Health Bulletin 2009

2.
3.
4.
5.
6.
7.
8.
9.
GLP (Good Laboratory Practice) 10 ‐ 4 110 100 ‐ 50 140 ‐
GLP (Good Laboratory Practice) 25 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐
GLP (Good Laboratory Practice) 20 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐
GLP (Good Laboratory Practice) 14 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐
GLP (Good Laboratory Practice) 5 ‐ 20 60 40 ‐ ‐ ‐ 240
Computer Training (Refresher) 14 6 2 13 ‐ ‐ 25 50 ‐
Security Management Training 5 ‐ ‐ ‐ ‐ ‐ ‐ ‐ 30
English Language Training 28 ‐ ‐ ‐ ‐ 40 51 ‐ ‐
Source: IPH, Mohakhali, Dhaka
Diagnosis of bronchiolitis may be masked under cover of pneumonia leading to improper
management: findings of ICMH study
Bronchiolitis remains a major public health problem throughout the world exerting significant morbidity
and mortality. Bronchiolitis due to Respiratory syncytial virus (RSV) remains a significant cause of
respiratory disease all over the world including South-East Asian countries like India and Pakistan. It
is estimated that proportional morbidity among the infants of Bangladesh due to respiratory diseases
is 45%. In 2001-2002, epidemic of bronchiolitis was first reported in the country and high rate of this
disease continued to prevail over the next five years. A recent study by Kabir, et al of Institute of Child
and Mother Health shows 21% prevalence of bronchiolitis among the u-5 children who attended
different
hospitals. It is found that nearly 95% of bronchiolitis cases are of viral origin, RSV being the
commonest. The diagnosis of bronchiolitis is most often made on clinical grounds and the criteria may
vary. Very simply, the first attack of wheezing in a previously healthy child of less than two years of
age or for a diverse criteria with coryzal symptoms followed by rapid onset of wheeze, fever,
tachypnea, chest retractions, crepitation, ronchi with radiographic evidence of chesthyperinflation. The
study undertook middle line as the diagnostic criteria for
bronchiolitis (runny nose followed by breathing difficulty, chest indrawing and rhonchi (on auscultation)
in children aged less than 2 years. Misdiagnosis of bronchiolitis as pneumonia has been observed,
where antibiotics, have been used indiscriminately in 99% cases. Proportion of costly antibiotics, such
as, ceftriaxone, a third generation cephalosporine, was in high proportion. Treatment for bronchiolitis
require home management (in milder cases) and oxygen therapy or in severe cases measures such
as nebulized salbutamol, adrenaline, corticosteroids, aerosolized ribavirin, hypertonic saline and in
some cases critical management in pediatric intensive care unit (PICU). However, antibiotics remain a
common practice in treating bronchiolitis despite the rare likelihood of bacterial infection. Use of
antibiotics increases treatment cost and facilitates bacterial resistance. A recent multi-centre
randomized control trial conducted by Kabir, et al have shown that managing acute bronchiolitis
75