Thursday, March 20, 2008

Child care issues: problem with absolute breast feeding

Recently I am encountering many mothers who are reluctant to continue absolute breast feeding for the first six months. This is happening even after repeated counselling.
Other than conventional reasons such as ignorance, lack of proper counselling, working nature of mother, advocacy by the Formula producing companies for early weaning by 4 months, a reason mothers are citing is 'the difficulty to switching over to non breast milk items once the baby is too habituated with the breast feeding'. So they are preferring to accustom the baby to one or two feeds of artificial milk from early months.

We need to examine the problem more closely. Any comment or suggestion on the issue will be appreciated.

Badrud Doza

WHO on breast feeding
CDC on breast feeding
AAP on breast feeding

Sunday, March 16, 2008

Case: A Massive Empyema Thoracis drained by VATS (Video Assisted Thoracoscpic Surgery)

The boy Abid, 1 and 1/2 years of age from Chittagong had fever and cough for 15 days, respiratory distress for 10 days which increases to severe degree for a day for which he was compelled to take admission in our hospital.

He was dyspnic, no cyanosis, no clubbing, H/R-160/m, R/R-80/m, temp-100◦ F, BP 90/60 mmHg.
His intercostal spaces were full, chest movement was restricted, expansibility was diminished on the right side, trachea and apex beat shifted to the left, vocal fremitus was decreased, percussion note dull, breath sound was absent and there was no added sound on the right side.

His CBC was normal, Blood culture shows no growth, X-ray shows – massive homogeneous opacity on the right side with shifting of the trachea and mediastinum on the left side.

Pleural fluid study shows- out of 4800 cell/cmm 400 are pus cells and 800 lymphocytes, sugar-28.1 mg/dl, protein-3.6 gm/dl, gram stain –gram +staphylococci , culture shows –staphylococcal aureus.

Video assisted thoracosurgery was done on 13/3/08 by our colleague Dr. Jafrul Hannan and intrathoracic tube was left for few days to clear out the accumulating pus.

Patient was given ceftriaxoneand and cloxaacillin and antibitotics.
The patient was improved and discharged on oral antibiotics.

Dr. Badrud Doza
Dr. Saiful


Monday, March 10, 2008

Case: Subdural Effusion with ARI

Imtiaz Mahmud, age 4 yrs from Chittagong presented with respiratory distress, cough, bulging fontanelle, fever and vomiting of 2 – 3 days duration.

His birth history is normal; he is breast fed, immunized with normal milestone and from a low socioeconomic group.He has no definite history of head injury.

On examination,his fontanelle was found wide and budged, OFC- 43cm.
Heart rate 100/m, temp-102, respiration 40/m, Lungs –creps and rhonchi, no papilloedema.

On investigation, peripheral blood picture was normal, MP negative, CSF- normal, ICT for malaria – negative, Urine R/E normal, a repeatt CSF also shows normal finding. US of the brain–shows mild hydrocephalus.

CT scan – shows subdural effusion.

The patient is labeled as Subdural Effusion with ARI.

No precipitating factor was identified

Our surgical colleague Dr. Jafrul Hannan was consulted. He preferred not to intervene.

The patient gradually improved.

Dr. Badrud Doza,
Dr. Saiful,
Dr. Fahim

Saturday, March 8, 2008

Thoughts:Privatization of Medical Education

As the time passing by, no of private medical institutes (schools of colleges) are increasing in different countries. With the addition of this Medical schools/colleges ,the medical education is affected in many ways.
Let us consider Bangladesh as a test case (as I am from Bangladesh but the condition here may simulate the state in many countries)

First rivate medical college in Bangladesh started in 1988 in Dhaka by the name Bangladesh Medical College with the promulgation of an ordinance by the name ‘ Bangladesh Private Medical College ordinance’ The medical college started to develop in many parts of the country like mashrooms. There are more private medical colleges than public ones.

Bangladesh Medical and Dental Council is responsible for regulation of the quality , curriculum, manpower and structure of the medical colleges in Bangladesh. But the primary permission is to be taken from the Ministry of Health. The medical Colleges are to affiliate with the local Public Universities which are responsible to conduct the professional examinations.

As the system shown, its looks sound. But the real scenario is a little bit different.
The private medical colleges developed as a business venture to earn money not with the good intention of imparting special knowledge to the students.
The initial admission fee is also not dictated by the national authorities rather the individual colleges charge exuberant fees as admission fee and the fees are mainly taken at a time for 5 years and not on term/semester basis. So the opportunity remains open only for the affluent.

Among the private medical colleges, most are not yet recognized but they are continuing their admission and education with the hope that one day they will get recognition with retrospective effect..

The quality of the students during admission is also compromised.

Ultimately the graduates who will come out of these institutions will be undereducated and ill trained.

The respective Government should look into matter and take necessary steps to prevent the medical education to degrade further.

Badrud Doza

Thursday, March 6, 2008

Thoughts: Professionalism in Medical Practice

In the complexity of increasing materialism, growth of the medical service as an industry,commercialization of medical practice,compromise in ethics and decay in moral attitude, a look into the professionalism will not be an unworthy exercise.

The highest sense of professionalism has been tried to be induced in the physician with the Hippocratic Oath which every physical have to take at the start of his career.

Professionalism means commitment to one’s profession.
It means ones’ endeavor to attain excellence in knowledge
It means attaining maturity in clinical evaluation.
It means attaining highest judgment in clinical diagnosis.
It means developing empathy for your patients
It means sharing knowledge with your colleagues.
It means convey necessary information to your patients.
It means not to be dogmatic.
It means listenening with patience to others opinion.
It means ability to understand the logic of others content.
It means considering ethics in your practice and research.
It means respect to your patient and not to abuse your patients in any form.
It means keep your morality intact and not to sexually harass your patients.
It means to serve the humanity as the prime motive of your profession.
It means earning money as a secondary consideration.
It means to avoid temptation for indirect earning that is not ethically acceptable.
It means not to be benefited from the promotion products of the pharmaceutical companies and not to be personally benefited from them in other ways.
It means not to take commission on the pathological tests.

It means many things that words can not express but conscious can tell and it means always to be true to your conscious.

Badrud Doza


Sunday, March 2, 2008

Case: A boy of 2 months with congenital hydrocephalus, Meningomyelocele and incidental diagnosis of Pyogenic Meningitis

A boy of 2 months presented admitted to the Hospital with increasing head size and a swelling on the back at the lumber region.
The patient is normally delivered and there was no history of perinatal insult.

On examination, OFC was 43 cm, anterior fontanelle was wide open, no sun set sign, no papilloedema,

Reflexes were normal, no paraplegia, no bladders or bowel involvement. US confirms the ventricular dilatation.

The patient was operated to institute V-P Shunt. During operation, ventricular fluid was collected and studied and incidentally CSF was found to have pus cell- 7600/cmm, sugar-10.6mg/dl, Protein 430.6 mg/dl., Xray chest and Electrolytes normal.

So the patient is labeled as Congenital Hydrocephalus with Meningomyelocele with Pyogenic Meningitis.

After incidental diagnosis of Meningitis, the patient is sent our special care unit. He is now under antibiotic coverage for meningitis and is slowly improving.

We have a plan to do the CT scan to exclude any intracranial malformation.

Dr. Badrud Doza
Dr. Fahim