational dosing of antibiotics), D (acceleration or deceleration of the doses) and E (adverse drug reaction). Out of total CCP’s 650 suggestions, 566 (87.08%) suggestions were accepted by doctors and modified the therapies, accordingly. CCP being a part of ICU’s multi professional team contribute the professional roles in generating safe, appropriate and quality prescriptions, which finally turns into quality pharmacotherapy for critically ill patients at ICU. Dhaka Univ. J. Pharm. Sci. 18(1): 113-119, 2...