True hermaphrodite - a rare case for hysterectomy

One apparently healthy male patient reported at the Urology outpatient department, Bangabandhu Sheikh Mujib Medical University, Bangladesh, with the history of cyclical bleeding per urethra. He started bleeding from the age of 10. The bleeding lasted for 2-3 days. He also had cyclical lower abdominal pain, which remained unexplained. Menstruation occurred every 3-4 months. Left testis was normal but there was a separate soft palpable mass from its lower pole. Chromosomal analysis showed translocation of X and Y chromosome 45(t X/Y). Ultrasonography revealed normal kidneys with well-filled urinary bladder that appeared regular in outline. Left testis was normal in size, measuring about 2.73 × 1.72 cm. Its echotexture was finely homogenous with no evidence of collection or mass. There was a multiloculated cystic mass in the right half of scrotum. Right testis was not visualised along the line of descent. Surprisingly, uterus was found to be present and normal in size and anteverted in position. Fluid collection was noted in the uterine cavity. No ovarian outline was noted. FSH level was almost four times the normal level for males (31.74 IU). The LH level was slightly raised (16.17 IU). The testosterone, Estradiol and Prolactin level were within normal male range, being 3.5 microgram/L, 24 pg/L, and 13.54 microgram/L respectively. Semen analysis revealed azoospermia but the amount of semen was normal. After discussion with the patient, a total abdominal hysterectomy with right-sided salpingo-oophorectomy and left salpingectomy was performed under general anaesthesia. True hermaphrodites must be distinguished from a false one, they have both male and female gonadal tissue, false hermaphrodites are unisexual, but their sex organs resemble those of the opposite sex. This particular patient raised great interest because true hermaphrodites are rare. Attempts were made to make his life normal as a male. If he had the opportunity to have easy access to medical treatment, would he be raised as a female? Controversies are paramount. In this patient, subsequent surgery was done by urologists to correct the chordee and the hypospadias. The overall life of this patient is still a dilemma to us. It was a rare case of hysterectomy done, from the gynaecologist's point of view.

Clinical outcomes of management of myofacial pain dysfunction syndrome

The purpose of the present study was to investigate two years clinical outcome of patients having myofacial pain dysfunction syndrome (MPDS). A total of 50 patients (male: 15, Female: 35, age: raged from 20 to 65 years) were included for this study. Clinical diagnosis for the assessment of anxiety and depression of each patient was performed by Hospital anxiety and depression (HAD) scale. Patients were then received either one of the following treatments: Occlusion correction only (n=14), Muscle Relaxant + anti-depressant drug (n=26), Physiotherapy + antidepressant drug + muscle relaxant (n=6) and Appliance + muscle relaxant (n= 4). Following two years observation, it was revealed that the treatment was apparently successful in 95% case; only 5% case was not successful due to their irregular visit. It can be concluded that MPDS is not primarily related to occlusal factors and a complex psycho physiological mechanism is involved in this type of pain problems.

Successful outcome of pregnancy with mechanical heart valve with home heparin therapy

There is high incidence of rheumatic valvular heart disease in developing countries like Bangladesh, for which large number of young females undergo valve replacement with mechanical prosthetic heart valve. Pregnancy with mechanical heart valve carries risk of warfarin embryopathy and increased incidence of maternal thrombo-embolism. We had successful outcome of pregnancy of a patient with mechanical prosthetic heart valve with home heparin therapy.

Colposcopic evaluation of pre-invasive and early cervical carcinoma with histologic correlation

This observational study was done in Colposcopy clinic of Mymensingh Medical College Hospital, to evaluate the accuracy of colposcopic assessment of pre-invasive and early cervical carcinoma comparing with the reference standard of histology, in order to evaluate the justification of colposcopic examination. This study included 227 VIA (visual inspection of cervix with application of 5% acetic acid) test positive patients, who were referred to us for colposcopic evaluation during a period of January 2011 to June 2011. Patient with clinically evident of invasive cervical carcinoma were excluded from this study. VIA test was performed again in all patients prior to systematic colposcopic examination and it was found that 72.6% patients had abnormal colposcopic findings (p<0.05). Directed punch biopsy specimen was taken only from abnormal colposcopic appearances and then it was send for histopathological examination. Records of all available biopsy results were recorded. Correlation of colposcopic impression with colposcopy guided biopsy results was compared. Among 79 colposcopically diagnosed Low-grade Squamous Intraepithelial Lesions (LSIL) or low-grade Cervical Intraepithelial Neoplasia (CIN I) cases, 22.8% cases were chronic cervicities, 69.6% were LSIL (CIN I) and 7.6% were High-grade Squamous Intraepithelial Lesions (HSIL) and among 38 HSIL(CIN II/CIN III) cases, 7.8% were found to chronic cervicities, 31.6% were LSIL and 60.5% were HSIL. Fifteen cases of colposcopically diagnosed preclinical invasive carcinoma were confirmed by histopathology (p<0.05). The rate of false positive is higher in the diagnosis of HSIL than LSIL (39 vs. 30%); on the other hand the rate of false negative was higher in LSIL (9 vs. 4.5%). The sensitivity of colposcopic diagnosis of pre-invasive cervical carcinoma was ranging from 79-82% and specificity ranged between 73-87%. Positive predictive value was 62% for HSIL and 70% for LSIL and the colposcopic accuracy was 91% and 95% for the diagnosis of LSIL and HSIL respectively. All the statistical results were 100% for the diagnosis of preclinical invasive carcinoma. This study showed that colposcopy is a valid tool for the detection of pre-invasive and early cervical carcinoma. It can be considered as a secondary testing tool for VIA positive women.

Emergence of multidrug-resistant NDM-1-producing Gram-negative bacteria in Bangladesh

The main objective of this study was to investigate the prevalence of bla (NDM-1) in Gram-negative bacteria in Bangladesh. In October 2010 at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) laboratories, 1,816 consecutive clinical samples were tested for imipenem-resistant Gram-negative organisms. Imipenem-resistant isolates were tested for the bla (NDM-1) gene. Among 403 isolates, 14 (3.5 %) were positive for bla (NDM-1), and the predominant species were Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. All bla (NDM-1)-positive isolates were resistant to multiple antibiotics. Among β-lactamase genes, bla (CTX-M-1-group) was detected in ten isolates (eight bla (CTX-M-15)), bla (OXA-1-group) in six, bla (TEM) in nine, bla (SHV) in seven, and bla (VIM) and bla (CMY) in two isolates each. The 16S rRNA methylase gene, armA, was detected in five K. pneumoniae isolates and in one E. coli isolate. rmtB and rmtC were detected in a Citrobacter freundii and two K. pneumoniae isolates, respectively. qnr genes were detected in two K. pneumoniae isolates (one qnrB and one qnrS) and in an E. coli isolate (qnrA). Transferable plasmids (60-100 MDa) carrying bla (NDM-1) were detected in 7 of the 11 plasmid-containing isolates. Pulsed-field gel electrophoresis (PFGE) analysis grouped K. pneumoniae isolates into three clusters, while E. coli isolates differed significantly from each other. This study reports that approximately 3.5 % of Gram-negative clinical isolates in Bangladesh are NDM-1-producing.

Evaluation of the results of posterior decompression, posterolateral fusion and stabilization by pedicle screw and rod in traumatic thoracolumbar fractures

This study is to evaluate the clinical and radiological success of posterior decompression, posterolateral fusion and stabilization by pedicle screw and rod in the management of traumatic thoracolumbar fractures. It is a prospective interventional study which is carried out in Bangabandhu Sheikh Mujib Medical University and different private hospitals in Dhaka city from January 2008 to December 2010. Total 16 patients were selected according to the inclusion and exclusion criteria. There were 10 male patients and 06 female within a age range of 21-40 years. Mean age was 33.32 years. Total 08 cases involved L1, 03 cases involved at D12, 02 cases involved at D1, and at L2 each whereas 01 case at L3. Total 10 cases were of compression fracture and remainder 06 burst fractures. Ten (10) patients presented with paraparesis, 05 patients with incomplete paraplegia and 01 patient with complete paraplegia. All the patients were followed up for minimum 1 year. Patients with paraparesis fully recovered neurologically and could walk without support. All the 05 patients with incomplete paraplegia also recovered fully except 01 which gained partial improvement and walks with aids. One patient with complete paraplegia remained unchanged. Our results show that posterior decompression posterolateral fusion and stabilization by pedicle screw and rod provides a safe and effective surgical option for management of traumatic thoracolumbar fractures.

Different doses of atropine on heart rate fluctuations during reversal of neuromuscular blockade

It was a prospective comparative clinical study carried out in the Department of Anaesthesia, Combined Military Hospital (CMH), Dhaka, to evaluate the heart rate changes during reversal of neuromuscular blockade by using 3 different doses of atropine (in a mixture with neostigmine) and thereby detect comparatively safer dose. Sixty patients of ASA (American Society of Anesthesiologists) grade I and II physical status were divided equally into 3 groups. Neostigmine 0.05 mg/kg body weight mixed with atropine 0.02, 0.015 and 0.01 mg/kg body weight given intravenously in group A, B and C respectively during reversal. The 3 groups were compared in age, sex, body weight, and ASA grades, but there was no significant difference (p>0.05) between 3 groups. It is revealed that in Group C (atropine at a dose of 0.01 mg/kg with neostigmine), heart rate affected very little but salivary and tracheobronchial secretions were more. One of them had laryngospasm which was managed conservatively. In Group B (who received atropine 0.015 mg/kg) incidence of tachycardia observed was less than Group A (who received atropine 0.02 mg/kg). The patients of this group also had some salivary secretions but less than group C. Tachycardia was most marked in Group A but had minimum salivary secretions. Statistical analysis of heart rate changes in different times among the 3 Groups was significant (p<0.05). It was highly significant (p<0.01) in 1 minute after reversal. So relatively lower dose (0.015 mg/kg) of atropine with neostigmine than the conventional dose (0.02mg/kg) can be used to decrease tachycardia during reversal of neuromuscular blockade especially in haemodynamically unstable patients.

The first detection of Brucella canis in cattle in the Republic of Korea

Twenty mammary lymph node samples were collected from cattle on a farm in the Republic of Korea. These cattle were serologically negative for Brucella by tube agglutination test (≤ 1:50) and serum agglutination test (≤ 1:50). Out of 20 lymph node samples, two samples were positive for Brucella growth on Brucella agar as well as blood agar. Tests for urease, hydrogen sulphide and reactions against monospecific sera A and M indicated that these two isolates (No. 15 and 16) belong to the genus Brucella. Genus specific, AMOS (abortus, melitensis, ovis, suis) and Bruce-ladder multiplex polymerase chain reaction (PCR) assays confirmed the Brucella isolates as either a B. abortus or a B. canis strain. This is the first report of the occurrence of a B. canis infection in cattle in Korea. More survey data are needed to determine whether B. canis is a significant aetiology in the cases of cattle brucellosis in Korea.

Maternal outcome of grand multipara

This prospective comparative study was conducted to determine the incidence of grand multiparity, compare the maternal outcome of grand multiparity to low parity and identify the frequency of maternal mortality associated with obstetrical complications of grand multiparity. It was carried out in the Obstetric and Gynaecology department of Rangpur Medical College Hospital, Rangpur, during the period of 1st January to 30th September' 2003. All pregnant (>28 weeks) parous women were included and primigravida were excluded. A total 2728 pregnant patients were initially recruited on the study. From them 200 cases were randomly selected. Among them 100 cases were grand multipara (parity 4 and above) comprising study groups and 100 cases were non grand multipara (parity 1-3) consisting of control group. All relevant maternal parameter were recorded and then compared between study group and control group. According to this study the incidence of grand multiparity is 9.8%. Among the grand multipara patient 95% were suffering from anaemia of different severity (p<0.05). The incidence of hypertension and gestational diabetes in grand multipara were significantly higher than non grand multipara (45% vs. 12%) and (12% vs. 02%) respectively. The other complications like placenta praevia, abruptio placentae, multiple pregnancy, malpresentations, postpartum haemorrhage, ruptured uterus were significantly higher among grand multipara and statistically significant results were observed. Proportion of women who underwent caesarean section was also high in study group (32% vs. 21% p<0.05). During the study period 7 maternal death were observed in grand multipara and 1 maternal death in non grand multipara (p<0.05).

Preoperative use of granisetron plus dexamethasone and granisetron alone in prevention of post operative nausea and vomiting in tonsillectomy

This prospective study was done for to see the efficacy of preoperative use of granisetron plus dexamethasone (Group A) & granisetron (Group B) alone for the postoperative prevention of nausea & vomiting after tonsillectomy operation. One hundred patients undergoing tonsillectomy & adenoidectomy operation under general anaesthesia who were admitted in the Mymensingh Medical College Hospital during the period from July 2008 to June 2009 with American Society of Anaesthesiologists (ASA) grade I & II with age 3-40 years, body weight 10-60 kgs, were studied. Observation of this study was analyzed in the light of comparison between the two groups. All results were expressed as mean±SEM. Age in Group A 15.98±1.028 & Group B 17.18±0.961 years; Weight in Group A 38.40±1.492 & Group B 39.76±1.561 kgs and operational duration in Group A 52.60±0.786 & Group B 52.70±0.823 minutes. The studied groups were statistically matched for age, weight, duration of surgery. We observed that the effects of combination of granisetron & dexamthasone are more than granisetron alone in prevention of nausea & vomiting after tonsillectomy operation. The frequency of vomiting was 4% in combination & 16% in single therapy which is statically significant (p<0.05).

Effectiveness of levofloxacin in enteric fever

This intervention study was conducted to determine the efficacy of Levofloxacin in the treatment of uncomplicated enteric fever. Among 100 patients, who were purposively selected for the study had presented sign and symptoms of enteric fever with blood culture positive salmonella in laboratory findings during the admission in the department of Medicine, Uttara Adhunik Medical College & Hospital, Dhaka. Patients who fulfilled the diagnostic criteria were enrolled in the study and divided into two groups. One group was treated with oral levofloxacin 750mg once daily (OD) and another was injected with Levofloxacin 500mg once daily for 7 days. All the patients were examined twice daily to observe the clinical cure or failure of levofloxacin. Study was conducted from January 2008 to December 2008. Statistical analysis was performed by using statistical software SPSS version 12. Among the 100 patients in the study, majority of them 46(92%) were aged between 15 to 25 years, the next group was between 25 to 35 years 26(52%) and only three patients were aged above 65 years. Significant number of the patients were male (67), and the rest of them were female. The patients were clinically examined specially for anaemia, jaundice, caecal gurgling, hepatosplenomegaly in both the groups and the relevant investigations were performed. It was found that 46 patients in group A, who took oral levofloxacin, were cured after seven days, whereas 48 patients in group B were fully cured by taking injectable levofloxacin by seven days. In this study, levofloxacin was found to be the most effective drug in both oral and injectable form in one-week treatment of uncomplicated typhoid.

Investigation of the possible sources of heavy metal contamination in lagoon and canal water in the tannery industrial area in Dhaka, Bangladesh

This study evaluated the heavy metal pollution level of tannery effluent-affected lagoon and canal water in the southwestern Dhaka, Bangladesh. The measured physicochemical parameters (electrical conductivity, chemical oxygen demand, pH, SO²⁻₄, PO³⁻₄, Cl-, and NO⁻₃) and metals (As, Ca, Cd, Co, Cr, Cu, Fe, K, Mn, Ni, Pb, and Zn) were subjected to principal component (PCA) and hierarchical cluster analyses, and examining correlation matrix as well in order to explain the behavior and sources of the parameters/metals. The mean concentrations of the heavy metals in the lagoon and canal water were very high and, in most cases, exceeded the standard limits recommended by the Bangladesh Government. The following elemental associations were obtained from PCA and CA: Ca-Cd-Cr-Fe-K-Mn-Pb-Zn, Co-Cu-Ni, and As, which could be linked to anthropogenic sources (i.e., processes of the tannery and paint industries with some contributions from the municipal waste system). Potassium, Ca, Cr, Mn, Fe, Zn, As, and Cd occurred as important anthropogenic markers in the lagoons and lower part of the canal. Copper, Co, and Ni were importantly distributed in the lower part of the canal, which also received metal inputs from the municipal waste and other industrial sources, including paint industry. GIS-based factor score maps, generated to show the spatial controls of the major processes affecting surface water hydrochemistry, suggest that the activities of paint and tannery industries and municipal sewage are pervasive processes in the area, whereas the contribution from pesticides (used for tanning and disinfecting hides) has localized effects. This study has provided the evidence that effluents discharged from the tannery and auxiliary industries and urban sewage system are the main sources of heavy metal pollution in the lagoon and canal water systems in the Hazaribagh area of southwestern Dhaka. The high mean concentrations (in mg/l) of Cr (5.27), Pb (0.81), As (0.59), and Cd (0.13) observed in the water samples may have serious public health and potential environmental hazard implications.

Microbiological quality of drinking water from dispensers in roadside restaurants of Bangladesh

The microbiological status of water from dispensers in different roadside restaurants of Dhaka city and Savar area was analyzed in this study. Seven samples from Dhaka and 8 samples of Savar were checked. The heterotrophic plate count was in a range of 1.0 x 10(3) CFU mL(-1) to 2.0 x 10(4) CFU mL(-1) (from new bottles), 1.0 x 10(3) to 1.5 x 10(4) CFU mL(-1) (after dispensation), and 1.5 x 10(3) CFU mL(-1) to 1.0 x l0(5) CFU mL(-1) (from serving glass). In several of the samples, the heterotrophic plate count was higher than the count in water from new bottle or after dispensation, suggesting added contamination from the serving glass. 80% of the samples were contaminated with total and fecal coliform bacteria, which render these waters unacceptable for human consumption. The samples were found to contain gram negative bacteria like E coli, Shigella sp., Klebsiella sp., Enterobacter sp., Pseudomonas sp., and Salmonella sp., which are potential pathogens and thus pose a serious threat to public health. This study elucidates the importance of monitoring the bottling companies and the restaurants and put them under strict regulations to prevent future outbreak of any water borne diseases caused by consumption of dispensed water.

POEMS Syndrome

A 49 years old male patient admitted with 2 years history of lower extremity symmetrical sensorimotor polyneuropathy, sclerodermic skin change, erectile dysfunction, hepatosplenomegaly and monoclonal gammopathy. The clinical evaluation met the criteria for the diagnosis of (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes) POEMS syndrome. The patient was treated with corticosteroid and melphelan and responded well. We present a case different from the other cases with severe unusual burning sensation all over the body, which was his sole complaint and with this complaint he visited lot of doctors including psychiatrist.

Comparison between bipolar diathermy tonsillectomy and cold dissection tonsillectomy

A prospective study was carried out in the department of otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Bangladesh Medical college Hospital, Dhaka. From January, 2007 to January, 2009 to compare between Bipolar Diathermy Tonsillectomy and Cold Dissection Tonsillectomy. Two hundred patients were divided equally into two groups- bipolar diathermy tonsillectomy and cold dissection tonsillectomy. The two groups were compared in age and sex distribution but there was no significant difference (p>0.05) between the two groups. Operative time, operative blood loss, postoperative pain, diet intake, activity level and complications were compared in the two groups. Operative time and blood loss was significantly less in the diathermy group which was highly significant (p<0.001). No significant difference (p>0.05) in the postoperative pain was observed. Percentage of normal diet taken was higher in the diathermy group on the 1st day and lower on the 7th day while the difference was not statistically significant (p>0.05). No significant difference (p>0.05) was noted between the two groups in terms of postoperative activity and postoperative blood loss. Operative blood loss & time was significantly less in bipolar diathermy tonsillectomy. So it is a safe technique and can be used safely with less morbidity & complication.

Uroflowmetry before and after transurethral resection of prostate for bladder outlet obstruction

This prospective study evaluates the effectiveness of uroflowmetry to follow up the patients of benign prostatic hyperplasia treated by transurethral resection of prostate. Total sixty eight patients of 50 to 70 years age group attending for the treatment of BPH with bladder outlet obstruction in the department of Urology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka were recruited for the study. All the TURP's were performed by experienced urologist. Patients were advised to come after 3 months and 6 months for follow up visits. In each visit, the patients were evaluated through history, physical examination and relevant investigations including IPSS and uroflowmetry. Significant improvement was observed in term of Qmax, voided volume, and voiding time in all patients after TURP. Mean (+/-SD) IPSS change in pre to post TURP was 16.2(+/-0.76) (p<0.05). The objective parameters of uroflowmetry correlated well with the subjective parameters represented by IPSS in this study.

Testosterone secreting adrenal adenoma in an adult female patient

Adrenal tumours that secrete testosterone are extremely rare and we describe such a case in a 35 years old female with virilization. She had steroid biochemical profile in normal limit, except increased serum testosterone level. She had left adrenal adenoma 7.5 X 6.4 cm in size, her ovaries were normal. After left adrenalectomy the serum testosterone level returns to normal and has remained in the normal range. Hirsutism decreasing gradually and menstruation restarts after 3 months. Histopathological examination confirmed the diagnosis of adrenal adenoma.

Genetic Testing for Huntington's Disease in Parkinsonism

The study was conducted to find out Huntington's disease (HD) by genetic analysis from those presenting with parkinsonism in the Neurology department of Mymensingh Medical College & Hospital. A sample of about 5ml blood was collected by veni puncture in EDTA tube with informed consent from 9 patients & 7 healthy individuals after approval of the institutional ethics committee for genetic study. The neurological disorder along with a complete history and physical findings were recorded in a prescribed questionnaire by the neurologists of Mymensingh Medical College & Hospital. Extraction of genomic DNA from the venous blood using FlexiGene DNA kit (Qiagen, Japan) was performed in Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh. The extracted DNA was stored and accumulated and then these DNA were sent to Division of Clinical Genetics, Department of Medical Genetics, Osaka University Medical School, Suita, Osaka 565 0871, Japan for PCR and further analysis. PCR amplification of the CAG repeat in the 1T15 gene was performed with primers HD1 and HD3. HD PCR products revealed the DNA product of about 110bp (no. of CAG repeats=21) to 150bp (no. of CAG repeats=34) in both healthy individual and suspected PD patient DNA.

Evaluation of hazardous metal pollution in irrigation and drinking water systems in the vicinity of a coal mine area of northwestern Bangladesh

An integrated approach of pollution evaluation indices, principal component analysis (PCA) and cluster analysis (CA) was employed to evaluate the intensity and sources of pollution in irrigation and drinking water systems of northwestern Bangladesh. Temperature, BOD, chemical oxygen demand (COD), Mn, Fe, Co, Ni, Cu and Pb levels in most of the water samples exceed the Bangladesh and international standards. The heavy metal pollution index (HPI) and degree of contamination (C(d)) yield different results despite significant correlations between them. The heavy metal evaluation index (HEI) shows strong correlations with HPI and C(d), and gives a better assessment of pollution levels. Modifications to the existing HPI and C(d) schemes show comparable results with HEI, and indicate that about 55% of the mine drainage/irrigation waters and 50% of the groundwaters are moderately to highly contaminated. The CA, PCA and pollution indices suggest that the mine drainage water (DW) is contaminated by anthropogenic (mining operation and agrogenic) sources, and the proximal parts are more contaminated than the distal part. The groundwater system in the vicinity of the coal mine site is also heavily polluted by anthropogenic sources. The pollution status of irrigation and drinking water systems in the study area are of great environmental and health concerns.

A pilot study on the prevalence of sexually transmitted infections among clients of brothel-based female sex workers in Jessore, Bangladesh

The prevalence of bacterial sexually transmitted infections among clients of female sex workers (FSWs) was studied. A total of 156 condoms were collected from clients of 13 sex workers during three consecutive days. Condoms used by clients of FSWs were collected and DNA was extracted from the seminal fluid and used for the diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis by polymerase chain reaction. The prevalence of N. gonorrhoeae, C. trachomatis and T. vaginalis among clients of FSWs was 4.5% (7/156), 2.5% (4/156) and 7% (11/156), respectively.

Use of in situ extracorporeal shock wave lithotripsy in upper ureteric stone

This study was done to determine the effectiveness of in situ extracorporeal shock wave lithotripsy (ESWL) in upper ureteric calculi in terms of stone clearance, peroperative & postoperative complications and also to determine some criteria for selection of patients for this procedure. From July, 2003 to July 2004, a total of 67 patients, with excreting kidneys and having stone size less than 2 cm were treated by in situ ESWL using Lithostar plus Lithotriptor. The patient group comprised of 52 men and 15 women, age ranged from 14 years to 65 years. Of the total 67 patients selected for study 44 patients were included in group I, having stone size ?1.5 and visible distal flow of contrast on IVU & 23 patients were included in Group II with stone size>1.5 cm to 2 cm and contrast seen only upto stone. Four (04) patients from Group I and three (03) patients from group II were dropped out during the follow up period so that data of 40 patients in group I and 20 patients in group II were analyzed finally. Number of shock wave was given in 1 to 3 sessions. Finally 95% of group I and 85% of group II achieved complete clearance of calculi at the end of 3 sessions. In situ ESWL is a good option for the treatment of upper ureteric calculi.

Prevalence and antimicrobial resistance of methicillin resistant Staphylococcus epidermidis isolated at Mymensingh Medical College Hospital

The study was done to determine the drug resistance pattern of Methicillin resistant Staphylococcus epidermidis (MRSE) isolated from different clinical specimens at Mymensingh Medical College Hospital, Mymensingh during the period from July 2007 to June 2008. A total of 32 Staphylococcus epidermidis were isolated from 200 different clinical specimens by standard microbiological techniques. Antimicrobial susceptibility of all the isolates was carried out by disk diffusion method as per recommendation of Clinical and Laboratory Standard Institute 2007. Out of 32 Staphylococcus epidermidis 18(56.25%) were detected as Methicillin resistant Staphylococcus epidermidis (MRSE) by disk diffusion method. In this study, Methicillin resistant Staphylococcus epidermidis showed multidrug resistance. Resistant to penicillin, amoxycillin, oxacillin and cloxacillin was 100% followed by gentamycin (56%), erythromycin (50%), doxycycline (44%), cephradine (44%), ciprofloxacin (39%), fucidic acid (33%), cefuroxime (33%) and ceftriaxone (28%). All isolates of MRSE were susceptible to rifampicin and vancomycin.

Identification, characterization, and expression analyses of class II and IV chitinase genes from Douglas-fir seedlings infected by Phellinus sulphurascens

Laminated root rot (LRR) disease, caused by the fungus Phellinus sulphurascens, is a major threat to coastal Douglas-fir (DF) (Pseudotsuga menziesii) forests in western North America. Understanding host-pathogen interactions of this pathosystem is essential to manage this important conifer root disease. Our research objectives were to identify DF pathogenesis-related (PR) genes and analyze their expression patterns over the course of infection. We constructed a cDNA library of Phellinus sulphurascens-infected DF seedling roots and sequenced a total of 3,600 random cDNA clones from this library. One of the largest groups of identified genes (203 cDNA clones) matched with chitinase genes reported in other plant species. We identified at least three class II and six class IV chitinase genes from DF seedlings. Quantitative reverse-transcriptase polymerase chain reaction analyses showed significant differential expression patterns locally in root tissues and systemically in needle tissues after fungal invasion. Nonetheless, there was a common trend in gene expression patterns for most of the chitinase genes: an upregulation within 12 h of pathogen inoculation followed by down-regulation within 2 to 3 days postinoculation (dpi), and then further upregulation within 5 to 7 dpi. Western immunoblot data showed differential accumulation of class IV chitinases in Phellinus sulphurascens-infected DF seedlings. Further detailed functional analyses will help us to understand the specific role of DF chitinases in defense against Phellinus sulphurascens infection.

Heavy metal pollution of coal mine-affected agricultural soils in the northern part of Bangladesh

Total concentrations of heavy metals in the soils of mine drainage and surrounding agricultural fields in the northern part of Bangladesh were determined to evaluate the level of contamination. The average concentrations of Ti, Mn, Zn, Pb, As, Fe, Rb, Sr, Nb and Zr exceeded the world normal averages and, in some cases, Mn, Zn, As and Pb exceeded the toxic limit of the respective metals. Soil pollution assessment was carried out using enrichment factor (EF), geoaccumulation index (I(geo)) and pollution load index (PLI). The soils show significant enrichment with Ti, Mn, Zn, Pb, As, Fe, Sr and Nb, indicating inputs from mining activities. The I(geo) values have revealed that Mn (1.24+/-0.38), Zn (1.49+/-0.58) and Pb (1.63+/-0.38) are significantly accumulated in the study area. The PLIs derived from contamination factors indicate that the distal part of the coal mine-affected area is the most polluted (PLI of 4.02). Multivariate statistical analyses, principal component and cluster analyses, suggest that Mn, Zn, Pb and Ti are derived from anthropogenic sources, particularly coal mining activities, and the extreme proximal and distal parts are heavily contaminated with maximum heavy metals.

Swine flu: a new emerging disease

Swine flu is an important zoonotic disease that has been recognized as an important global health problem by any one of several types of swine influenza virus or swine-origin influenza virus. Due to its increasing incidence in many countries of the world and occurrence of several large outbreaks in present year, it is a burning issue nowadays. It is thought to be a mutation--more specifically, a reassortment of four known strains of influenza A virus subtype H1N1. Swine influenza virus is common throughout pig populations worldwide. Transmission of the virus from pigs to humans is not common and does not always lead to human influenza, often resulting only in the production of antibodies in the blood. Due to variability of clinical features and limited availability of laboratory facilities, the disease remains largely under-reported. Early and specific diagnosis is important to ensure a favourable outcome. In this paper we attempted to explore history, classification, transmission, sign symptoms, diagnosis and prevention of swine flu as a critical review to provide some new upgrade regarding this devastating pandemic disease.

A Comparison of Regional Variations of Fertility in Bangladesh

This study, based on the 2004 Bangladesh Demographic and Health Survey (BDHS), examines the extent to which regional variations of reproductive behavior are explained by inherent demographic, socioeconomic, and programmatic differences among regions. This article also attempts to investigate the impact of four intermediate fertility variables; namely marriage, contraception, lactational infecundability, and induced abortion, on fertility among different regions in Bangladesh. The contribution of proximate variables was observed through the decomposition of the total fertility rate (TFR) into proximate components. The results indicate that contraception is the highest fertility reducing factor in all the regions.

Factors associated with delivery complications in rural Bangladesh

OBJECTIVES

There are only a few studies on maternal morbidity, delivery complications and maternal mortality in Bangladesh. This study analyzes data from a follow-up study conducted by the Bangladesh Institute of Research for Health and Technologies (BIRPERHT) on maternal morbidity in rural Bangladesh in 1993.

METHODS

A total of 1020 pregnant women were interviewed in the follow-up component of the study. The survey collected information on socioeconomic and demographic characteristics, pregnancy-related care and practice, morbidity during the period of follow-up as well as in the past, information concerning complications at the time of delivery and during the postpartum period. For the purpose of this study, we selected 993 pregnant women with at least one antenatal follow-up. Both bivariate and multivariate analyses were conducted to identify the potential risk factors for complication during delivery and duration of labor.

RESULTS AND CONCLUSIONS

It appears that complications during the antenatal period can result in various complications at the time of delivery. Some of the important findings are: hemorrhage during the antenatal period increases the risk of excessive hemorrhage during delivery, the risk of obstructed labor increases significantly if abdominal pain is observed during the antenatal period, prolonged labor appears to be significantly higher for the first pregnancy, and pregnancies suffering from abdominal pain during pregnancy tend to have a higher risk of prolonged labor during delivery. The duration of labor appears to be negatively associated with the number of previous pregnancies, being longest for the first pregnancies. The duration of labor pain is significantly higher for the respondents who reported the index pregnancy as undesired, and, similarly, the respondents who were reported to be involved with gainful employment would have a shorter duration of labor pain than those having no involvement with gainful employment.

Antibiotic susceptibility pattern of Staphylococcus epidermidis

The present study was done to evaluate the antibiotic susceptibility pattern of Staphylococcus epidermidis isolated from different clinical specimens and healthy controls in the department of Microbiology, Mymensingh Medical College from July, 2007 to June, 2008. A total of 62 Staphylococcus epidermidis were isolated from 230 specimens. Among them 32(23%) S. epidermidis were isolated from 200 cases and 30(100%) were isolated from 30 healthy controls. Antimicrobial susceptibility test of the isolates was carried out by disk diffusion method as per recommendation of Clinical and Laboratory Standard Institute, 2007. Isolates of S. epidermidis from cases showed multidrug resistance as follows-penicillin 94%, oxacillin 56%, gentamycin 44%, erythromycin 41%, doxycycline 37%, cephradine 34%, ciprofloxacin 28%, ceftriaxone 28%, fusidic acid 22% and cefuroxime 19%. On the other hand, isolates of S. epidermidis from controls were susceptible to all antibiotics except penicillin, which was only 10% resistant. A remarkable difference was observed in the resistance pattern of S. epidermidis isolated from cases and healthy controls. However in our study no isolates of S. epidermidis was resistant to rifampicin and vancomycin, which can be used as last line of drugs to treat nosocomial S. epidermidis infection.

Determination of toxic trace elements in foodstuffs, soils and sediments of bangladesh using instrumental neutron activation analysis technique

The concentrations of arsenic (As), chromium (Cr) and iron (Fe) were determined in the foodstuffs, soils and sediments from various areas in Bangladesh and new data for these toxic trace elements were given. The arsenic pollution problems in the most of the areas of Bangladesh are of geological origin. The high level of As in foodstuffs, soils and sediments, except for tannery sediments is probably positively correlated to the Fe concentration. An excessive amount of chromium was found in the sediments from the tannery area of Bangladesh.

Ultrastructural studies of Phellinus sulphurascens infection of Douglas-fir roots and immunolocalization of host pathogenesis-related proteins

Interactions between roots of Douglas-fir (DF; Pseudotsuga menziesii) seedlings and the laminated root rot fungus Phellinus sulphurascens were investigated using scanning and transmission electron microscopy and immunogold labelling techniques. Scanning electron micrographs revealed that P. sulphurascens hyphae colonize root surfaces and initiate the penetration of root epidermal tissues by developing appressoria within 2 d postinoculation (dpi). During early colonization, intra- and intercellular fungal hyphae were detected. They efficiently disintegrate cellular components of the host including cell walls and membranes. P. sulphurascens hyphae penetrate host cell walls by forming narrow hyphal tips and a variety of haustoria-like structures which may play important roles in pathogenic interactions. Ovomucoid-WGA (wheat germ agglutinin) conjugated gold particles (10 nm) confirmed the occurrence and location of P. sulphurascens hyphae, while four specific host pathogenesis-related (PR) protein antibodies conjugated with protein A-gold complex (20 nm) showed the localization and abundance of these PR proteins in infected root tissues. A thaumatin-like protein and an endochitinase-like protein were both strongly evident and localized in host cell membranes. A DF-PR10 protein was localized in the cell walls and cytoplasm of host cells while an antimicrobial peptide occurred in host cell walls. A close association of some PR proteins with P. sulphurascens hyphae suggests their potential antifungal activities in DF roots.

Brain lesions in young broiler chickens naturally infected with a mesogenic strain of Newcastle disease virus

Thirty-nine 4- to 5-week-old broiler chickens from an outbreak of Newcastle disease (ND) in Japan were examined pathologically. The causative agent was identified as a mesogenic strain of ND virus. Predominant gross lesions included haemorrhage in the lungs, congestion of the trachea, splenomegaly, atrophy of the thymus and bursa of Fabricius, and whitish discolouration of the brain. Microscopically, there was mild haemorrhagic pneumonia, catarrhal tracheitis, lymphoid necrosis in the spleen, thymus, bursa of Fabricius and caecum and diffuse non-suppurative encephalitis. Lesions associated with encephalitis were characterized by multifocal perivascular cuffing, malacia, demyelination and proliferative vasculitis. Malacic lesions occurred in the hyperstriatum, neostriatum, subleptomeningeal and periventricular regions of the cerebrum, whereas demyelination was seen mainly in the brain stem. The morphological changes that occurred in the brain in these cases were distinctive and the lesions in the lymphoid tissues were related to concurrent infection with infectious bursal disease virus.

Relationship between blood groups and coronary artery disease

There are mounting evidences of relationship of different blood groups to disease. For many years, ABO blood group has been associated with predisposition to both arterial and venous disorders, such as venous thromboembolism, peripheral vascular disease and coronary artery disease. To evaluate the relationship of ABO and Rhesus blood groups with coronary artery disease. Total ninety five patients with coronary artery disease admitted in the Cardiac Surgery Department of Zarina Sikhder Women Medical College, Dhaka, and ninety five healthy stuff of same Medical College were studied. Their ABO and Rhesus Blood Groups were determined by standard method in the department of Transfusion Medicine, Zarina Sikhder Women Medical College, Dhaka, Bangladesh with full support from the department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. The results obtained in this study show that the prevalence of Coronary Artery Disease (CAD) in blood group O is invariably higher than in all other ABO blood groups (p<0.05). It is striking that despite the fact that the most prevalent blood group among Bangladeshi people is phenotype B, the prevalence of CAD risk is associated with phenotype O (Odd ratio 2.034, 95% confidence interval 1.127 to 3.67). This suggests that a certain CAD risk is associated with phenotype O. Thus we conclude that, in Bangladeshi people, blood group phenotype O is associated with a substantially increased risk for CAD.

Effect of micronutrients on morbidity and duration of hospital stay in childhood pneumonia

A cross-sectional and controlled clinical trial was conducted in under-5 children to compare the effects of supplementation of five micronutrients (vitamin-A, vitamin C, vitamin E, folic acid and zinc) on the morbidity and on the duration of hospital stay in pneumonia. Data were collected from 1150 children. Among them 350 children were excluded for various reasons and finally data from 800 children were analyzed. Among these 800 children 59.00% (475) were male and 41.00% (325) were female. The mean+/-SD age was 6.5+/-5.6 months and 56.25% (450) were infants. The children were divided into two groups-400 in control group and 400 in intervention (case) group. In both the groups, specific treatment was given by ampicillin and gentamycin. In intervention group, five micronutrients were given in 200 children from the day of admission and continued up to discharge. Another 200 children were again divided into 5 sub-groups (40 in each sub-group) and a single micronutrient was given in the same way in each sub-groups. All the subjects were suffering clinically from severe pneumonia and radiologically from bronchopneumonia. Cases and controls were matched by parents' occupation, education level, economic status and family members. All the children were fully vaccinated as per existing EPI schedule of the country, partially breastfed up to six months and after six months weaned by carbohydrate rich diet. All the children were in mild (grade I) PEM according to Gomez's classification. Venous blood was collected for estimation of serum level of five micronutrients from all the samples before starting treatment by standard procedures. The average blood level of all the micronutrients was low. The average duration of hospital staying was 6.75 days in intervention group and 7.75 days in control group (p<0.01). Chest indrawing and fast breathing disappeared earlier in the intervention group (p<0.01) suggesting that supplementation of micronutrients decrease the morbidity and duration of hospital stay of children suffering from pneumonia.

Crossbred bull selection for bigger scrotum and shorter age at puberty with potentials for better quality semen

Shortening age at puberty of crossbred breeding bull is an important issue in the tropics. This study aimed at selecting crossbred bulls at earliest possible age with bigger scrotum and potential for donating quality semen. One hundred and 31 pre-joining crossbred bulls of Central Artificial Insemination Laboratory, Saver, Dhaka were examined. The bulls being trained by seeing semen collection from mature bulls were allowed ejaculation into the artificial vagina at homosexual mount during a 20 min time at three occasions, every three months. Eighty one of 131 bulls produced at least one ejaculate during the study and their mean +/- SD age and scrotal circumference (SC) were 20.3 +/- 4.7 months and 28.2 +/-2.7 cm, respectively. Bulls' body weight, body condition score (BCS) and SC influenced the attainment of their puberty (p < 0.05). Bull's body weight had positive effects on scrotal circumference and ejaculate volume (p < 0.05). Scrotal circumference positively influenced the percentages of normal spermatozoa (p < 0.05). Scrotal skin-fold thickness negatively influenced the proportion of spermatozoa with normal head (p < 0.05). Based on age at first ejaculate and SC, 29.6% bulls (n = 24) were selected by cluster analysis. Selected bulls had mean +/- SD age 17.9 +/- 2.2 months, body weight 287.3 +/-48.6 kg, SC 30.5 +/- 1.5 cm, ejaculate volume 3.4 +/- 1.3 ml, sperm motility 50.8 +/- 17.2%, total spermatozoa per ejaculate 2541.9 +/- 1699.2 million and normal spermatozoa 81.5 +/-14.5%. The selected pubertal bull group was different from the unselected pubertal bulls at MANOVA (p < 0.0001). About 30% of pubertal crossbred bulls can be selected with shorter age and larger scrotum at puberty under conditions prevailed in Bangladesh.

Neutron capture cross-section measurement for the 186W(n,gamma)187W reaction at 0.0536eV energy

The thermal neutron-induced activation cross section for the (186)W(n,gamma)(187)W reaction was measured at 0.0536eV neutron energy using TRIGA Mark-II research reactor, Atomic Energy Research Establishment, Savar, Dhaka, Bangladesh. The (197)Au(n,gamma)(198)Au monitor reaction induced in a high-purity gold foil was used to determine the effective neutron beam intensity. The activities induced in sample and monitor foils were measured nondestructively by a high-resolution HPGe gamma-ray detector. The present experimental cross-section value is the first one at 0.0536eV. The obtained new cross section that amounts to 26.6+/-1.6b is 2% higher than the recently reported data in ENDF/B-VII and 5% lower than that of JENDL-3.3.

Sex preference and contraceptive norms among regions in Bangladesh

Using data derived from the 2004 Bangladesh Demographic and Health Survey (BDHS, 2004) the present study examines the effect of sex preference on contraceptive use among different regions in Bangladesh. The study also investigates the impact of some selected socio-economic and demographic variables on the use of contraceptive methods. The result shows that sex preference has a significant effect on the use of contraceptive methods. The families who have one child of each sex are most satisfied with their current family composition. The result reveals a huge unmet need for contraception in the eastern part of Bangladesh. The study confirms that sex preference may be a constraint in the acceptance of contraceptive methods in Bangladesh. The demand for large families and sex preference can be reduced through affirmative social and economic policies. It was also observed that female education has a positive effect on contraceptive use among almost all regions.

Host-Pathogen Interactions in Douglas-Fir Seedlings Infected by Phellinus sulphurascens

ABSTRACT Several aspects of the host-pathogen interaction between Douglas-fir (Pseudotsuga menziesii) and the fungal pathogen Phellinus sulphurascens were investigated in an in vitro inoculation system using young seedlings and fungal mycelia. Light microscopy confirmed that P. sulphurascens mycelia can successfully penetrate host epidermal cells within 3 days postinoculation (dpi). Extensive fungal colonization and cortical cell decay occurred within 14 dpi. Western immunoblot studies showed significant upregulation (five to sixfold) of four specific pathogenesis-related (PR) proteins in infected roots. These proteins were a Douglas-fir thaumatin-like protein (PmTLP), an endochitinase protein (ECP), a Douglas-fir PR10 (DF-PR10) protein (PsemI), and a 10.6-kDa antimicrobial peptide (PmAMP1). The highest accumulation of PmTLP and PmAMP1 occurred at 12 dpi, whereas accumulations of the ECP and DF-PR10 proteins peaked at 7 dpi. For both inoculated and control Douglas-fir seedlings, only one of the four PR proteins, PmAMP1, was clearly detectable in needles. Immunolocalization experiments using fluorescein isothiocyanate-conjugated secondary antibodies confirmed accumulation of all four PR proteins mainly in and around cell walls of root cortical tissues. Overall, the highest immunofluorescence was observed in infected roots at 12 dpi, whereas labeling in control roots was negligible at all sample times. The ECP produced the highest fluorescence; the DF-PR10 the lowest. Upregulation and localization of these PR proteins in cortical tissues of inoculated roots suggest that they play a defensive role in response to infection by P. sulphurascens. This in vitro inoculation system will facilitate further proteomic and genomic studies of this important pathosystem.

Prevalence of psychiatric ailments among patients with sexually transmitted disease

A cross-sectional descriptive study conducted on 250 sexually transmitted disease patients was carried out in two teaching institutes and their tertiary hospitals. These subjects constitute a special group of population for psychiatric diagnosis by using Structured Clinical Interview for Diagnostic and Statistical Manual IIIR. The study was done in the dermatology and venereology outpatient department of two tertiary hospitals of Dhaka, between January 1998 and January 1999. The findings show that 34% of total sexually transmitted disease patients had psychiatric disorders. Anxiety disorders (11.2%) were found to be the most common disorder among these psychiatric patients; this was followed by depressive disorder (8.4%), psychoactive substance use disorder (6.8%), sexual dysfunction (6.8%), bipolar mood disorder (0.4%), and schizophrenia (0.4%). Four percent of anxiety disorder was associated with psychoactive substance use disorder and sexual dysfunction. Similarly 3.6% of depressive disorder was found with psychoactive substance use disorder and sexual dysfunction while 1.6% of sexual dysfunction was associated with substance use disorder. Most of the patients in the sexually transmitted disease population recruited in the present study had both anxiety disorder and depressive disorder though majority of them were undetected and untreated. These findings underscore that special attention needs to be given to the mental health component of our health care delivery system.

Outcome of management of differentiated thyroid carcinoma

A prospective study was done on 93 cases of differentiated thyroid carcinoma to find out the outcome of management according to the protocol followed in the Department of ENT-Head and Neck Surgery of Bangabandhu Sheikh Mujib Medical University Hospital. Here Papillary carcinoma is more common (76.35%) than follicular carcinoma. Papillary carcinoma affected in the younger patients more commonly than the follicular carcinoma with a mean age of 34.37years (SD=12.81) for papillary carcinoma and 44.93 years (SD=16.01) for follicular carcinoma; but age as a risk factor showed no significant difference between two histological types (p>0.05). Female was the predominant sex with a ratio of 3.04:1. In this series majority of patients were categorized as high risk group (75.27%). There is strong association between histological type & risk group (P<0.05). High risk group is more common in follicular carcinoma (95.45% Vs 69.01%). There was a significant differences between the two histological types for extrathyroidal extention and distant metastasis as risk factors (p<0.01 and p<0.001); but tumour size and lymphatic metastasis showed no significant difference (p>0.05). All low risk patients were treated by hemithyriodectomy followed by life long thyroxine. All high risk cases were treated with total thyroidectomy with (35.71%) or without (62.86%) different types of neck dissection (according to the degree of lymph node involvement) followed by radioiodine ablasion and lifelong thyroxine therapy routinely. Overall rate of complication of thyroid surgery was 23.08%. The commoner complications were vocal cord palsy (5.5%), hypoparathyroidism (5.5%) and haemorrhage (4.4%). Less common complications were laryngeal oedema (2.2%), wound infection (2.2%), tracheal injury (1.1%) and death (2.2%). Many cases lost to follow up. Sixty seven cases (73.64%) responded well for follow-up. Mean duration of follow up was 3.40 years (SD=1.41). There was recurrence in thyroid remnant in 9.09% of hemithyroidectomy cases and were treated by completion thyroidectomy followed by radioiodine ablasion. Regional lymphatic metastasis was seen in six cases and was treated by different types of neck dissection. Recurrence at distal site was seen in 4 cases (18.18% of follicular carcinoma). These were treated by radioiodine ablation; two of them died during the period of follow-up.

The emerging strains of Shigella dysenteriae type 2 in Bangladesh are clonal

A total of 113 strains of Shigella dysenteriae type 2 isolated from patients attending the Dhaka diarrhoea treatment centre of ICDDR,B: Centre for Health and Population Research during the period 1999-2004 were studied. Serotype of the isolates was confirmed using commercially available antisera. Except for arabinose fermentation, all the strains had similar biochemical reactions. More than 60% of the strains were sensitive to commonly used antibiotics; only 6% (n=7) of the strains were resistant to nalidixic acid, and none of the strains were resistant to mecillinam and ciprofloxacin. All strains were invasive as demonstrated by the presence of a 140 MDa plasmid, ial, sen and ipaH genes, Congo Red absorption ability and by the Sereny test performed on representative strains. Plasmid patterns were heterogeneous but more than 50% of strains were confined to a single pattern. All strains possessed a 1.6 MDa plasmid and 87% of the strains contained a 4 MDa plasmid. Middle-range plasmids (90 MDa to 30 MDa) present in 36% of the strains were not associated with antibiotic resistance. All the strains were clustered within a single type with four subtypes by pulsed-field gel electrophoresis while ribotyping patterns of all the strains were identical.

Prevalence of sputum smear-positive tuberculosis in a rural area in Bangladesh

The objective of the study was to determine the prevalence of smear-positive tuberculosis (TB) in a rural area in Bangladesh at Matlab. A TB surveillance system was established among 106,000 people in rural Bangladesh at Matlab. Trained field workers interviewed all persons aged > or = 15 years to detect suspected cases of TB (cough > 21 days) and sputum specimens of suspected cases were examined for acid-fast bacilli (AFB). Of 59,395 persons interviewed, 4235 (7.1%) had a cough for > 21 days. Sputum specimens were examined for AFB from 3834 persons, 52 (1.4%) of them were positive for AFB. The prevalence of chronic cough and sputum positivity were significantly higher among males compared to females (P < 0.001). The population-based prevalence rate of smear-positive TB cases was 95/100,000 among persons aged > or = 15 years. Cases of TB clustered geographically (relative risk 5.53, 95% CI 3.19-9.59). The high burden of TB among rural population warrants appropriate measures to control TB in Bangladesh. The higher prevalence of persistent cough and AFB-positive sputum among males need further exploration. Factors responsible for higher prevalence of TB in clusters should be investigated.

Intravesical adjuvant therapy using mitomycin C

Bladder cancer is mostly superficial at first diagnosis. High incidence of recurrence is the major problem after initial management with transurethral resection (TUR) of bladder tumor. Adjuvant chemotherapy has been advocated to reduce the incidence of recurrence. A study was carried out to observe the efficacy of intravesical adjuvant therapy with single immediate versus delayed multi-dose regimen of Mitomycin C (MMC) in preventing recurrence of superficial bladder cancer. One hundred Patients having intermediate risk superficial bladder cancer were randomized into two equal groups. All patients were followed carefully. Total duration of follow-up was minimum 12 months, maximum 36 months, mean 29 months. No recurrence was seen on 3(rd), 6(th) and 9(th) month of intravesical therapy. As much as 94% and 96% of recurrence free rate was observed in immediate single and delayed multi-dose group respectively on 12(th) month; 86% and 84% on 18(th) month; 74% and 72% on 24(th) month; 70% and 68% on 36(th) month of follow-up cystoscopy respectively. Efficacy of post transurethral resection of bladder tumour (TURBT) MMC single immediate dose was found similar to that of MMC delayed multi-dose regimen in preventing the recurrence of intermediate risk superficial bladder transitional cell carcinoma (TCC) in the study. The difference between the two groups insignificant (p>0.05).

Trend of selected risk factors for hepatitis B infection among the drug addicts in Bangladesh: a five year statistics

The present retrospective study was conducted by review of records of last five years from 1996 to 2000, among 1497 drug addicts, admitted in a selected drug addicts treatment centre in Dhaka, with an aim to find out the trend of occurrence of hepatitis B infection among the drug addicts, as well as the trend of the risk factors. It was found from the study that during the period of five years, among the total drug addicts, sixty-nine addicts were found to be hepatitis B positive as determined by HBsAg status. The main contributing risk factors were found to be history of exposure to the commercial sex workers (CWS), injecting drug use (IDUs) and needle sharing. It was also found that the trend of hepatitis B infection was gradually falling down among the drug addicts probably due to reduction of the risk factors, especially the injection of drugs. It can be recommended that as a considerable portion of (NUDS) have shown evidence of hepatitis B infection, especially those who were using and sharing needles with others. Therefore, for protecting them from this dreadful infection, drug addicts should be counseled to avoid the above high risk behavior.

Development of a new model for batch sedimentation and application to secondary settling tanks design

Assuming that settling takes place in two zones (a constant rate zone and a variable rate zone), a model using four parameters accounting for the nature of the water-suspension system has been proposed for describing batch sedimentation processes. The sludge volume index (SVI) has been expressed in terms of these parameters. Some disadvantages of the SVI application as a design parameter have been pointed out, and it has been shown that a relationship between zone settling velocity and sludge concentration is more consistent for describing the settling behavior and for design of settling tanks. The permissible overflow rate has been related to the technological parameters of secondary settling tank by simple working equations. The graphical representations of these equations could be used to optimize the design and operation of secondary settling tanks.

Improvement of coverage and utilization of EmOC services in southwestern Bangladesh

OBJECTIVE

The Government of Bangladesh has implemented safe motherhood programs throughout the country supported by the United Nations Children's Fund (UNICEF) and United Nations Population Fund (UNFPA) aimed at reducing maternal morbidity and mortality. The objective of this study is to assess the effect of the interventions on the UN emergency obstetric care (EmOC) process indicators in Khulna division, Bangladesh.

METHODS

Of the 71 government health facilities in Khulna division, 32 were providing comprehensive and 20 were providing basic EmOC services. Another 4 facilities were providing comprehensive or basic EmOC services during the first three-quarters but became non-functional during the last quarter. EmOC data, from January to December 2002, were collected from all these 56 facilities to determine the levels of EmOC process indicators relative to the UN guidelines and compared with baseline data from 1998 to 1999.

RESULTS

There were 1.04 and 0.64 comprehensive and basic EmOC facilities respectively per 500,000 population. When compared with the baseline data, the coverage of comprehensive EmOC services was substantially increased from 0.23 to 1.04 per 500,000 population, which achieves the minimum UN standards but the coverage of basic EmOC services remained the same. The data also showed that, compared with the baseline survey, the proportion of births at the EmOC facilities increased 119% from 5.3% to 11.7% (p<0.001), met need increased 141% from 11.1% to 26.6% (p<0.001), and cesarean section as a proportion of all expected births, increased 151% from 0.5% to 1.3% (p<0.001), while the overall case fatality rate (CFR) decreased by 51% (p<0.001).

CONCLUSION

With the exception of coverage of basic EmOC after the interventions, there was significant improvement in all the EmOC process indicators in Khulna division. However, most of the process indicators are still far from the minimum recommended UN standards.

RECOMMENDATIONS

Efforts should continue to keep the EmOC facilities functional 24/7 while increasing the number of basic EmOC facilities, and improving utilization of services to reach the minimum UN standards. Community mobilization should be directed to understand the danger signs and utilization of services at functional facilities when necessary. Further research to identify the factors influencing utilization of EmOC services and continuous monitoring and periodical assessment of the process indicators are recommended to evaluate the overall situation from time to time.