Background: Electrolyte disturbances are frequently encountered in patients with Type 2 Diabetes Mellitus (T2DM) and are closely associated with poor glycaemic regulation, renal dysfunction, cardiovascular complications, and increased morbidity. Pharmacist-led interventions have emerged as a valuable strategy for optimizing therapeutic outcomes; however, their influence on long-term electrolyte homeostasis remains inadequately characterized. Objective: To evaluate the longitudinal impact of pharmacist-provided educational and therapeutic interventions on electrolyte balance among patients with T2DM over a 12-month follow-up period. Methods: A controlled longitudinal study was conducted involving patients with T2DM allocated to either an interventional group receiving structured pharmacist-led care or a control group receiving standard management. Serial assessments of serum sodium, potassium, chloride, calcium, magnesium, and phosphorus were performed at baseline and at 3-, 6-, 9-, and 12-month intervals. Temporal changes in electrolyte parameters were analyzed using comparative statistical methods, with significance established at p<0.05. Results: Participants receiving pharmacist intervention demonstrated substantial and sustained improvements in electrolyte regulation throughout the study period. Significant reductions in serum sodium and potassium concentrations were observed in the interventional cohort, accompanied by progressive normalization of chloride levels (p<0.001). Magnesium concentrations increased markedly from baseline, indicating enhanced metabolic and cellular electrolyte equilibrium. Calcium levels remained physiologically stable, whereas phosphorus concentrations exhibited a modest but significant decline over time. In contrast, the control group displayed comparatively limited or inconsistent electrolyte modulation across follow-up assessments. The magnitude and consistency of change were significantly greater among intervention recipients, suggesting superior maintenance of electrolyte homeostasis. Conclusion: Pharmacist-led interventions exerted a pronounced positive effect on long-term electrolyte stability in patients with T2DM. Integrating clinical pharmacists into multidisciplinary diabetes care may facilitate improved metabolic regulation, enhance biochemical monitoring, and mitigate the risk of electrolyte-related complications, ultimately contributing to better clinical outcomes and disease management.

Background: Tympanic membrane perforation can result in hearing impairment, recurrent ear discharge, and other otologic symptoms. Tympanic membrane repair aims to restore membrane integrity and improve auditory function. This study evaluated the clinical and audiological outcomes following tympanic membrane repair in adults. Methods: This prospective observational study was conducted at the Department of Otorhinolaryngology, Narsingdi Sadar Hospital, Bangladesh, from January to December 2025. Thirty consecutive adults with tympanic membrane perforation undergoing repair were included. Clinical outcomes, graft uptake, postoperative complications, pure-tone average (PTA), and air-bone gap (ABG) were assessed at final follow-up. Results: Successful graft uptake was achieved in 27 (90.0%) patients, while 25 (83.3%) had complete resolution of ear discharge. Mean PTA improved from 39.1 ± 8.6 dB to 28.0 ± 7.1 dB, while mean ABG decreased from 26.2 ± 6.3 dB to 14.8 ± 5.2 dB (both p<0.001). PTA improvement of ≥10 dB occurred in 76.7% of patients, and 63.3% achieved a postoperative ABG of ≤10 dB. Overall, 66.7% had excellent and 23.3% had good outcomes; no poor outcomes were observed. Conclusion: Tympanic membrane repair provided favorable clinical and audiological outcomes with high graft uptake, significant hearing improvement, and low postoperative morbidity in adults.

Background: Gram-negative infections and multidrug resistance (MDR) constitute a substantial and escalating threat in critically ill patients, contributing to increased morbidity, mortality, and healthcare burden. The emergence of resistant pathogens in intensive care units (ICUs) is driven by multiple factors, including excessive antimicrobial exposure, prolonged hospitalization, invasive procedures, and underlying comorbidities. Early identification of patients at risk for MDR infections is essential for optimizing empirical therapy and strengthening antimicrobial stewardship strategies. Objectives: To identify predictors of Gram-negative infections and determine independent risk factors associated with multidrug resistance among critically ill patients using a predictive modelling approach. Methods: A prospective observational predictive modelling study was conducted among 100 critically ill patients admitted to a tertiary care ICU. Demographic, clinical, and microbiological variables including age, sex, ICU stay, antibiotic burden, comorbidities, infection source, and organism type were analysed. Univariate associations were assessed using Chi-square testing, and independent predictors were identified through multivariable logistic regression analysis. Statistical significance was defined as p<0.05. Results: Gram-negative organisms predominated (79.1%), and the overall prevalence of multidrug resistance was 42%. Univariate analysis demonstrated significant associations between MDR and prolonged ICU stay (p=0.012), ≥5 antibiotic exposure (p=0.009), resistant isolate burden (p=0.004), and urinary source infections (p=0.031). Multivariable logistic regression identified ≥5 antibiotics (aOR 3.41; 95% CI 1.44–8.06; p=0.005), ICU stay >8 days (aOR 2.89; 95% CI 1.19–7.03; p=0.019), Gram-negative isolate (aOR 3.27; 95% CI 1.22–8.77; p=0.018), and diabetes mellitus (aOR 2.21; 95% CI 1.01–4.84; p=0.046) as independent predictors of MDR. Conclusion: Poly-antibiotic exposure, prolonged ICU stay, Gram-negative infections, and diabetes mellitus were identified as significant independent determinants of multidrug resistance. Predictive risk stratification models based on these variables may enhance empirical antimicrobial decision-making and support targeted stewardship interventions in critical care settings.