Prevalence and antimicrobial susceptibility pattern of ESBL producing isolates

Extended spectrum β-lactamases (ESBLs) are produced by Gram negative bacteria showing resistance to new generations of antimicrobial agents. This study was undertaken to characterize ESBL producing bacteria from 222 urinary isolates. Antimicrobial resistance was screened by disc diffusion test. The ESBL status was confirmed by double disc diffusion test (DDDT) and minimum inhibitory concentration (MIC) by agar dilution method by standard procedure. The study revealed the following distribution of ESBL producing isolates: Klebsiella spp (81.6%), Proteus spp (78.1%) E. coli (72.3%) and Pseudomonas spp (66.7%). All the isolates were sensitive to imipenem and nitrofurantoin followed by amikacin 92.9%. A relatively higher rate of resistance to gentamicin, co-trimoxazole, azithromycin and quinolones were also observed for ESBL producers. The study suggested routine detection of ESBL and avoidance of irrational use of third generation cephalosporins to reduce the emergence of multidrug resistance bacteria following an antibiotic policy.

Speed limit of the insulator-metal transition in magnetite

As the oldest known magnetic material, magnetite (Fe3O4) has fascinated mankind for millennia. As the first oxide in which a relationship between electrical conductivity and fluctuating/localized electronic order was shown, magnetite represents a model system for understanding correlated oxides in general. Nevertheless, the exact mechanism of the insulator-metal, or Verwey, transition has long remained inaccessible. Recently, three-Fe-site lattice distortions called trimerons were identified as the characteristic building blocks of the low-temperature insulating electronically ordered phase. Here we investigate the Verwey transition with pump-probe X-ray diffraction and optical reflectivity techniques, and show how trimerons become mobile across the insulator-metal transition. We find this to be a two-step process. After an initial 300 fs destruction of individual trimerons, phase separation occurs on a 1.5±0.2 ps timescale to yield residual insulating and metallic regions. This work establishes the speed limit for switching in future oxide electronics.

Improving and sustaining quality of child health care through IMCI training and supervision: experience from rural Bangladesh

BACKGROUND

The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities.

OBJECTIVES

To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision.

METHODS

Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities.

FINDINGS

Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities.

CONCLUSION

IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular supervision and task shifting the management of sick under-five children to lower-level service providers.

Physico-Chemical Characterization Of Silt Prepared From Bijoypur Soil

Silt obtained from fractionated Bijoypur soil based on particle size (53~140?m) was characterized by SEM (Scanning electron microscopy), LIBS (Laser induced breakdown spectroscopy), XRD (X-Ray diffraction) and FT-IR (Fourier transform infra-red spectroscopy). pHzpc (Zero point charge pH) of silt was also determined by titrimetric method. The scanning electron micrograph of silt was taken in two different magnifications. Micrographs show that the surface of silt is slightly homogenic in nature and the particle size varied between 50 and 100 ?m. Elemental analysis of silt was performed by LIBS. According to this Fe, Si, Ti, Cu, Zn and Na are present in silt. XRD analysis indicates that silt fraction of Bijoypur soil is closely similar to kaolinite but it contains significant proportion of quartz. FT-IR analysis shows the presence of Zn=O, OH, Al-O-Si, Fe-O, Al-OH and Si-O bonds. The pHzpc value of silt was obtained as 6.39 ± 0.02 indicating neutrality of the surface. J. Asiat. Soc. Bangladesh, Sci. 39(1): 53-60, June 2013 DOI: http://dx.doi.org/10.3329/jasbs.v39i1.16033

Correlation between Intracerebral Hemorrhage Score and surgical outcome of spontaneous intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) comprises 10-15% of all strokes and has a higher risk of morbidity and mortality (40-45%). A simple and widely valid clinical grading scale, the Intracerebral Hemorrhage Score (ICH score) was developed to predict to outcome of spontaneous ICH. The aim of the present study was to assess the relation between the ICH score and the surgical outcome of ICH by Glasgow Outcome Scale (GOS) at the 30th post ictus day in our perspective. This prospective study was done during the period of April 2009 to October 2010 in Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Forty three cases were enrolled by set inclusion and exclusion criteria. Intracerebral Hemorrhage Score was calculated during admission and the surgical outcome of ICH was determined by GOS by face to face or telephone interview using structured questionnaire on their 30th post ictus day. Correlation between the ICH score and the surgical outcome of ICH was done by Pearson’s correlation coefficient test. Value of r was found to be -0.635 which was statistically highly significant (p=.001) and the relation was found to be negative. Higher ICH score had unfavorable outcome. As correlation between the ICH score and the surgical outcome of ICH was found statistically highly significant, it can be used widely as a grading scale in preoperative counseling. The use of ICH score could improve standardization of clinical treatment protocols and clinical research studies in ICH. Bangladesh Med Res Counc Bull 2013; 39: 1-5

Evaluation of Antifungal Efficacy in an Optimized Animal Model ofTrichophytonmentagrophytes-Dermatophytosis

Dermatophytoses are known to cause considerable discomfort, cosmetic problems and financial loss that have been recognized as a significant health concern worldwide. Since currently available antifungal agents have limitations in their efficacy, new agents are being developed. This study was undertaken to optimize an in vivo model of experimental dermatophytosis for evaluation of the efficacy of antifungal compounds. Guinea pigs were infected with different inocula of T. mentagrophytes to establish dermatophytosis. The optimal conditions for dermatophytosis in guinea pigs were found to be an inoculum size of 1 x 10(7) fungal cells applied on abraded skin. After optimization, animals were treated with oral or topical formulations of terbinafine. The optimized guinea pig model was found to be highly reproducible, and useful in the primary screening and evaluation of the anti-dermatophytic efficacy of topical and oral formulations of antifungal agents.

Peak expiratory flow rate of normal school going children in Mymensingh municipality

This cross sectional study was conducted to measure the PEFR values of normal school going children of Mymensingh, Bangladesh. Peak expiatory flow rate (PEFR) is a lung function test which is easily measurable and reproducible but the base line values of PEFR have not been studied in large scale among Bangladeshi children. In Mymensingh municipality out of 79 schools 4 schools were selected purposively. A total of 984 (499 boys and 485 girls, nearly equal in ratio) normal children (6-15 years), were selected randomly by using lottery technic in classroom. To obtain peak expiratory flow rate (PEFR) mini Wright peak flow meter was used. The highest of three readings was taken as the correct value. Anthropometric parameters including body weight and height were recorded by bathroom scale and stadiometer respectively and body surface area was calculated. According to age interval (10 months) in boys and girls the mean difference of PEFR values showed that among age categories of 6, 7 & 8 years had no significant (p were <0.18, <0.73 and <0.70 accordingly) and all other age categories the mean difference of PEFR between boys and girls had significant (p<0.01). The correlation coefficient (r values) and the level of significance between different anthropometric parameters and PEFR in case of boys and girls were significant (p<0.001). Correlation of height (boys r=0.961 & girls r=0.954) with PEFR was the highest in comparison to other anthropometric parameters (age, sex and body weight). Boys had significantly higher values of PEFR than the girls at any height.

Detection of TEM, SHV and CTX-M in Mymensingh region in Bangladesh

The development of antibiotic resistance in bacteria following introduction of antimicrobial agents has emerged as an important medical problem everywhere in the world including Bangladesh. Extended spectrum β-lactamases (ESBLs) are rapidly evolving group of β-lactamase enzymes produced by the Gram negative bacteria. This study was undertaken to characterize ESBL producing gram negative bacilli from urine, skin wound (pus and wound infection). A total of 300 gram negative bacilli were screened for resistance to third generation Cephalosporins (3GCs) by disc diffusion test. The ESBL status was confirmed by double disc diffusion test (DDDT), minimum inhibitory concentration (MIC) by agar dilution method as recommended by Clinical Laboratory Standard Institute 2010 (CLSI) and multiplex PCR for TEM, SHV and CTX-M, CTX-M-3, CTX-M-14 genes. The present study revealed a higher occurrence of multi drugs resistant ESBLs production among gram negative isolates where Klebsiella spp. were the leading bacteria 36/45 (80%), followed by Proteus spp. 40/55 (72.7%), Esch. coli 105/156 (67.3%) and others 25/35 (71.4 %). Rate of TEM, SHV and CTX-M genes present in study population were 50.46%, 18.69% and 46.72% respectively. Among the CTX-M positive genes CTX-M-3 and CTX-M-14 were 78.0% (39/50) and 80.0% (40/50) respectively. Results indicate that routine ESBL detection should be made mandatory and irrational use of third generation cephalosporins must be discouraged to reduce multi drugs resistance bacteria, to increase patients' compliance and to make an antibiotic policy.

Two guard cell-preferential MAPKs, MPK9 and MPK12, regulate YEL signalling in Arabidopsis guard cells

We report that two mitogen-activated protein kinases (MAPKs), MPK9 and MPK12, positively regulate abscisic acid (ABA)-induced stomatal closure in Arabidopsis thaliana. Yeast elicitor (YEL) induced stomatal closure accompanied by intracellular reactive oxygen species (ROS) accumulation and cytosolic free calcium concentration ([Ca(2+) ]cyt ) oscillation. In this study, we examined whether these two MAP kinases are involved in YEL-induced stomatal closure using MAPKK inhibitors, PD98059 and U0126, and MAPK mutants, mpk9, mpk12 and mpk9 mpk12. Both PD98059 and U0126 inhibited YEL-induced stomatal closure. YEL induced stomatal closure in the mpk9 and mpk12 mutants but not in the mpk9 mpk12 mutant, suggesting that a MAPK cascade involving MPK9 and MPK12 functions in guard cell YEL signalling. However, YEL induced extracellular ROS production, intracellular ROS accumulation and cytosolic alkalisation in the mpk9, mpk12 and mpk9 mpk12 mutants. YEL induced [Ca(2+) ]cyt oscillations in both wild type and mpk9 mpk12 mutant. These results suggest that MPK9 and MPK12 function redundantly downstream of extracellular ROS production, intracellular ROS accumulation, cytosolic alkalisation and [Ca(2+) ]cyt oscillation in YEL-induced stomatal closure in Arabidopsis guard cells and are shared with ABA signalling.

Heavy Metals and Major Ionic Pollution Assessment in Waters of Midstream of the River Karatoa in Bangladesh

In a quantitative assessment of water collected from the midstream of Karatoa river in Bangladesh, 31 water samples were analyzed to assess heavy metals, major ionic constituents and suitability parameters for irrigation usage. The electrical conductivity of all collected samples were within the range of 450 to 1653 ?S cm-1 indicating medium to high salinity. Total dissolved solids ranged from 247 to 789 mg L-1 and the samples were rated as fresh water (<1000 mg L-1). The anion chemistry in the Karatoa river water was dominated by HCO3- and Cl-, which contributed 66 and 31%, respectively of the total anionic mass balance. On the other hand, the cation chemistry indicated that 8 samples showed dominance sequence as Ca > Mg > Na > K, 8 samples as Ca > K > Na > Mg, 7 samples as Ca > Mg > K > Na, 6 samples as Ca > Na > K > Mg and only 2 samples as Ca > K > Mg > Na. Among the studied heavy metals (Fe, Mn, Cu, Zn, Pb, Cr and Ni), the most dominant metal was Fe and Mn. The concentration of Mn in 13 water samples exceeded the surface water quality standard (0.10 mg L-1) indicating Mn toxicity. Considering hardness, 6 water samples were graded as moderately hard while the rest 25 samples were graded as hard. As regards to permeability index, 65% of the water samples collected from the midstream of Karatoa river belongs to the unsuitable category.DOI: http://dx.doi.org/10.3329/jesnr.v5i2.14806 J. Environ. Sci. & Natural Resources, 5(2): 149-160 2012

Serotype and serovar distribution of Neisseria gonorrhoeae isolated from high-risk populations in Bangladesh

Neisseria gonorrhoeae, the causative agent of gonococcal infection, is known to frequently change their characteristics to evade host immune mechanism. Characterization of the clinical isolates of the organism can lead to identification of the circulating strains and often a sexual network in a community to help in designing the control strategy. Keeping in mind the above consideration, a total of 239 N. gonorrhoeae, isolated from high-risk populations, were characterized for serotypes and serovars by monoclonal antibodies against protein 1 of the organism. Majority of the serotypes were serotype B (142, 59.4%). Majority of the isolates showing resistance to at least one of the antibiotics tested were also serotype B (139, 59.2%), whereas, majority of the isolates showing resistance to any three of the antibiotics (multidrug resistant, MDR) (63%) was serotype A. A total of 41 different serovars were also identified and five of which (Arst, Bropt, Bopt, Arost, and Brop) included the highest percent (49.3%) of the isolates. Many serovars (23/41, 56.1%) were new emergent and included 58 (24.3%) of the isolates investigated. All of the new serovars were resistant to at least one of the antibiotics tested and the highest rate (40/102, 39.2%) was MDR. Serotyping and serovar determination was found contributory to understand the microepidemics of the N. gonorrhoeae isolates. Further studies including antibiogram and contact tracing can efficiently help in control of the disease.

Methicillin-resistant coagulase-negative staphylococci (MRCoNS) by disk diffusion method

The antimicrobial susceptibility of 80 coagulase-negative staphylococci (CoNS) isolates from surgical wound, pus from infected skin lesions, burn exudates and diabetic ulcer exudates of patients in Mymensingh Medical College Hospital, Bangladesh, was evaluated in order to see their pattern of antimicrobial resistance. The study was carried out in the department of Microbiology, Mymensingh Medical College during the period from July 2009 to May 2011. The 80 CoNS isolates were subjected to antimicrobial susceptibility to relevant antibiotics including oxacillin by disk diffusion method. Out of 80 CoNS isolates, the highest number were resistant to oxacillin 36(45%), followed by gentamicin 32(40%), cefuroxime 25(31%), ceftriaxone 24(30%) and ciprofloxacin 18(22%). All isolates of CoNS were sensitive to imipenem and vancomycin. As MRCoNS were found multidrug resistant, therefore, antibiotic sensitivity must be done prior to treatment in infections caused by these species.

Iron status in children with febrile seizure

This hospital based cross sectional analytic study was carried out in department of Pediatrics Dhaka Medical College Hospital and Combined Military Hospital from July 2009 to June 2010 to find out the relationship of iron status with febrile seizure in children. Sixty children aged 6 months to 5 years having febrile seizure were enrolled as cases after taking proper consent by purposive sampling. Sixty age matched children with fever but no seizures were taken as control after taking proper consent. Children having a febrile seizure, developmental delay, hemorrhagic disorder, severe malnutrition or micronutrient deficiency and abnormal CSF findings were excluded from the study. In cases after control of seizure 2 ml of CSF was taken for cytology, biochemistry, Gram & AFB staining. Two milliliter of blood from cases as well as control was collected, released to EDTA bottle for Hb, MCV and MCHC. Again 2 ml of blood was taken in plain test tube for testing serum iron, TIBC and for serum ferritin. Serum iron, TIBC, serum ferritin was estimated by automated analyzer (PENTRA for serum iron, DADE BEHRING for TIBC, IMMULITE 1000 for serum ferritin). There was no significant difference between two groups regarding age (p>0.05), sex (p>0.05). High fever (p<0.001) and continuous fever (p<0.001) was significantly associated with febrile seizure. Seizure was generalized in all with positive family history in 83.3% cases. The Mean±SD of blood Hb (Case 9.8±1.6; Control 10.7±0.9), MCH (Case 22.1±2.3; Control 24.3±3.6) & serum ferritin (Case 55.1±29.3; Control 99.6±81.9) level were significantly low associated with febrile seizure (p<0.05). No significant difference was found between cases and control regarding MCV, serum iron and serum TIBC.

Nutritional status among primary school children of Mymensingh

The school age is a dynamic period of growth and development. During this period physical, mental, social development of child takes place. The purpose of the study is to observe the nutritional status among the school aged children and to compare the urban and rural children. It is a descriptive cross sectional study. Data were collected from 600 children of primary school in Mymensingh district for a period of one year from October 2009 to September 2010. Among the primary school children in Mymensingh, Bangladesh 15.1% were wasted, 22.1% were stunted, 2.3% were both stunted and wasted and 60.4% children were within normal limit. Malnutrition was more in rural area in comparison with urban area. In rural area severely underweight, moderately underweight children were 62.1%, 65.6%, and corresponding result in urban area were 37.9%, 34.4% respectively. In rural area severely stunted, moderately stunted children were 100%, 58.6%, and in urban area they were 0%, 41.4% respectively. Again severely wasted and moderately wasted, children were 62.5%, 59.5% in rural area and 37.5%, 40.5% in urban area respectively. Malnutrition among girls were more then the boys.

Bioequivalence study of FlunacTM and DiflucanTM in healthy Bangladeshi male volunteers

A bioequivalence study of a local antifungal drug, fluconazole (FlunacTM), was compared with that of innovator product DiflucanTM. The study was conducted on 15 healthy volunteers and single cross-over dose of 150 mg fluconazole was administered orally. Two milliliter of blood was collected at different time intervals for 96 hours. The drug was extracted by liquid-liquid extraction and estimated by high performance liquid chromatography with diode array detector (260 nm). The chromatographic separation was accomplished using C18 analytical column with a mobile phase consisting of water and acetonitril (80:20, v/v). The Cmax of DiflucanTM and FlunacTM was 2.48 ± 0.29 g/mL and 2.23 ± 0.29 g/mL respectively. The Tmax of DiflucanTM and FlunacTM was 2.18 ± 0.98 hours and 2.56 ± 0.81 hours respectively. The area under the curve (0 to 96 hours) of DiflucanTM and FlunacTM was 73.28 ± 13.80 hours/mL and 74.49 ± 16.03 hours/mL. The half-life of both the drugs was 44.59 ± 13.79 hours for DiflucanTM and 42.73 ± 11.71 hour for FlunacTM. This study shows that FlunacTM is comparable to DiflucanTM in pharmacokinetic aspect.DOI: http://dx.doi.org/10.3329/kyamcj.v2i2.13255KYAMC Journal Vol.2(2) January 2012, 159-163

Post-transfusion increment of platelet count in thrombocytopenic patients treated with platelet concentrates

The Platelet (PLT) Transfusion Therapy plays an important role in the support of surgical, haematological, oncological and transplant patients. The present study was assigned to find out the post transfusion increment of platelet count among the thrombocytopenic patients in Bangladeshi population. This descriptive study was conducted at the Departments of Haematology and Transfusion Medicine, BSMMU, Dhaka. Total 42 thrmbocytopenic patients were randomly assigned to receive a transfusion when their platelet counts below 10000 per cubic millimeter or with active bleeding. Pre transfusion and post transfusion platelet count were measured in all patients. Out of 42 patients, 26(61.90%) were male and 16(38.10%) were female. Leukemia was the most common cause of thrombocytopenia (47.62%). Most of the patients (71.34%) required transfusion of multiple units of platelet and 12(28.57%) patients required double units. Before transfusion of platelet concentrate <30×10⁸/L, 30-80×10⁸/L and >80×10⁸/L platelet count were found in 30(71.43%), 08(19.05%) and 04(09.52%) patients respectively. After transfusion of platelet concentrate <50×10⁸/L, 50-100×10⁸/L and >100×10⁸/L platelet count were found in 30(71.43%), 08(19.05%) and 04(09.52%) patients respectively. In all patients post transfusion platelet count increases but 2 or multiple units of transfusion were needed.

A hybrid cellular automaton model of solid tumor growth and bioreductive drug transport

Bioreductive drugs are a class of hypoxia selective drugs that are designed to eradicate the hypoxic fraction of solid tumors. Their activity depends upon a number of biological and pharmacological factors and we used a mathematical modeling approach to explore the dynamics of tumor growth, infusion, and penetration of the bioreductive drug Tirapazamine (TPZ). An in-silico model is implemented to calculate the tumor mass considering oxygen and glucose as key microenvironmental parameters. The next stage of the model integrated extra cellular matrix (ECM), cell-cell adhesion, and cell movement parameters as growth constraints. The tumor microenvironments strongly influenced tumor morphology and growth rates. Once the growth model was established, a hybrid model was developed to study drug dynamics inside the hypoxic regions of tumors. The model used 10, 50 and 100 \mu {\rm M} as TPZ initial concentrations and determined TPZ pharmacokinetic (PK) (transport) and pharmacodynamics (cytotoxicity) properties inside hypoxic regions of solid tumor. The model results showed that diminished drug transport is a reason for TPZ failure and recommend the optimization of the drug transport properties in the emerging TPZ generations. The modeling approach used in this study is novel and can be a step to explore the behavioral dynamics of TPZ.

Comparative study of immunochromatographic assay (IgM) and widal test for early diagnosis of typhoid fever

Typhoid fever is a severe systemic infection endemic in many developing countries, including Bangladesh. Present study evaluated immunochromatographic test (ICT) and Widal test in the early diagnosis of typhoid fever cases. The study was carried out in the department of Microbiology, Mymensingh Medical College, Mymensingh between July, 2010 and June, 2011, including 200 individuals of different age and sex. Of them, 150 were clinically suspected cases of typhoid fever and 50 age-sex matched controls. Among 150 blood samples from the suspected cases 106(70.7%) were positive for IgM of Salmonella typhi by ICT and 67(44.7%) were positive by Widal test. Whereas, among the 50 controls 4(8%) were positive by ICT and 6(12%) were positive by Widal test. The sensitivity, specificity, positive and negative predictive value of the ICT was found as 83.3%, 92.00%, 91.9% and 83.6% respectively. On the other hand corresponding values for Widal test were of 44.4%, 88%, 80% and 59.5% respectively. Thus, The ICT (IgM) is better alternative to Widal test for early and accurate diagnosis of typhoid fever. The ICT (IgM) is rapid, easy to perform, applicable for field use and highly sensitive and specific for detection of antibodies in patients with typhoid fever.

Adsorption and desorption of copper(II) ions onto garden grass

The garden grass (GG) was firstly used to remove copper(II) from water as bioadsorbent. From the results of characterisation, the GG had the merits of high specific surface area, significant adsorption sites and functional groups. Copper-adsorption significantly depends on the initial copper concentrations, contact time, pH, adsorbent doses, particle sizes and temperature. The positive values of ΔG° indicates that the adsorption of copper onto garden grass is non-spontaneous and values lies within the ranges of 4.452-13.660 kJ/mol for supporting physical adsorption. 0.1N H(2)SO(4) was found as suitable eluent, which could be used 5 cycles of adsorption-desorption. The data from adsorption and desorption equilibrium were well fitted by the Langmuir, SIPS and Redlich-Peterson isotherm models. The maximum adsorption and desorption capacities were 58.34 and 319.03 mg/g, respectively, for 1g dose. Adsorption and desorption kinetics could be described by the Pseudo-first-order model.

Enteropathogens associated with acute diarrhea in a tertiary hospital of Bangladesh

Acute diarrheal diseases are great concern throughout the world, as they are responsible for considerable morbidity and mortality, especially in developing countries. The present study was carried out during the period from January' 2011 to December' 2011 in the Department of Microbiology, Mymensingh Medical College. A total of 300 stool specimens were examined by standard laboratory methods for identification of enteropathogens. Rotavirus was detected by Polyacrylamide Gel electrophoresis (PAGE). Different diarrheagenic E. coli (DEC) were detected by Multiplex PCR following standard methods. Of the 300 stool specimens examined, Enteropathpgens were detected in 160(53.5%) cases. Rota virus was detected in 82(27.5%) cases, followed by DEC in 54(18%), Shigella spp. in 8(2.4%), Salmonella spp. in 5(1.6%), Entameoba histolytica in 4(1.5%) and Giardia lamblia in 3(1.0%) cases. Among the DEC, the Enterotoxigenic E. coli (ETEC) was most prevalent (72%, 39/54). The present study revealed a high prevalence of rotavirus and DEC as the predominant causes of diarrhea in this region.

Comparative Study on Cryosurgery with Carbamazepine and Alcohol injection in Trigeminal Neuralgia

Objectives: To assess the efficacy of Cryosurgery for the treatment of Trigeminal neuralgia and to compare this procedure with Carbamazepine and alcohol block. Materials and method-A prospective study with 75       cases of Trigeminal neuralgia was carried out in the Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University from January 2006 to December 2007. Out of 75 cases 25 treated with Carbamazepine only, starting dose 100 mg b.d. with incremental dose up to 800 mg, 25 received alcohol block with maintenance dose of Carbamazepine 200 mg b.d. over the study period and 25 received       Cryosurgery with initial maintenance dose of Carbamazepine 100 mg b.d. then tappered on 1st follow up visits and withdrawn on the 2nd follow up visits. Visual linear analogue scale (VAS) was used to measure pain intensity in different groups. Results: Out of different treatment modalities on follow up onwards pain control was better in Cryosurgery than Carbamazepine and alcohol block. Conclusion: This study reveals that the efficacy of Cryosurgery is better than Carbamazepine and alcohol block to eliminate the pain intensity in Trigeminal neuralgia.   DOI: http://dx.doi.org/10.3329/bjms.v11i3.11721   Bangladesh Journal of Medical Science Vol. 11 No. 03 July’12    

Avascular tumour growth dynamics and the constraints of protein binding for drug transportation

The potential for the use of in-silico models of disease in progression monitoring is becoming increasingly recognised, as well as its contribution to the development of complete curative processes. In this paper we report the development of a hybrid cellular automaton model to mimic the growth of avascular tumours, including the infusion of a bioreductive drug to study the effects of protein binding on drug transportation. The growth model is operated within an extracellular tumour microenvironment. An artificial Neural Network based scheme was implemented that modelled the behaviours of each cell (proliferation, quiescence, apoptosis and/or movement) based on the complex heterogeneous microenvironment; consisting of oxygen, glucose, hydrogen ions, inhibitory factors and growth factors. To validate the growth model results, we conducted experiments with multicellular tumour spheroids. These results showed good agreement with the predicted growth dynamics. The outcome of the avascular tumour growth model suggested that tumour microenvironments have a strong impact on cell behaviour. To address the problem of cellular proteins acting as resistive factors preventing efficient drug penetration, a bioreactive drug (tirapazamine) was added to the system. This allowed us to study the drug penetration through multicellular layers of tissue after its binding to cellular proteins. The results of the in vitro model suggested that the proteins reduce the toxicity of the drug, reducing its efficacy for the most severely hypoxic fractions furthest from a functional blood vessel. Finally this research provides a unique comparison of in vitro tumour growth with an intelligent in silico model to measure bioreductive drug availability inside tumour tissue through a set of experiments.

Congenital hypertrichosis (Were Wolf Syndrome): a case report

Hypertrichosis is abnormal increase in body hair, when it becomes extensive known as Were Wolf Syndrome. Any part of body can be affected and body hairs are longer and darker. Hairs may be of any type like lanugo, vellous or terminal. It may be present since birth or may occur later in life. A 8 years old boy was admitted in our hospital with excess body hair, he was diagnosed as a case of Were Wolf syndrome after excluding possible acquired causes of hypertrichosis. He had history of delayed developmental milestone and has been suffering from epilepsy. He was treated with developmental stimulation and anti epileptic drug. Then he was discharged after proper counseling.

Beta thalassemia in a tertiary care hospital with their chelation habit

Beta-thalassemia which is one of the most common genetic disorders in Bangladesh encompasses a group of monogemic diseases that have reduced synthesis or no synthesis of one or more globin chain of haemoglobin. The defects involved are extremely heterogenous and give rise to a large phenotypic spectrum with patients that are almost asymptomatic to cases in which regular blood transfusions are required to sustain life. The aim of the study is to estimate the frequency of beta thalassemia among the blood recipients in the Day Care Centre of Transfusion Medicine Department of Mymensingh Medical College Hospital from July, 2009 to June, 2010 along with their chelation habit. Retrospective cross-sectional study with the sample size of 784, clinical and family data was collected and descriptive statistics were done in the Laboratory of Transfusion Medicine Department. Among the 784 subjects, the beta thalassemia was 521 (66.46%), among the thalassemic patients only 59(11.32%) take injection Dysferrioxamine (Dysferol), the iron chelating agent. Male are predominant than female (63.53%). Those of the affected patients 67.18% were in age group 6 to 20 years. Although beta thalassemia is one of the first monogemic diseases and represents a global health problem, only recently has the scientific community started to focus on the real molecular mechanisms that underline this disease, opening new & exciting therapeutic perspectives for thalassemic patients worldwide. It is concluded from our study that availability of blood transfusion facilities along with an orally and cheaper iron chelator is an urgent need to ensure the management of needy thalassemic patients in Bangladesh.

Evaluation of PCR with culture for the diagnosis of pulmonary tuberculosis

Tuberculosis (TB) is a major public health problem in most developing countries. The present study was carried out among 100 clinically suspected pulmonary TB patients. One hundred sputum specimens were collected one from each of the suspects attending DOT'S corner of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The aim of the study was to evaluate the sensitivity and specificity of a polymerase chain reaction (PCR) based method detecting IS6110 sequence present in all Mycobacterium tuberculosis strains using sputum samples in comparison to culture on Lowenstein-Jensen mediums. The PCR was done using primers mtb1 & mtb2 which commonly target an insertion sequence of the organism (IS6110). Out of 100 samples, 18 (18%) showed PCR positive, whereas culture in Lowenstein-Jensen media were positive in 19(19%). In PCR 1 was false negative but none was false positive. In present study, sensitivity and specificity of PCR found 94.74% and 100% respectively. Analyzing the findings of the present study, it can be concluded that the PCR technique is a rapid and alternative method of culture on Lowenstein-Jensen medium for the diagnosis of pulmonary tuberculosis. In the present study, only presence or absence of M. tuberculosis was determined.

Multiplex polymerase chain reaction for rapid identification of diarrheagenic Escherichia coli

Despite the fact that diarrhaegenic Escherichia coli (DEC) has been identified as a major etiologic agent of childhood diarrhea which represent a major public health problem in developing countries, only a few studies have been performed in Bangladesh to identify these organisms. To detect DEC in patients with acute diarrhea, a total of 300 stool specimens were tested by multiplex polymerase chain reaction (PCR). The multiplex PCR was designed for the detection of target genes of "eae" for enteropathogenic E. coli (EPEC), "stx" for enterohemorrhagic E. coli (EHEC), "ipaH" for enteroinvasive E. coli (EIEC), "aspU", "CVD432" and "aggR" for enteroaggregative E. coli (EAEC) as well as "elt" and "est" for enterotoxigenic E. coli (ETEC). Out of 300 stool specimens collected from patients with acute diarrhea, the DEC was detected in 18% (54/300) cases. The dominating strain was ETEC (13%, 39/300), followed by EAEC (5%, 15/300) and no EHEC, EIEC and EPEC could be detected. Both heat-stable toxin (ST) and heat-labile toxin (LT) genes of ETEC were detected in 66.68% (26/39) strains and only ST or LT as single gene was detected in 23.07% (9/39) or 10.25% (4/39) strains respectively. The multiplex PCR assay could be used as a rapid as well as efficient diagnostic tool for identification of DEC in the clinical laboratory settings.

Imaging the first-order magnetic transition in La0.35Pr0.275Ca0.375MnO3

The nature of the ferromagnetic, charge, orbital, and antiferromagnetic order in La0.35Pr0.275Ca0.375MnO3 on the nano- and microscale was investigated by photoemission electron microscopy (PEEM) and resonant elastic soft x-ray scattering (RSXS). The structure of the ferromagnetic domains around the Curie temperature T(C) indicates that they nucleate under a high degree of lattice strain, which is brought about by the charge, orbital, and antiferromagnetic order. The combined temperature-dependent PEEM and RSXS measurements suggest that the lattice distortions associated with charge and orbital order are glassy in nature and that phase separation is driven by the interplay between it and the more itinerant charge carriers associated with ferromagnetic metallic order, even well below T(C).

Palm oil fruit shells as biosorbent for copper removal from water and wastewater: experiments and sorption models

Palm oil fruit shells were evaluated as a new bioadsorbent to eliminate toxic copper from water and wastewater. Without any chemical treatment, palm oil fruit shells were washed, dried and grounded into powder (<75 μm) for use in the experiments. Characterization showed mesopore based bioadsorbent was prepared from palm oil fruit shells. The results indicate that the highest Cu removal efficiency was found in an aqueous solution with pH of 6.5. The equilibrium sorption capacity of copper was significantly high (between 28 and 60 mg/g) at room temperature. Nonlinear regression analyses for isotherm models revealed that three-parameter isotherms had a better fit to the experimental data (R(2)>0.994) than that of two-parameter isotherms. The copper sorption system was heterogeneous as the values of exponents were lying between 0 and 1. The highly correlated pseudo-second-order kinetics model (R(2)>0.998) ascertained the applicability of copper removal by palm oil fruit shells.

Chikungunya virus infection, a threat to public health

Many countries in the world have reported human infections by chikungunya virus (CHIKV) a mosquito-borne togavirus belonging to the genus alpha virus. After half a century of focal out breaks of acute febrile poly arthralgia, the disease had spread unexpectedly in the past decade with large outbreaks in Africa around the Indian Ocean and in Bangladesh. In Asia, CHIKV is thought to be transmitted by the same mosquito as dengue, Aedes aegypti and Aedes albopictus. Due to similarities in clinical presentation with dengue, limited awareness and a lack of laboratory diagnostic facilities, CHIKV is probably often under diagnosed or misdiagnosed as dengue. Treatment is supportive. The prognosis is generally good although some patients experience chronic arthritis. There is no vaccine or antiviral therapy against CHIKV. Early identification of disease and control of vector will prevent the spread of disease.

Comparison between ICT and PCR for diagnosis of Chlamydia trachomatis

Chlamydia trachomatis is an obligate intracellular gram-negative bacterium which is the most prevalent cause of bacterial sexually transmitted infections (STI). The present study was carried to diagnose genital Chlamydia trachomatis infection among women of reproductive age, attending Mymensingh Medical College Hospital, during July 2009 to June 2010 by Immunochromatographic test (ICT) and Polymerase chain reaction (PCR). A total of 70 females were included in this study. Out of 70 cases 56 were symptomatic and 14 asymptomatic. Endocervical swabs were collected from each of the cases and examined by Immunochromatographic test (ICT) for antigen detection and Polymerase chain reaction (PCR) for detection of endogenous plasmid-based nucleic acid. A total 29(41.4%) of the cases were found positive for C. trachomatis either by ICT or PCR. Of the 56 symptomatic cases, 19(33.9%) were found ICT positive and 17(30.4%) were PCR positive. Among 14 asymptomatic females, 2(14.3%) were ICT positive and none were PCR positive. Though PCR is highly sensitive but a total of twelve cases were found ICT positive but PCR negative. It may be due to presence of plasmid deficient strain of C trachomatis which could be amplified by ompA based (Chromosomal gene) multiplex PCR.

Postnatal development of renal function in preterm and term neonates

The study was done to determine the renal function in preterm and term newborn infants in the neonatology unit of the Department of Paediatrics and Labour Ward of the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of February 2002 to February 2003. Sixty physiologically stable newborn infants were enrolled in this study, 40 of those were preterm and 20 were term. The gestational ages of preterm and term babies were 35.6±4.7 and 39.10±1.41 weeks respectively. Mean weight of preterm babies was 1840±410 gm and term babies was 3150±340 gm respectively. Male to female ratio was1.6:1. The concentration of serum creatinine was high during the first week of life in both the term and preterm babies. The concentration decreased in both the groups during the subsequent 3 weeks. Although creatinine values were significantly high in preterm babies than the term babies at first week (p<0.001), the values reach to almost similar at 3rd week of life. A negative correlation was found between serum creatinine and gestational age (r=0.86, p<0.001). Creatinine clearance was found low at birth, the lowest values being observed in the most premature infants (p<0.0001) and was increased in the subsequent 3 weeks of the study period. Creatinine clearance showed a positive correlation to gestational age from the first week onwards (r=0.87, p<0.001). Fifteen percent preterm babies were hyponatraemic and in all term babies serum level of sodium was within normal limit. Fractional excretion of sodium was high in preterm neonate than the term neonate especially in early weeks of life (p<0.001). The value correlated negatively to gestational age (r=0.67, p<0.001). It was evident from the present study that the renal function is significantly lower in preterm neonates than term neonates. The study also indicates that the maturation of renal function occurs earlier in the term babies than the preterm babies.

Non-culture diagnosis of Chlamydia trachomatis genital infection in sexually active women

Infections caused by Chlamydia trachomatis (CT) are one of the most prevalent of all sexually transmitted diseases (STD). This cross sectional study was carried out to diagnose genital CT infection on 108 (59 pregnant and 49 non-pregnant) women attending at Department of Gynaecology and Obstetrics, Mymensingh Medical College Hospital (MMCH) during the period from January 2009 to December 2009. This non- culture technique was based on detection of CT major outer membrane protein (MOMP) by Direct Fluorescence Antibody Test (DFAT) from endocervical swab. Chlamydial inclusion bodies (IB) were looked for using Iodine stain. CT antigens were detected in 45.3% (49/108) cases by DFAT; IBs were detected in 5.5% cases (06/108) by Iodine staining technique. Majority of CT positive cases (65%) were found in the younger age group (15 to 25 years). The CT infection was found 47.2 % (35/74) in symptomatic cases, 41.1% (14/34) in asymptomatic cases and 47.4% in pregnant group, 42.8% in non-pregnant group. Although high incidence of genital chlamydia infection is common both in pregnant, non-pregnant, symptomatic and asymptomatic women in Bangladesh an early and reliable diagnostic method for genital chlamydia infection in Bangladesh should be further explored.

Nested polymerase chain reaction for early diagnosis of typhoid fever

Typhoid fever, caused by Salmonella typhi, is an important cause of morbidity and mortality in many developing countries. A rapid and sensitive method for the detection of S. typhi is essential for early diagnosis. This was a study to prospectively evaluate the sensitivity and specificity of nested polymerase chain reaction (PCR) to identify the S. typhi using flagellin gene related primers. The study was carried out in the department of Microbiology, Mymensingh Medical College, Mymensingh between July, 2010 and June, 2011, including 82 individuals of different age and sex. Of them, 62 were clinically suspected cases of typhoid fever and remaining 20 were apparently healthy controls. Cultures as well as PCR of blood specimens were performed for each of the cases. Among the 62 suspected typhoid fever cases, 8(12.9%) were blood culture positive and 55(88.7%) were PCR positive for S. typhi. All culture positive cases were positive by PCR and among 54 culture negative cases, 47(87%) were positive by PCR. Neither of the healthy controls was positive by PCR or blood culture. The sensitivity, specificity, positive predictive value and negative predictive value of PCR using blood culture as gold standard were 88.7%, 100%, 100% and 74% respectively for typhoid fever. In this study, the PCR appears highly specific, very sensitive and superior to blood culture for the early diagnosis of typhoid fever.

Feeding practices and nutritional status of children under two years of age

A descriptive cross sectional study was done in the department of Pediatrics Mymensingh Medical College Hospital. The purpose of the study was to assess breast feeding pattern, complementary feeding pattern, types of complementary foods and also to assess the nutritional status and to detect any relationship with the nutritional status and the feeding practices. Mothers with their children aged less than 2 years were included and very sick children, mother less children, handicapped children were excluded. Four hundred (400) consecutive children were enrolled from eight upazillas of Mymensingh district who were selected randomly. Out of 400 children, 214 children (53.5%) were male and 186 children (47.5%) were female and M:F was 1.2:1. Exclusive breastfeeding rate was 41.5%. Pre-lacteal feeding rate were 30.7% and most common pre-lacteal foods were honey and sugar water. Colostrum was given in 69.3% children. Breast feeding continued at the time of interview was 58.1%. Complementary feeding started in time in 35.8%, early weaning in 44.5% children. Type of complementary food was mainly luta (rice powder mixed with boiled water and sugar only) in 38.8% and khichuri (rice, pulses, soybean oil) in 19.5%. Bottle feeding rate was 31.30%. Around 43% children were underweight and 10.25% children were severely underweight and common in between 12 to 23 months of age group. Around 29% children were stunted among 11.25% were severely stunted. About 13.5% children were wasted and among them 2.5% were severely wasted. Stunting prevalent over the age of 9 months and wasting started after 6 months of age. Malnutrition was common in partially breast fed and early weaning with carbohydrate rich food.

Osteopetrosis

A 15 years old Bangladeshi boy presented with hepatosplenomegaly, anaemia, multiple fractures (symptomatic and asymptomatic) without jaundice was investigated. Laboratory findings revealed leukoerythroblastic blood picture with reduced haemoglobin (7.7 gm/dl). Skeletal survey showed generalized increased bone density, sclerosed medulary space, Rugger-Jersey spine and diploic space filled with dense materials. Overlapping clinical features of both intermediate autosomal recessive and adult autosomal dominant variety of osteopetrosis were found in this patient but diagnosis were made on the basis of typical radiological finding which was mostly consistent with the adult autosomal dominant variety. The patient was treated conservatively and specialist consultation was taken in managing bony abnormalities. This patient was discharged with advised of subsequent follow-up.

An overview of Brucellosis

Brucellosis is the most important zoonotic disease caused by Brucella species comprising Gram negative, facultative, intracellular pathogens. The true incidence of human brucellosis is unknown for most countries of the world including Bangladesh. But brucellosis is not uncommon in our country. Due to its increasing incidence in many countries of the world it is an important issue now days. Domestic animals such as cattle, goats, sheep, pigs, camel, buffalo and dogs serve as a reservoir hosts. Transmission of brucellosis to humans occurs through the consumption of infected, unpasteurized animal milk and milk products, through direct contact with infected animal parts, through ruptures of skin and mucous membranes and through the inhalation of infected aerosolized particles. 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 regarding this zoonotic disease.

Pathogenic Bacteria, Pesticide Residues and Metal Content in Giant Fresh Water Prawn, Macrobrachium Rosenbergii (De Man) Sold in Local Markets

The giant fresh water prawn, Macrobrachium rosenbergii (de Man), a leading export item of Bangladesh was studied in terms of pathogenic bacteria, pesticide residues and metal contents. In microbiological analysis, total viable bacteria, total coliform, total faecal coliform, total Salmonella and total Vibrio count were ranged from 6.8 × 104 to 1.6 × 106, 1.5 × 102 to 1.8 × 105, 0.0 to 5.0 × 102, 0.0 to 1.8 × 102 and 0.0 to 3.6 × 102 cfu/gm, respectively. Pesticide residue was analyzed by HPLC. Out of six samples studied, one was found to be contaminated with Quinalphos and another with Cypermethrin, where the concentrations were 0.03 and 0.56 ppm, respectively, below the maximum residue limit set by joint FAO/WHO expert committee. Copper (Cu), cadmium (Cd) and lead (Pb) concentrations were measured by atomic absorption spectrophotometer. The range found for Cu and Cd was from 0.01 to 0.11 ppm and 0.01 to 0.06 ppm, respectively, which is below the maximum residue limit set by joint FAO/WHO expert committee (10 ppm for Cu and 0.2 ppm for Cd). Relatively high microbial load and presence of pathogens in all the tested samples, collected from local market revealed that the samples had exposure to an unhealthy environment.DOI: http://dx.doi.org/10.3329/jbas.v35i1.7974Journal of Bangladesh Academy of Sciences, Vol.35, No.1, 91-97, 2011

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).

Molecular diagnosis of genital Chlamydia trachomatis infection by polymerase chain reaction

The present study was carried to diagnose genital Chlamydia trachomatis infection among women of reproductive age, attending Mymensingh Medical College Hospital, during July 2009 to June 2010 by Polymerase chain reaction (PCR). A total of 70 females were investigated including 56 symptomatic and 14 asymptomatic cases. Endocervical swabs were collected and dipped in 500μl Tris buffer. Polymerase chain reaction (PCR) amplification was done for detection of endogenous plasmid-based nucleic acid. A total 17 out of 56 of the symptomatic cases (30.4%) were positive for C. trachomatis and none were found positive among the 14 asymptomatic cases. These findings suggest high prevalence of C. trachomatis infection among this group of population.

Status of liver enzymes in babies with perinatal asphyxia

Because of hypoxemia, different organ systems of the body are affected in perinatal asphyxia. In this study, the functional status of liver of the asphyxiated babies was assessed through estimation of liver enzymes to see any correlation existing between enzyme changes and severity of perinatal asphyxia. A total of 70 full-term asphyxiated newborns (study group) were studied during January'2008 to December'2008 in the department of Paediatrics, Mymensingh Medical College Hospital. After enrollment these babies were grouped according to Sarnat & Sarnat stages of Hypoxic-ischemic encephalopathy (HIE) as stage I, II & III. Babies who are small for gestational age, having severe jaundice, sepsis or congenital anomalies of the hepatobiliary system were excluded from the study. Another 50 healthy newborns were also studied as control group. Venous blood was analyzed between 2nd and 5th day of life to estimate serum AST, ALT & alkaline phosphatase (ALP). Unpaired student's 't' test and Spearman's rank correlation was used for data analysis and P value of <0.05 were considered significant. Mean AST, ALT and ALP of the asphyxiated babies were 76.27±37.44, 82.16±48.08 & 369.59±123.05 U/L and that of normal babies were 23.46±8.45, 26.54±7.76 & 208.20±46.95 U/L respectively and these rise were statistically significant (p<0.001). The levels of transaminases and ALP were positively correlated with the severity of asphyxia and these correlations were also statistically significant (p<0.001). So, this study concludes that AST, ALT & ALP significantly elevated in perinatal asphyxia and this elevation was proportional to the severity of hypoxia.

Iron chelation therapy and thalassemia - an overview

New developments in the epidemiology, treatment and prognosis of thalassemia have dramatically altered the approach to the care of affected patients. In the last 30 years, conventional treatment of β-thalassemia major, based primarily on regular blood transfusions and iron chelation therapy with desferrioxamine (DFO) has markedly improved the prognosis of the disease. Adequate administration of parenteral DFO reduces or prevents iron accumulation. The unavailability of DFO (dysferol) for most patients with thalassemia major and the failure of prescribed therapy to prevent complications in other patients have led to a search for alternative iron chelators; one of them, deferiprone (DFP) has been commercially available. Patients may ultimately benefit from having a choice between several chelators, including orally active drugs. Combination therapy and organ-targeted chelation, may soon have a considerable impact on the therapeutic outcome and quality of life of patients with thalassemia.

Human rabies among the paediatric population in Bangladesh

This cross sectional study in the Infectious Disease Hospital (IDH), Mohakhali, Dhaka on rabies affected paediatric population was carried out to see the patterns of presentation, age group at risk, state of vaccination following animal exposure and the interval between animal exposure and the development of the disease. This one year study included the patients aged less than 15 years with clinically diagnosed rabies referred to the IDH between July 2008 and June 2009. Data was collected from the case sheets of rabies patients given by the relatives and attendants of the victims. A total of 70 cases were included in the study. In the present study most common age group were 5 to 10 years of age with 31(44.3%) patients followed by less than 5 years 23(32.9%) and the rest 16(22.9%) were more than 10 years of age. The male female ratio was 3:1. Among the 70 patients 59(84.3%) were from rural areas and only 11(15.7%) were from urban areas. Sixty six (94.3%) patients presented with bleeding from the site of injury and 4(5.7%) were without bleeding. Among the patients 53(75.7%) presented with bite on the limbs followed by bite on the face 8(11.4%), body 5(7.1%) and head 4(5.7%) cases. Thirty nine of the cases (55.7%) presented with multiple bites and 31(44.3%) had single bite. More than half that is 37(52.9%) patients presented with severe bite, 31(44.3%) had moderate bite and only 2(2.9 %) patients presented with mild bite. Fifty nine (84.3%) patients were unvaccinated whereas 11(15.7%) had history of vaccination after bite. Fifty two (74.3%) gave the history of bite by stray animal, 10(14.3%) by known rabid animal whereas 8(11.4%) had the history of bite by pet animal. Sixty eight patients (97.1%) had the history of bite by dog whereas 2(2.9%) reported cat bite. The mean±SD incubation period 45.38±26.91 days and range was 11-150 days. In the present study it is concluded that the 5-10 years group children were affected most, bites were mostly by stray animal, most of the children did not get post exposure prophylaxis and incubation period was between 11 to 150 days.

Analysis of post operative complications following total thyroidectomy

This prospective study was carried out to find out the incidence and nature of post operative complications following total thyroidectomy in the management of carcinoma thyroid and multinodular goiter and to analyze the factors which are related with the development of complications. Study was done in the Department of ENT & Head-Neck Surgery, Surgery, Bangabandhu Sheikh Mujib Medical University and Department of ENT & Head-Neck Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh from April 2006 to September 2006. Fifty patients (50) were included prospectively for this work. The patients were between 12-63 years of age with a maximum incidence in 4th decade. Female was the predominant sex with a ratio of 4.55:1. Twenty eight patients were suffering from papillary carcinoma. Nine patients were suffering from follicular carcinoma, four patients from medullary carcinoma and nine patients from multinodular goiter. Out of 50 patients, 14(28%) developed complications. The complications were haematoma (4%), recurrent laryngeal nerve palsy (6%), hypoparathyroidism (16%) and wound infection (2%). All of them suffered from temporary complications except one patient, who suffered from persistent hypoparathyroidism. Recurrent laryngeal nerve paralysis in all three cases was unilateral. Complications were relatively more common in male. In carcinoma patients the rate of complications was more than twice than the multinodular goiter cases. Among the carcinoma cases, 7.31% cases developed recurrent laryngeal nerve paralysis and 19.51% cases developed hypoparathyroidism. From this study it is observed that a good number of patients still suffer from complications following total thyroidectomy.

Seroprevalence of genital Chlamydia trachomatis infection in women of reproductive age

The genital chlamydial infection is the most common sexually transmitted diseases (STD) and major cause of infertility and ectopic pregnancy for millions of women in the world particularly in developing countries. This study was performed to find out the seroprevalence of Chlamydia trachomatis (CT) genital infection in women of reproductive age attending the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital (MMCH) during the period from January 2009 to December 2009 through a cross sectional study. A total of 108 serum samples from symptomatic and asymptomatic pregnant and non-pregnant women were tested for CT specific IgG antibody by Enzyme Linked Immunosorbent Assay (ELISA). A total of 31(28.7%) patients were found to have antibody of which 44% (26/59) were from pregnant group and 10.2% (5/49) from non-pregnant group. The seropositivity was 21.6% (16/74) in symptomatic cases and 44.1% (15/34) in asymptomatic cases. The study shows high prevalence of Chlamydial antibody which is common in pregnant and non-pregnant, symptomatic and asymptomatic adult women in Bangladesh. So, screening for chlamydial infection should be done routinely by suitable tests in sexually active symptomatic and asymptomatic women including pregnant women to prevent serious complications.

Drop-out and admission cancel rate among the students in a selected medical college

A record based descriptive type of study was carried out among the under-graduate students of Mymensingh Medical College from the session 1966-67 to 2006-07. The academic years were divided into four decades and admission was followed into three categories such as retained, cancellation and drop-out. Total number of the students was 5892. Among them 3848(65.30%) were male and 2044(34.69%) were female. Out of 5892 students drop-out was 282(4.78%) and admission cancel was 304(5.15%). It was also found that drop-out in male was 232(6.02%) and in female was 50(2.44%) and admission cancel in male was 266(5.87%) and in female was 78(3.81%). The difference was found statistically significant (p<0.001). It was observed that gradually the drop-out and admission cancel rate is decreasing from the very beginning to till now. It was also observed that all drop-out and admission cancellation were in first & second year students. There was no continuation of their class roll numbers in third year registration.

Recurrent synovial chondromatosis of the foot

Synovial chondromatosis rarely occurs in the foot. We have diagnosed such a case in National Institute of Cancer Research and Hospital, Mohakhali, Dhaka. The patient came to us with a swelling in the dorsum of left foot. He had a history of operation but one year later swelling reappeared in the same place. Fine Needle Aspiration Cytology (FNAC) of the swelling revealed few atypical cells and diagnosed as a case of malignant neoplasm. Later on surgical intervention was done in the form of wide excision and final histopathology report came as Synovial chondromatosis. No special treatment was given other than periodical follow up. The patient has been responding well. There was no clinical or radiographic evidence of recurrence.