Category: Uncategorized

Children and elderly are more likely to get sick than others during winter, summer, or monsoon due to seasonal changes in nature. Thus, the type of care for children should also be changed according to the season. But compared to other seasons, summer becomes quite difficult for children. Therefore, taking special care of children to prevent them from getting sick during this time is essential.

Children sweat excessively in summer. If water or liquid food is not given properly, excessive sweating can cause dehydration.

Dehydration can be expressed as a decreased volume or frequency of pee, or it may present as feeling weaker and thirsty than normal. Besides, dehydration can cause many complications in the body.

Other diseases seen mostly during summer are diarrhea, vomiting, cold, pneumonia, and scabies etc.

During summer time, it is suggested to follow the following advice as a way to protect the child from various diseases –

– After bathing with lukewarm water, the child’s head should be thoroughly dried, as child may catch cold with wet hair which may result in fever and cough.

– Give the baby boiled water, fresh fruit juice, or any liquid food now and then to prevent dehydration.

– Infants under six months should be encouraged to breastfeed frequently, and mother should drink liquid adequately.

– The baby should be dressed in loose cotton clothes.

– Sports are essential for the physical and mental development of the child but playing outside in extreme heat can cause excessive sweating that may result in catching cold. Therefore, the child should be allowed to play indoors during extreme heat outside.

– An open, comfortable, well-ventilated room in the house should be set aside for the child.

– Special attention should be given to older children as they usually eat roadside ice cream or juices to quench their thirst. It can cause vomiting, diarrhea, or diseases like typhoid.

– During summer, the possibility of viral fever increases. Antibiotics have no role in viral fever. Paracetamol should be given for fever. Apart from this, plenty of water and liquid should be ensured to maintain adequate hydration.

– Virus infection can also cause cough-cold and pneumonia. There could be nose block for this, which will hamper normal breathing; so, nose should be kept open by applying frequent saline drops in nose.

– If cough, it’s not wise to give cough syrup without a doctor’s advice. It can cause many complications. Drinks made with lemon juice, tulsi leaf juice, and liquor tea are good remedies for coughing.

– Children often suffer from heat rash during summer. Therefore, children should be kept at a normal temperature as much as possible. In extreme hot weather, the baby’s body should be wiped in normal-temperature water and dried with cotton cloth 2-3 times daily.

– The child’s nails should be cut small

Even with these precautions, the child might still get sick, but the chances will be low. A doctor should be consulted immediately if any of the following symptoms appear in the child during their sickness.

– Frequent vomiting, loose stool, and decreased urine output or lethargy in the baby.

– Decreased appetite

– High fever

– Decrease activities and alertness than normal

– Shortness of breath, frequent breathing, or tightness in the chest

All children need care. In extreme heat, children suffer equally as adults. So, it is important to take special care of children so that they will stay healthy in summer.

One of the most widely used treatment for cancer management in the modern age is radiation therapy. It involves the use of high-energy ionizing radiation, such as X-rays or gamma rays, produced by radioactive materials or radiation generators. Through this radiation, the aim is to target and destroy cancer cells in the body.
Not all cancers require radiation treatment, but a good number of cancers need to be treated with radiation at some point during the course of treatment. Whether radiation therapy will be used for a patient depends on the type, stage, and location of the cancer, as well as the patient’s overall health.
Radiation therapy is mainly used to treat cancer locally; however, in some cases, it can also be used as a systemic treatment. Systemic radiation therapy involves the use of radioactive materials that travel throughout the body to kill cancer cells that have spread to other parts of the body.
There are several machines used in radiation treatment. Deep X-ray therapy is one which, although no longer used nowadays, was previously an essential. There is also the Cobalt-60, another old model with limited use. Other machines include the widely used linear accelerator, the high-end Cyber Knife whose use is limited, the Gamma Knife, and the highly sophisticated Proton Beam Therapy which is also used in a limited capacity. Other machines used for radiation therapy include LDR and HDR brachytherapy machine.
Radiation therapy can be delivered using different modalities, such as 2D, 3D-CRT, IMRT, VMAT/Rapid Arc, IGRT, SRS/SRT, SBRT, TBI, and Brachytherapy. These are treatment planning techniques used for suitable patients, depending on the type and location of the cancer.
Although there is no feeling of pain during radiation therapy, it does come with side effects. These include skin pigmentation, sometimes excoriation, and region-wise complaints such as difficulty in swallowing when treatment is given to the neck region. The side effects vary depending on the organ or region being treated.
The cost of radiation therapy depends on the machine used, treatment planning modality, and quality assurance issues. It is a product of teamwork. Fortunately, compared to other countries, radiation treatment is not very expensive in Bangladesh.
In fact, almost all facilities of radiation treatment are available in Bangladesh. Patients can access various types of radiation machines and treatment planning techniques in different hospitals and cancer centers across the country.
Radiation therapy is a valuable treatment option for cancer management. It is a local treatment that targets cancer cells and can be used in combination with other cancer treatments. The type of radiation machine and treatment planning modality used may vary depending on the patient’s specific cancer type, location, and stage. It is important for patients to understand the potential side effects of radiation therapy and work closely with their healthcare team to manage any side effects that may occur.

Writer:
Dr. Biswajit Bhattacharjee
Senior Consultant – Clinical & Radiation Oncology
Coordinator-Radiation Oncology

Strokes are medical emergencies due to interruption of blood supply in the brain. It can be due to blockage of the blood vessels or rupture of it but not from any traumatic cause.
Brain has different unique parts for different specific functions. Clinical features are depending on which part of the brain is involved in stroke. Think the word F-A-S-T. F -for facial drooping or weakness, A- for any arm weakness, S- for speech problem, T – for time, don’t waste time. Immediately rush to a hospital having stroke treatment facility.
Stroke may be present as sudden Confusion, difficulty in understanding speech, dizziness, unsteadiness, problem in vision and rarely loss of consciousness.

Types of strokes
Stroke may be Ischemic (85% of cases) and hemorrhagic (15% of cases). Treatment is totally different in Ischemic and in Hemorrhagic case.
Sometimes the weakness or deficit does not persist for 24 hours. Then it is called TIA (transient ischemic attack).

Causes of ischemic stroke
A fatty substance called plaque collects in our arteries and narrows them. This process is called atherosclerosis, and it slows the flow of blood. When this Plaque breaks off and lots of cells come to the rescue causing a clot and blocking blood flow through the artery.
Besides atherosclerosis, other things that can raise your chances of getting an ischemic stroke are:
• Atrial fibrillation
• Heart attack
• Problem with heart’s valves
• Injury to blood vessels in neck
• Blood clotting problem

What are the risk factors?
Age – stroke risk is increased with increasing age.
High blood pressure –
Irregular heartbeat
Diabetes mellitus
Smoking
Family history of Stroke
Lack of physical exercise

Why time is important?
Stroke damages our brain cell. Dying cell can be saved if blood circulation can be restore. There is very little time to treat stroke by restoring the circulation in feasible cases. So time is called brain in stroke. In stroke there are dead brain cell in the Centre surrounded by larger area of dying cell called ischemic penumbra. This penumbra zone can be saved by intervention. Most common and available option is thrombolysis. We get 4.5 hours to save this penumbra zone from the time of onset of stroke if it is a ischemic one (85% is ischemic).

What to do if one has a stroke?
Before reaching to Hospital
Ensure breathing. Face should be open. Clean the mouth if food material is present with in mouth.
Make. loose the clothing if it is tightly fitted. Loose the knot of necktie and belt if present
Keep the patient in horizontal position
Do not use any blood pressure medicine.
Do not try to give any thing in mouth.
Don’t try to continuously talking with the patient, only give reassurance of better outcome in hospital.

If there is no pulse in any limb and in neck and BP is not recordable with loss of consciousness, then live saving measure CPR should be given. Press over lower middle part of the chest forcefully 6 times in 5 second followed by once mouth to mouth breathing by blowing air as much as possible. Repeat this till pulse comes back. It should be done on the way before reaching the hospital if required.

What happened if stroke is not treated early?
Following may be the results.
Permanent weakness of the limbs. Permanent problem in forming and understanding of speech. Persistent problem in vision and Seizure in future.

Hemorrhagic stroke
Hemorrhagic stroke can be Subarachnoid and intracerebral. Subarachnoid hemorrhage usually occurs due to rupture of an aneurism (abnormally dilated part of the blood vessel due to developmental defect). Intracerebral hemorrhage usually results from complicated hypertension.
Subarachnoid hemorrhage is present as sudden onset of very severe headache, with vomiting consciousness may be lost.
Intracerebral hemorrhage presented with moderate to severe headache with acute weakness of face with or without limbs weakness, disorientation to unconsciousness.

Surgery in stroke
If ischemic part of the brain is very large and causing pressure by brain swelling with edema then decompressive craniectomy (part of the skull bone is removed temporarily for giving space for swelled brain) is done to save the life.
Massive intracerebral hematoma can cause pressure effect like massive stroke and decompressive craniectomy is done to save life.

Physiotherapy and rehabilitation
Physiotherapy and occupational therapy is essential for better outcome after stroke. Maximum improvement can be achieved with one month after stroke. Up to 3 months significant physical improvement can be possible if rehabilitation therapy can be ensured.

Anxiety, depression, anger control problem, agitation, inadequate sleep is common in post stroke states in survivors. Proper medication is needed to combat this situation.

Dr. Khandker Mahbubar Rahman

Senior Consultant & Coordinator

Department: Neurology

World Kidney Day is celebrated on 10th March every year. Every year the activities of the day are organized with different objectives. The theme of this year’s Kidney Day is “Bridge the Knowledge Gap to Better Kidney Care”. Children, especially, need to be more aware about kidney disease, treatment, and care.

Kidneys are active while the baby is in the womb. Although the kidneys are less mature after birth and during childhood than in adulthood, they do not cause any hindrance to the normal development of the child. However, children’s kidneys can be easily damaged due to serious illnesses or side-effects from medication. In order to prepare better for any such situation, let us learn some important facts about kidneys.

What are the functions of kidneys in our body?

The kidneys remove accumulated impurities from the blood and retain essential substances; regulate blood pressure in the body; create and assist hormone production; help in blood clotting and keeping bones healthy. Every function of the kidney is very important in keeping the human body healthy. If the kidneys are not healthy, these functions are disturbed and cause severe problems. Let’s find out about these problems, and how they can be especially severe for children.

Congenital Kidney Problems in Children:

Congenital kidney diseases can be detected before the baby is born through ultrasonography. Urethral and bladder structural problems; Obstruction of urethral valves; Absence of kidney; irregularly sized kidneys; displacement and swelling of the kidneys are among some of the problems that may be confirmed through ultrasonography. Urinary tract infection (UTI) is one of the most common diseases in children. In many cases, proper diagnosis and treatment of this disease is neglected. Repeated infections of the urinary tract can case the child to be at risk of kidney failure. It also increases the risk of high blood pressure for them in the future. In most cases, if the children do not receive proper treatment, their kidney functions deteriorate. However, it is completely possible to prevent or control kidney disease by using appropriate treatment at the right time. But how do you know if the child has kidney problems or not?  s

Symptoms and Treatment of Kidney Disease in Children:

Frequent urination; urinary tract infection; bedwetting (over 6 years of age); passing blood in the urine; abdominal/back pain during urination; excessive water retention/swelling of the body; decreased urination; accumulation of water in the kidneys, enlargement of the kidneys; high blood pressure; congenital defects in kidneys, etc. These symptoms may appear if someone in your family has kidney disease, if the baby is born prematurely or if the baby’s weight is less than normal after birth. The help of a specialist must be sought out as soon as there is suspicion of any of these symptoms. If the child is suffering from chronic kidney disease (CKD) and needs dialysis or a kidney transplant, there is no reason to worry because treatment for kidney disease is now available in the country.

Dr. Sabina Sultana

Senior Consultant and Coordinator

Department of Pediatrics and Neonatology

Evercare Hospital Dhaka

An invisible enemy of only 125 nanometers in size has taken the whole world in its control. Words such as masks, PPEs, hand sanitizers, social Distancing, lockdowns, and quarantine have become incredibly common nowadays. Educational institutions have been closed, while children are becoming narrow-minded by spending too much time alone at home, their gadget addiction is increasing, and they are going through many behavioral problems as a result. With the global economic collapse and rising crime rates, our lives seem to be going out of control. Our loved ones are disappearing, so we are also becoming very afraid of our lives. Fear and stress are some natural human emotions during these times, but when we panic for too long, we will become mentally ill. Our lowered mental health also starts to negatively affect our immune system.

The main weapon in this fight against COVID is a stronger immunity. It is important to be mentally strong and to exercise good health practices for a stronger immunity. There are several ways to reduce anxiety and fear, so that we stay healthy and cope with COVID-19.

Spend Quality Time: Family members need to spend quality time with each other. For example, they can listen to music or watch movies together. In this way, one can also learn to respect other people’s choices. This can improve relationships between family members, so that they can enjoy being together.

Light Exercise: Apartments and flat houses are quite small in size, so there is no space for exercise. Those who don’t have an exercise machine at home can move some furniture aside to make room for exercise. Regular exercise will reduce the restlessness of our minds and develop good habits among children.

Religious Practice: Practicing religion helps to calm the human mind. So, the whole family or you alone can start practicing religion. Younger family members will be interested to see you.

Social Media: At this time, we are getting a lot of information from different social media, all of which are not correct. The spread of rumors and misinformation is increasing the restlessness of our minds. Besides, if you see or hear negative news for a long time, there is a chance to get depressed. So, news and social media exposure should be reduced.

Social communication: Due to lack of time we cannot communicate with friends and relatives, but the pandemic has created a space for us to communicate with other and improve our relationships.

Laugh to the Fullest: Laughter is a drug that cannot be bought on the market, but it helps to keep our minds healthy. So, everyone in the family can enjoy their time together and laugh together to boost their immunity.

Breathing Exercise: Take a deep breath through the nose and hold it for a while and release it through the mouth. Do these breathing exercises a few times to reduce the restlessness of the mind.

Use of Language: We all should be aware of our use of language. During the times when are locked up in our houses with each other, we should be careful not to criticize each other but to be kind and understanding towards each other.

Positive Thoughts: It is difficult to think positively during an on-going global crisis. Worrying unnecessarily will not bring solutions, but it will only demotivate us. So, if we extend a helping hand to people, it will help us to maintain a peace of mind. Positive actions increase positive thoughts.

Sleep and Diet: Everyone in the family should be encouraged to get enough sleep and eat nutritious food.

Finally, remember, you are not alone. Millions of people around the world are making sacrifices to fight COVID-19. Hoping and working for a better future is the key to our survival.

Alia Ferdous Azad

Senior Consultant, Evercare Hospital Dhaka

An estimated 200 million people have COPD Globally, of which about 3.2 million die each year, making it the third-leading cause of death worldwide. The damage to the airways & lungs caused by COPD is permanent, but treatment can help slow down the progression of the condition.

The GOLD international COPD guidelines1, advise spirometry as the gold standard for accurate and repeatable measurement of lung function. Evidence is emerging that when spirometry confirms a COPD diagnosis, doctors initiate more appropriate treatment.

Treatments include:

Stopping smoking – if you have COPD and you smoke, this is the most important thing you can do.

Inhalers and medicines – to help make breathing easier.

For most people with COPD, short-acting bronchodilator inhalers are the first treatment used. Bronchodilators are medicines that make breathing easier by relaxing and widening your airways. There are 2 types of short-acting bronchodilator inhaler: Examples of short-acting bronchodilators are albuterol /Salbutamol/ levalbuterol and ipratropium.

A current recommendation of treatment in COPD is that two “fixed triple” combinations of an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) in a single inhaler have become available for patients with COPD.

The indication of using ICS in COPD is stronger if the patient has concomitant asthma and or blood increased -Eosinophil levels. Apart from reducing the risk of exacerbations, there is also data indicating t

hat ICS has a small but significant positive effect on lung function decline and mortality

Stem cell therapy: There is some evidence that stem cell therapy for lungs may be effective in improving lung function and reducing inflammation in people with COPD. However, the effectiveness of stem cell therapy for COPD is still being studied, and more research is needed to determine its long-term effectiveness.

Author:

Dr. SM Abdullah Al Mamun

MBBS(DMC), MD (Chest), MCPS(Med), FRCP(Edin)

Senior Consultant

Respiratory Medicine

Evercare Hospital Dhaka

Cardiac disease is the major cause of death among dialysis patients. In the United States Renal Data System (USRDS) database, the single, largest, specific cause of death is attributed to arrhythmic mechanisms or sudden cardiac death (SCD). The overall best estimate is that SCD is responsible for approximately 29 percent of all-cause mortality in dialysis patients.
In the general as well as the dialysis population, most SCA events are believed to be due to ventricular arrhythmias; that is, ventricular tachycardia (VT) or ventricular fibrillation (VF). A minority may have been attributed to bradyarrhythmia’s.
The increased risk associated with low-potassium dialysate was greatest at lower levels of pre dialysis serum potassium. Increased ultrafiltration volume and low-calcium dialysate were also linked to SCA in this study. Compared with dialysate potassium ≥3 mEq/L, dialysate potassium concentrations ≤1.5 and ≤2 to 2.5 mEq/L were associated with increased risk of SCD.
In Evercare Hospital for the first time in Bangladesh we have modified our dialysis potassium and calcium bath to reduced mortality, intradialytic hypertension, and cardiac events. We are offering high potassium low calcium bath dialysate specially for patients who are having intradialytic hypertension and cardiac arrhythmia. Our dialysis mortality rate (21%) is lower than the international standard mortality rate in developed countries. We are continuously improving our standards and currently doing CRRT with online dialysate fluid which is a cheaper and more effective option for critical patients then with prepared dialysate bags.

Dr Ebadur Rahman
MRCP(UK), FRCP(UK), FRCPI, FASN, MMEDSCI (UK) DM(UK), Sren nephrology (UK).
Senior Consultant
Department of Nephrology
Evercare Hospital Dhaka
Vice President of IRTA
E-MAIL: ebadurmr@gmail.com, ebadur.rahman@evercarebd.com

A Paediatric ICU or Paediatric intensive care unit is a hospital department which is especially made to provide intensive care to children who are critically ill. Although children, in this regard, are categorized as being within 0 to 18 years of age, the maximum age limit for Paediatric ICU patients is determined as per the respective hospital’s protocol.

Critically ill infants, who are usually one month of age and older, receive medical care in Paediatric ICU. On the other hand, Neonatal ICU (NICU) is for babies who are less than one month-old. In the Paediatric ICU, the presence or use of various types of equipment along with trained doctors and nurses play a significant role in providing timely and accurate treatment.

Various critical illnesses of children, such as severe pneumonia, asthma-related breathing problems, heart failure, heart rhythm abnormalities, risk of heart failure, complications from kidney failure, age-related changes in blood pressure, brain infections (meningitis, encephalitis), prolonged seizures, and complications from diabetes (diabetic ketoacidosis) increase the risk of death.

In these conditions, breathing, blood pressure, heart rate, body salt, water, oxygen, and carbon dioxide all lose their equilibrium. In such cases, timely and need-based treatment is required, which is not possible without close monitoring. Artificial respiration or life support is sometimes required, which can only be seen in the ICU. Moreover, there are some life-saving drugs, which require intensive care units for implementation.

In the last few years, there has been an increase in the severity of dengue (dengue shock syndrome) and Multisystem Inflammatory Syndrome (MISC), which is a post-pandemic COVID infection complication. In this case, heart vein swelling and heart failure can occur. The treatment of these children requires close monitoring and care, which is possible only in the ICU. Paediatric intensive care units/Paediatric ICUs are of immense importance in instances when the patient needs proper post-treatment monitoring and medical care after bone marrow transplants in Paediatric cancer treatments, kidney transplant in patients with long-term renal failure, and post-complex surgery.

Moreover, in order to reach the milestone of Sustainable Development Goals (SDG) by the year 2030, it is very important to establish child emergency and child intensive care centers, which will be especially helpful in reducing child mortality. The number of Paediatric ICU/Child Intensive Care Centers in Bangladesh is insufficient in both public and private sectors. Besides, there are also very few experienced doctors and nurses in this department. Evercare Hospital is one of the private hospitals in the country that have doctors, nurses, advanced medical equipment and modern medical systems in their Paediatric ICUs. Paediatric ICUs are crucial in providing comprehensive care and emergency treatments by experienced physicians and skilled health workers who can save the lives of children.

Writer:

Dr. Nurun Nahar

Consultant-Paediatric ICU

Evercare Hospital Dhaka

A lot of research has been conducted around the world on how people can stay healthy and increase the strength of immunity in their bodies. According to doctors and nutritionists, if the body’s immune system is not strong, people will easily become weak and vulnerable to the attack of the diseases. Therefore, it is very important to maintain the immunity or the body’s immune system intact to stay healthy.

Fatigue, lethargy, anxiety, lack of sleep, consumption of tobacco products, lack of nutritious food and uncontrolled lifestyle are some of the main factors that reduce the immune system of the body. A strong immune system of the body is very important for the body to protect itself from various infectious organisms (bacteria, viruses, fungi, parasites) present in the environment. In this case, the doctors strongly advise people to follow the right way of eating and living. Let’s take a look at healthy food or drinks that are particularly effective in increasing the immune system of the human body:

1. Dairy foods: Dairy foods are scientifically known as ‘probiotics’, among which yogurt, chickpeas, cheese, etc. are notable. Dairy foods are very effective in boosting the immune system of the body.
2. Food containing vitamins B and C: Foods containing vitamins ‘B’ and ‘C’ are water-soluble, which is why they do not accumulate in the body. These two vitamins work to control the functioning of the body’s nerves.
3. Green tea: Green tea is a very beneficial drink for the body. It contains a substance called ‘catechin’, which is known as ‘EGCG’. It is a powerful antioxidant that helps to boost immunity.
4. Natural foods: Honey, coconut water, black cumin, almonds, sugar cane, fruit syrup, and such other foods are very beneficial for the body.

Suicide…the last act of a depressed, dejected and despondent being, which they choose as a last resort to solve their life’s problems. But is suicide really a solution? Although the body can be freed from worldly pain through suicide, can the soul?

According to statistics from the WHO, there is an average of 1 suicide every 40 seconds all over the world. This means while you’re taking a sip of your cup of tea, , somewhere in the world someone is voluntarily taking a vacation from life. Even Bangladeshi statistics for suicide are quite alarming. According to sources, a total of 14,436 people died due to suicide in Bangladesh last year alone, which is 70% more than the total number of deaths due to corona in the first year of the country’s corona epidemic. But as much as we have been able to stay aware and take precautions for the corona epidemic and other physical problems, have we been equally aware and prepared to resist this silent killer called suicide?

The first important step in preventing suicide is to find out the reasons why a person chooses this path. Suicide is usually the ultimate manifestation of some mental disorder, one of which is depression. Sufferers of depression, often failing to achieve any dreams or goals, feel that their lives are meaningless at some point; as a result, they seek salvation through suicide. People may also choose this extreme approach due to stress, relationship problems, fear of loss of respect, family problems, physical pain, drug addiction and psychological abuse. According to WHO statistics, suicide rates are higher among people under the age of 30. Men are more vulnerable than women. On the other hand, apart from these regular reasons, the financial crisis caused due to the ongoing coronavirus epidemic, tension in relationships and depression caused by loneliness, the tendency of people to commit suicide has increased significantly.

There are several signs shown by a person at risk of suicide, which can largely help in predicting their decision. This is because suicidal tendencies don’t develop overnight. On the contrary, after a long period of time, the person loses his will to live when depression and shame accumulate in their mind. During this time, various negative thoughts are seen in the speech and activities of the person. Self-hatred, guilt, feeling like a burden to others etc. emerge in their conversations. Such people tend to be restless, get easily irritated by everything and distance themselves from friends and family. They even start searching online for various suicide execution plans.

A suicidal person’s thoughts usually go round and round in circles, and at some point, they unknowingly push themselves towards suicide. Therefore, a person at risk of suicide can mostly be helped by family members and close friends. In many cases, a suicidal person has communicated his or her thoughts directly or indirectly to those close to them through social media. Therefore, it is important to discuss with loved ones as soon as any such symptoms are seen. They need to be convinced that suicide is not a solution to the problem and that it is possible to find alternative ways to solve it. In addition, any deadly and dangerous material should be kept out of the reach of these vulnerable people. Above all, the person at risk should be referred to psychiatrists and psychologists as soon as possible. This is because proper care and counselling can help turn a suicidal person away from this path.

Loving yourself and those you love, and a little attention and care from your loved ones can prevent this silent killer called suicide. Negative thoughts like suicide can be eradicated only by making life meaningful and enjoyable through social values, mutual harmony and understanding. This requires education, discussion and above all, awareness. So let us be aware and help others to be aware. Let awareness be the key to prevent suicide.

Fabia Alam

Counselor

Evercare Hospital Dhaka