Pratyay Hasan

Cardiac cephalgia: A headache of the heart

Atypical presentations of common diseases are often difficult to identify in time, nonetheless necessary, especially in cases of diseases like ischemic heart disease (IHD) which otherwise may progress into irreversible stage and ultimately, fatality, in the absence of timely administered medical treatment. We report a case of a 51-year-old male, presenting initially with only headache as the sole symptom, who later was diagnosed with severe coronary artery disease, and the symptoms resolved completely after coronary angioplasty with stenting. <Learning objective: Atypical presentations, such as headache, can be more prevalent in ischemic heart disease (IHD) than was thought of, so awareness of the possibility of IHD while assessing headache and further study to see actually how commonly headache is associated with IHD are necessary.>.

Pattern of Antibiotic Usage in Rural and Sub-Urban Settings in Bangladesh: Experience From a Primary Health Care Facility

Background: Bangladesh is not exempted from the grave dangers of antibiotic resistance and the other problems arising from its misuse. The prevalent aberrations in the practice of using antibiotics in Bangladesh include self-medication, prescription by quacks and nonphysicians, non-registered “village doctors”, irrational prescription, etc. The resultant rises in resistant strains of several bacteria are also seen, and probably much is yet unseen and unnoticed. Methods: This observational descriptive study attempted to describe the actual scenario. A total of 155 patients (60% male and 40% female) were included in this study with consecutive purposive sampling who took antibiotics prior to coming to the primary health care facility. Results: Most common problems were common cold symptoms, only fever with or without body ache but without any other specific features and gastrointestinal upset (constipation/diarrhea/abdominal pain) with/without fever. Most (67.9%) of the patients also had taken some antibiotics in the past year for similar reasons, most common of which is “mixed reasons”, followed by common cold. Most of the time, the antibiotic was prescribed by drug seller at medicine store (89, 57.4%), followed by quack/village doctor (29, 18.7%). In mere 14.2% of cases, the antibiotic was prescribed by registered Bachelor of Medicine and Bachelor of Surgery (MBBS) doctors (22, 14.2%). Most have no clear idea about the definition of a doctor, and most (137, 89%) consider non-medical as doctors and think them to be qualified enough to prescribe antibiotic. About 80% of the respondents had no idea or flawed idea about importance of regularity in taking antibiotics, or completion of the course or the concept and threat of antibiotic resistance. Most commonly taken antibiotic was ciprofloxacin (38, 24.7%), followed by cefixime (30, 19.5%), and azithromycin (26, 16.9%). Patients had already spent from a minimum of 12 Bangladeshi Taka (BDT) to a maximum of 675 BDT, average being 166.61 BDT and a median of 117 BDT, before they came for consultation. So the economic impact is also not negligible. Conclusion: This study shows that gross misuse of antibiotics is being done in Bangladesh. Most of the responsibilities of gross misuse belong to two parties, non-physicians, illegal medical practitioners, quacks, and lack of awareness among the patients.