Drug Addiction and Substance Use Among the Dalit Married Adolescent Girls in Bangladesh: a Cross-Sectional Survey

Dalits are referred to “shattered,” “outcasts,” and socially marginalized community in Bangladesh. In particular, Dalit adolescent girls are the most vulnerable owing to their caste and gender. Prior studies have looked at the prevalence and effects of drug addiction among the youths in mainstream population, but the Dalit adolescents were excluded from the samples. The study aimed to investigate the prevalence of drug addiction and substance use among the Dalit married adolescent girls (MAGs), and to identify the significant predictors associated with this addiction. A cross-sectional survey was carried out among 300 MAGs in the Dalit community. Involving systematic random sampling, participants were selected from both urban and rural settings located in Dhaka and Gaibandha districts. Bivariate and multivariate logistic regressions were performed to explore the significant factors associated with drug addiction. The prevalence of drug addiction was 11.3% among married Dalit adolescent girls. Multivariate analysis identified that participants’ habit of smoking (AOR=5.210, 95% CI=2.413–11.250), participant’s husband’s habit of smoking (AOR=10.415, 95% CI=3.911–27.739), and habit of using alcohol/highly risky substances (AOR=19.030, 95% CI=6.481–55.875) were significant associated with drug addiction. An alarming proportion of Dalit adolescent girls were recorded to be habituated in various forms of drugs use. Therefore, immediate policy measures focusing intensive campaigns, targeted counseling, and health education programs need to design to get over the risky health behaviors.

     

Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review

CONTEXT: The results of studies on noninvasive positive pressure ventilation (NPPV) for acute hypoxemic respiratory failure unrelated to cardiogenic pulmonary edema have been inconsistent. OBJECTIVE: To assess the effect of NPPV on the rate of endotracheal intubation, intensive care unit and hospital length of stay, and mortality for patients with acute hypoxemic respiratory failure not due to cardiogenic pulmonary edema. DATA SOURCE: We searched the databases of MEDLINE (1980 to October 2003) and EMBASE (1990 to October 2003). Additional data sources included the Cochrane Library, personal files, abstract proceedings, reference lists of selected articles, and expert contact. STUDY SELECTION: We included studies if a) the design was a randomized controlled trial; b) patients had acute hypoxemic respiratory failure not due to cardiogenic pulmonary edema; c) the interventions compared noninvasive ventilation and standard therapy with standard therapy alone; and d) outcomes included need for endotracheal intubation, length of intensive care unit or hospital stay, or intensive care unit or hospital survival. DATA EXTRACTION: In duplicate and independently, we abstracted data to evaluate methodological quality and results. DATA SYNTHESIS: The addition of NPPV to standard care in the setting of acute hypoxemic respiratory failure reduced the rate of endotracheal intubation (absolute risk reduction 23%, 95% confidence interval 10-35%), ICU length of stay (absolute reduction 2 days, 95% confidence interval 1-3 days), and ICU mortality (absolute risk reduction 17%, 95% confidence interval 8-26%). However, trial results were significantly heterogeneous. CONCLUSION: Randomized trials suggest that patients with acute hypoxemic respiratory failure are less likely to require endotracheal intubation when NPPV is added to standard therapy. However, the effect on mortality is less clear, and the heterogeneity found among studies suggests that effectiveness varies among different populations. As a result, the literature does not support the routine use of NPPV in all patients with acute hypoxemic respiratory failure.     

Sarcoidosis manifesting as massive splenomegaly: a rare occurrence

Sarcoidosis is a multisystemic granulomatous disease of unknown origin occurring worldwide and affecting people of all races and ages. This disease manifests most frequently with bilateral hilar lymphadenopathy, pulmonary infiltrates, and skin and ocular lesions. Granulomatous inflammation of the spleen is common in patients with sarcoidosis, but splenic enlargement is unusual and massive splenomegaly quite rare. Splenomegaly is usually homogeneous, but multiple low-attenuating nodular lesions are occasionally seen and easily mistaken for lymphoma, metastases, or infections such as tuberculosis. We describe an unusual case of sarcoidosis in a woman who presented with massive splenomegaly with extensive nodularity that cleared completely with corticosteroid therapy.     

Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period

Acute kidney injury (AKI) is a rare complication of pregnancy, but may be associated with significant morbidity and mortality in young and often otherwise healthy women. We conducted a retrospective population-based cohort study of all consecutive pregnancies over a 15-year period (1997–2011) in Ontario, Canada, and describe the incidence and outcomes of AKI treated with dialysis during pregnancy or within 12 weeks of delivery. Of 1,918,789 pregnancies, 188 were complicated by AKI treated with dialysis (incidence: 1 per 10,000 [95% confidence interval, 0.8 to 1.1]). Only 21 of 188 (11.2%) women had record of a preexisting medical condition; however, 130 (69.2%) women experienced a major pregnancy-related complication, including preeclampsia, thrombotic microangiopathy, heart failure, sepsis, or postpartum hemorrhage. Eight women died (4.3% versus 0.01% in the general population), and seven (3.9%) women remained dialysis dependent 4 months after delivery. Low birth weight (<2500 g), small for gestational age, or preterm birth (<37 weeks’ gestation) were more common in pregnancies in which dialysis was initiated (35.6% versus 14.0%; relative risk, 3.40; 95% confidence interval, 2.52 to 4.58). There were no stillbirths and fewer than five neonatal deaths (<2.7%) in affected pregnancies compared with 0.1% and 0.8%, respectively, in the general population. In conclusion, AKI treated with dialysis during pregnancy is rare and typically occurs in healthy women who acquire a major pregnancy-related medical condition such as preeclampsia. Many affected women and their babies have good short-term outcomes.     

Radial modulation imaging of microbubble contrast agents at high frequency

In this paper, radial modulation imaging of microbubbles is investigated at high frequency. A modulation pulse frequency of 3.7 MHz with an amplitude ranging from 0 to 250 kPa, and a 1.3-MPa 20-MHz broadband imaging pulse were used. Radial modulation effects were observed on a population of flowing microbubbles and quantified using a Doppler-type processing technique. Artifact signals related to the generation of harmonics by bubbles strongly resonating at the modulation frequency were observed. The bubble response to simultaneous modulation and imaging excitations was simulated for different combinations of bubble sizes and modulation amplitudes. Simulation results confirm the hypothesis that the generation of harmonics of the modulation frequency can be detected by the imaging transducer. Simulations indicate that the modulation frequency should be chosen lower than the resonant frequency of the biggest bubbles present in the population. The simulation also suggests that a 10% variation of bubble diameter induced by the modulation excitation is sufficient for radial modulation imaging. In conclusion, the effects of radial modulation are detectable at a high frequency. Therefore, radial modulation imaging has potential for high-resolution imaging of microbubbles in the microvasculature.