Comparative efficacy and safety of trimebutine versus mebeverine in the treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a functional disorder characterized by chronic or recurrent abdominal pain or discomfort with bowel disturbances. This prospective, randomized clinical trial has been conducted on IBS patients, using trimebutine and Mebeverine in separate group in parallel design to compare the efficacy and safety of Trimebutine 100mg twice daily with mebeverine 135mg twice daily. Patients of 15 to 60 years old and both sexes were included from the out patient department (OPD) of gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from June 2010 to December 2011. A validated IBS-QOL instrument consisted of 34 questions used to assess improvement of quality of life before and after treatment. A total of 140 patients were enrolled in this study. Eighteen patients dropped out. One hundred twenty two patients completed the trial. In this study at the end of 6 weeks therapy, improvement of symptoms was statistically significant. However, differences of improvement between the two groups in relieving various symptoms were not statistically significant. Mean QOL score before treatment was 103 in Trimebutine group and 106 in Mebeverine group. After 6 weeks of treatment mean QOL score was 82 in Trimebutine group and 95 in Mebeverine group indicating improvement in both groups was statistically significant. The difference between the two groups was also significant. No worsening of symptoms and no side effects of the therapeutic agents was observed in any patient during the trial.

Urinary tuberculosis presented as isolated bladder lesion - a case report

Extra-pulmonary Tuberculosis (EPTB) may affect all organs of the body with varied presentations. Genitourinary tuberculosis (GUTB) carries importance for its morbidity, though it is an uncommon form of TB. A widow of 45 years was admitted with several episodes of painless haematuria and recently developed urinary incontinence. Diagnosis of urinary bladder tuberculosis was made only by histopathology from bladder lesion with supportive evidence of few nonspecific constitutional symptoms and positive family history of pulmonary tuberculosis (PTB) and persistent sterile pyuria. Upper urinary tract involvement was not found. Category 1 anti-TB treatment was started. With this treatment recovery of the patient is satisfactory and symptoms are disappearing except for the incontinence. Urinary tuberculosis should be ruled out in a case of painless haematuria, repeated sterile pyuria.

Outcome of single-stage transanal endorectal pull through for short segment Hirschsprung's disease in neonates and infants

Hirschsprung's disease (HD) is developmental disorder of the enteric nervous system. Diagnosis can be confirmed by rectal biopsy. The surgical management of HD includes so many procedures. The purpose of this study was to evaluate the out come of single-stage transanal endorectal pull-through operation for short segment HD in neonates and infants. This prospective study was carried out in the Department of Pediatric Surgery, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh during the period from January 2004 to December 2009. The study included neonates & infants (age 1 day to 1 year) of both sex, who were clinically suspected and biopsy proven HD with barium enema suggesting rectosigmoid HD. We excluded patients with short segment HD who had associated anomalies, and with hugely dilated proximal colon, operated cases with less than 6 months' follow up. During study period, single-stage transanal endorectal pull through (TEP) operation done in 68 neonates and infants patients (8 excluded) of short segment HD. The mean operative time, postoperative hospital stay, followed up time were 120 minutes, 7.94 days and 12 months respectively. Transeverse colostomy was needed in 4 patients because of anastomotic leakage and they were complicated with anastomotic stenosis, however managed by progressive dilatation. Overall parents' satisfaction was achieved. Single-stage primary transnanl endorectal pull-through for short segment HD is feasible in neonates and infants. It preserves all the advantages of minimally invasive surgery. TEP is a better option in terms of comfort, operative success, postoperative morbidity, cosmetic appearance and parents' satisfaction.

Sustained virological response after treatment in patients with chronic hepatitis C infection--a five year follow up

Peginterferon alpha-2a and ribavirin combination therapy achieves a sustained virological response (SVR) in patients with chronic hepatitis C. Little is know about long-term durability of hepatitis C virus--Ribonucleic acid (HCV-RNA) negativity in patient treated with pegylated interferon and ribavirin therapy. Aim of this study was to evaluate the durability of virologic response in patients with SVR to anti-viral therapy treated at our centre. A total of 52 patients with chronic hepatitis C virus infection who had obtained SVR after Peginterferon alpha-2a and ribavirin combination therapy were followed up to 5 years with annual HCV-RNA testing. During this follow up period, 4 of 52 patients with initial SVR developed late relapse of hepatitis C virus infection. Relapse was more common in patients who has cirrhosis (3/6 [50%]) vs (1/46 [2.17%]) without cirrhosis. In conclusion, SVR is durable in most patients, but some patients do have late relapse; long-term follow up may be particularly important in a subset of patients with hepatitis C virus infection who have liver cirrhosis.

Pesticide Residues In Some Selected Pond Water Samples Of Meherpur Region Of Bangladesh

Water samples collected from some selected ponds of Meherpur region were studied for the presence of organophosphorus and carbamate pesticide residues. High performance liquid chromatography (HPLC) technique was used to determine the concentration levels of those residues. The results obtained indicate slight contamination of some of the water samples with residues of diazinon, chlorpyriphos (organophosphorus insecticide) and carbofuran (carbamate insecticide). The residues level of diazinon and chlorpyriphos ranged from 0.033 to 0.079 ppm and 0.010 to 0.471 ppm respectively. Among carbamate pesticides, carbofuran identified in two samples ranged from 0.0143 to 0.0387 ppm, and carbaryl was not detected in any of the samples. Limit of detection (LOD) was 0.01 ppm. However, the residue level was also within the acceptable ranges according to the WHO guideline value of water quality. But, the presence of such residues is indicative of weak regulatory control which is required to be in place for safety of the environment and to stop further aggravation of the situation. J. Asiat. Soc. Bangladesh, Sci. 39(1): 77-82, June 2013 DOI: http://dx.doi.org/10.3329/jasbs.v39i1.16036

Protective ileostomy in low anterior resection for rectal cancer -- can it be avoided?

The necessity of a protective ileostomy in patients subjected to low anterior resection for rectal cancer has been discussed controversially. This prospective observational study was carried out to see the outcome of low anterior resection without a covering ileostomy. Forty patients underwent low anterior resection for primary rectal carcinoma in mid and distal rectum without any covering ileostomy from January 2007 and June 2010 in the department of Surgery of Bangabandhu Sheikh Mujib Medical University and two other private hospitals in Dhaka city. The primary objective of the study was to demonstrate clinical anastomotic leak rate, reoperation rate and morbidity and mortality related to leak. Thirty two male and eight female patients underwent low anterior resection for primary rectal carcinoma. Median age was 53 years (range 23-67). Majority of the tumors were located within 10cm from anal verge and most of the cases were in Duke's stage B and C. One male patient (overall 2.5%) developed clinical anastomotic leakage, but responded well to conservative treatment. There was no 30 days mortality. Covering ileostomy can be avoided in selected patients with low anterior resection for primary carcinoma in mid and distal rectum.

Thelazia callipaeda infestation in Bangladesh: a case report

A 5 years old girl was admitted to Ophthalmology department of Mymensingh Medical College Hospital, Mymensingh with excessive watering, redness and movement of something in her right eye for last 2 months. She had unaided visual acuity- 6/6, matted eye lashes and mucoid discharge in right eye. Follicles were present on the fornices and lower palpebral conjunctiva of the same eye. On eversion of the right upper lid there were silicon tube like coiled moving structures seen at the lateral part of the upper fornics. Six nematodes were seen in the upper fornics around the duct of lacrimal glands. After removing the nematodes, one specimen was sent to parasitology department of Bangladesh Agriculture University for species identification. They reported that sending specimen is an adult "Thelazia Callipaeda". By the present study, the presence of human ocular T. callipaeda infestation is second reported case in Bangladesh. Ophthalmologists should be aware about parasitic infestation of conjunctiva.

Portopulmonary hypertension

Pulmonary involvement is common in patients with portal hypertension and can manifest in diverse manners. Changes in pulmonary arterial resistance, manifesting either as the hepatopulmonary syndrome or portopulmonary hypertension (POPH), have been increasingly recognized in these patients in recent years. The prognosis in patients with liver disease who also suffer from significant POPH is considered to be poor. Higher degree of pulmonary artery pressure (PAP) may preclude a patient from liver transplant as mortality in these patients is high. This review summarizes the clinicopathologic features, diagnostic criteria, as well as the latest concepts in the pathogenesis and management of POPH, which is defined as is a form of pulmonary arterial hypertension (PAH) associated with portal hypertension with or without underlying chronic liver disease.

Serum calcium level among smear positive pulmonary tuberculosis patients in Bangladesh

This case control study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh in cooperation with the Outpatient Department and Medicine Units of Mymensingh Medical College Hospital, Fulbaria Upazilla Health Complex, Mymensingh and some DOTS centers of BRAC, a non-government organization during the period of July 2006 to June 2007. The aim of the study was to explore the status of serum calcium level in smear positive Bangladeshi pulmonary tuberculosis patients. A total of 120 people of different age groups were included in this study. Subjects were divided into two groups - Group I (Control; n=60) apparently healthy people selected matching by age, sex and socioeconomic status with the cases and Group II (Case; n=60) people with smear positive pulmonary tuberculosis. Serum calcium was estimated by colorimetric principle. Serum calcium was adjusted by serum albumin concentration. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD of adjusted serum calcium in Group II (2.41±0.15mmol/L) was significantly higher (p<0.001) than that in Group I (1.85±0.11mmol/L). It is evident from the study that serum calcium level significantly increases in smear positive Bangladeshi pulmonary tuberculosis patients.

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.

Open Tension Free Mesh Repair of Inguinal Hernias: The Lichtenstein Technique- 26 Our Experience for Last Ten Years

Objective : Recurrences following hernia repair is one of the significant problem for both patient & surgeon. Open tension free mesh techniques of inguinal hernia repair offers good results. Prosthetic materials have been increasingly used in hernia repair to prevent recurrences. Their use has been associated with several advantages, such as less postoperative pain, rapid recovery and low recurrence rates. Materials and method : In this retrospective study, 1050 tension-free inguinal hernia repairs were performed between January 2001 and December 2010 in various medical institutes including BSMMU, DMCH & some private clinics in Dhaka city, using a polypropylene mesh (Lichtenstein technique). The main outcome measure was early and late morbidity and especially recurrence. Results : Inguinal hernia was indirect in 76 % of cases (798 patients), direct in 22% (231 patients) and of the pantaloon (mixed) type in 2 % (21 patients). Mean patient age was 44.5 years (range, 18 – 85). Follow-up was completed in 630 patients (60 %) by clinical examination or phone call. The median follow-up period was 2.5 years (range 1 – 5 years). Seroma and hematoma formation requiring drainage was observed in 25 and 8 patients respectively, while transient testicular swelling occurred in15 patients. Infection was found in 9 patients. Rejection of mesh occurred in 4 patients. There was 6 recurrence of the hernia (in one of these patients with late mesh rejection) (recurrence rate = 0.57 %). Postoperative neuralgia was observed in 25 patients (2.38 %). Conclusion : Lichtenstein tension-free mesh repair of inguinal hernia is a simple, safe, comfortable, effective method. Tension free repair using synthetic meshes have been reported to result in better patient comfort and lower recurrence rates compared with the conventional procedures like Shouldice’s or Bassini’s operation2-4. Therefore it is the preferred method for hernia repair since 1994. DOI: http://dx.doi.org/10.3329/jss.v16i1.14444 Journal of Surgical Sciences (2012) Vol. 16 (1) : 26-29

Surgical outcome of laparoscopic and open surgery of pediatric inguinal hernia

Inguinal hernia repair is one of the most frequently performed surgical procedures in infants and young children. This prospective comparative study was conducted with initial experience in the department of pediatric surgery, Dhaka Shishu (children) hospital during the period of July 2007 to August 2008. We enrolled 62 children undergoing surgery for inguinal hernia, of which 30 underwent laparoscopic procedure (bilateral in 21, unilateral 9) and 32 open procedures (bilateral in 5, unilateral in 27). Mean±SD patient age was 5.92±2.11 months in laparoscopic group and 6.63±2.64 months in open group (p=0.264), 3 months to 5 years in both groups. Patients were studied under variables of operative time, duration of postoperative hospital stay & post operative complications. During laparoscopy a contralateral patent processus vaginalis of ≥2cm was noted and repaired peroperatively in 18 out of 27 children (66%), who were initially diagnosed as unilateral hernia. For unilateral repair mean±SD operative time was significantly longer in Group A (62.63±52.75) minutes compares to the Group B (29.37±9.40), p<0.001. On the contrary, for bilateral repair Mean±SD operative time was comparable between the two groups (64.65±49.70) minutes for laparoscopy & (35.65±11.53 minutes) for open herniotomy & P=0.01, that was not remarkably significant. The mean±SD post operative length of hospital stay (in hours) 36.00±32.7 hours in Group A compared to 29.97±11.82 hours in Group B which was not statically significant (p=0.342). The mean±SD follow up was 24.5±10.5 months in laparoscopic group (Group A) & 22.5±10.5 months in open group (Group B), p=0.251. Regarding post operative complication, in this study, contra lateral metachronous inguinal hernia (CMIH) manifested in none of the patient out of 27 (total unilateral repaired number) patients in laparoscopic group but contrary to this in open group 2 patients out of 27 had developed CMIH & p value was <0.05, which is statistically significant. There were 2 cases of scrotal hydrocele out of 30, observed in Group A whereas 1 case out of 32 in Group B, p=0.49, which was statistically insignificant. The scrotal hydrocele was lasted only for 2 days & resolved spontaneously. About recurrence after operation, our study noted that, 1 case (3.3%) out of 30 in laparoscopic group and 2 cases (6%) out of 32 in open surgery group had developed recurrent inguinal hernia in about one year follow up where p value was 0.459, & it was statistically insignificant. In this study, none of the patient had developed post operative testicular atrophy (due to any vas or vascular injury) or testicular ascend. So, overall this study result implies that, Laparoscopic herniotomy might be a safe and effective option as open herniotomy for the treatment of inguinal hernia in children but which one would be superior or best option it requires a large series of randomized trial.

Demographic and clinical evaluation of secondaries to liver

Liver is one of the common sites of metastasis from primary malignancies from different sources. The study was undertaken to know the demographic profile, clinical presentation, investigation findings and primary sources of metastatic lesions in liver among Bangladeshi patients. The study was done on patients with secondary lesion in liver who were admitted into the department of Gastroenterology and department of Hepatology in Bangabandhu Sheikh Mujib Medical University over the period of one year from July 2009 to June 2010. Total 75 patients were included. Mean age of 49.6±6.92 years and the peak incidence was between 41 to 50 years. Seventy six percent (76%) were male and 24% were female and male to female ratio was 3.17:1. Only 5.3% had family history of cancer. More than half of patients had Hb level ≤11gm/dl and two third had raised ESR. All patients showed raised alkaline phosphatase and prolonged prothrombin time found in one forth of patients. Carcinoma stomach was the most common primary source of liver metastasis followed by carcinoma gallbladder, carcinoma pancreas, carcinoma of unknown primary and carcinoma colon.

Controlling scabies in madrasahs (Islamic religious schools) in Bangladesh

OBJECTIVES

To assess the effectiveness of a scabies control programme in reducing the prevalence of scabies in urban Bangladesh madrasahs, where the condition is extremely common.

STUDY DESIGN

A controlled trial involving four intervention madrasahs (total students 2359) and four control madrasahs (total students 2465) in Dhaka Metropolitan Area.

METHODS

A baseline scabies sample survey was carried out on 40 and 44 students of four intervention and four control madrasahs, respectively. Another 40 students of the intervention madrasahs were administered a pre-intervention test on scabies knowledge. This was followed by mass treatment of all students, teachers and staff of the eight madrasahs with topical 5% permethrin cream. The subsequent intervention involved daily monitoring of students for five key personal hygiene practices, weekly 10-min scabies health education classes, supply of simple and inexpensive products to students to prevent cross-infestation to/from peers (e.g. plastic bags, clothes hangers), and chemotherapy of new students detected with scabies. After 4 months of the intervention, the prevalence of scabies, personal hygiene practices and scabies knowledge were assessed in students of the intervention madrasahs.

RESULTS

Before the intervention, the prevalence of scabies was 61% and 62% in intervention and control madrasahs, respectively (P = 1.00). After mass scabies treatment in all eight madrasahs and 4 months of intervention, the prevalence of scabies was reduced to 5% and 50% in intervention and control madrasahs, respectively (P < 0.001). There were significant improvements in all five personal hygiene practices at the intervention madrasahs. Mean test scores for scabies knowledge were 40% before the intervention and 99% after the intervention in the four intervention madrasahs. The cost of this programme was US$1.60 per student, and primarily included products such as plastic bags and clothes hangers, and health education material.

CONCLUSIONS

This programme demonstrates a pragmatic and cost-effective way to control scabies in a residential institutional setting. It is recommended that this programme should be scaled up to all residential madrasahs in Bangladesh.

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.

Ventral free oral mucous membrane graft for bulbar urethral stricture

The use of oral mucous membrane graft onlay urethroplasty represents the most widespread method of bulbar urethral stricture repair. We investigated the short term result of oral mucous membrane graft placed on the ventral surface for management of bulbar urethral stricture. Patients with Bulbar urethral stricture of any length, infection free urinary tract and informed consent for oral mucosa harvesting and urethroplasty were selected for study. We enrolled 108 cases of bulbar urethral stricture patients from January 2004 to July 2009. The mean ± SD preoperative maximum flow rate of 5.2 ± 2.6 ml/sec and mean ± SD PVR 87 ± 58.3 ml were treated by substitution urethroplasty with oral mucous membrane by a single surgical team in a private hospital. Causes of stricture were trauma 26(24.1%), infection 58(53.7%), catheter induced 8(7.4%), post TURP 11(10.2%) and unknown 5(4.6%). Oral mucous membrane was harvested from the cheek or from the inner side of lower lip. Defect of the urethra displayed by longitudinal ventral urethrotomy and the graft was sutured over the edges of the incised urethral mucosa over a 14 Fr latex Foley's catheter. Spongiosum tissue was closed over the graft. Pericatheter urethrogram was performed in all cases to check for the anastomotic leakage and the Catheter was removed after 2 weeks of the procedure. After removal of catheter uroflowmetry & ultrasound scan of bladder were performed to estimate the maximum flow rate and post voidal residue. The patient was followed-up every 3 months with uroflowmetry & ultrasonography. The median (range) age of the patients was 32(21-72) years. Mean follow up period was 36 months (range 12-54). Mean ± SD stricture length was 3.7 ± 2.6 cm. The overall success rate was 91.7%. Mean ± SD flow rate was 23 ± 4.2 ml/sec, mean ± SD post void residue was 25 ± 15.5 ml and patient quality of life (QOL) was excellent in almost all patients. Overall complications were seen in 9(8.3%) cases. Of which, restricture occurred in 6 patients; periurethral fistulae seen in 2 cases and per urethral bleeding in 1 patient. No significant complications were observed at the donor site. Oral numbness and mild discomfort complained by 67.6% patients which were managed by reassurance only. In our experience ventral placement of oral mucous membrane graft along with spongioplasty is a very easy procedure with very encouraging short term result.

Responses of monosex nile tilapia (Oreochromis niloticus) to intraperitoneal challenge by Streptococcus iniae after vaccination with ghosts of the bacterium

The vaccine potential of Streptococcus iniae ghosts produced by gene E mediated lysis was investigated using tilapia (Oreochromis niloticus). Tilapia immunized with S. iniae ghosts (SIG) and formalin killed S. iniae (FKC) vaccines showed significantly higher serum agglutination titres than control fish. Fish immunized with SIG showed no significant differences with fish immunized with FKC in serum agglutination titres, but showed significantly higher bactericidal activity than fish immunized with FKC. Furthermore, fish immunized with SIG showed higher protection than fish immunized with FKC. As this promising type of a non-living whole cell envelope preparation seems to be favorable over conventional vaccines, we suggest S. iniae ghosts as a new vaccine candidate DOI: http://dx.doi.org/10.3329/bvet.v29i1.11889 Bangl. vet. 2012. Vol. 29, No. 1, 31-37     

Monitoring of selected pesticides residue levels in water samples of paddy fields and removal of cypermethrin and chlorpyrifos residues from water using rice bran

Consumption of pesticides associated foods increased in recent decades in Bangladesh. Most of the pesticides come from paddy, as rice is the main food items here and about 70 % pesticides are used only on paddy fields. Water samples of paddy fields and Kaliganga River of Manikganj district were analyzed to provide base line data on cypermethrin, chlorpyrifos and diazinon residue by using high performance liquid chromatography. Levels of Cypermethrin, chlorpyrifos and diazinon detected in the paddy field water samples were (0.605 ± 0.011 μg/L), (0.06 ± 0.001 μg/L) and (0.039 ± 0.002 μg/L), respectively. 0.11 ± 0.003 μg/L of cypermethrin and 0.012 ± 0.0006 μg/L of chlorpyrifos were also identified in the water samples of Kaligonga River. Diazinon residue was not detected in the river water samples. The detected concentrations of pesticide residues in the river water were below the accepted maximum residue limit (MRL) value of drinking water (0.1 μg/l) adopted by the FAO/WHO Codex Alimentarius Commission. Cypermethrin and chlorpyrifos were chosen for decontamination through rice bran, as it was found in river water. Two gm rice bran could easily decontaminated 95.6 % and 96.4 % of cypermethrin and chlorpyrifos. The result of this study showed that pesticide residue was detected in water samples were below the MRLs value, which can easily be decontaminated through absorption of rice bran.

IMPORTANT VIRAL DISEASES ASSOCIATED WITH MORTALITY OF LAYER CHICKENS IN COMMERCIAL POULTRY FARMS IN BANGLADESH

Disease profile investigation on 1751 dead chickens supplied from about 100 commercial large or small scale poultry farms of Gazipur district and surrounding area in Bangladesh during one year period from January to December 2002 at the BRAC Poultry Disease Diagnostic Centre, Nagapara, Gazipur showed that 22.73% (n = 398) cases with five different viral diseases, of which infectious bursal disease (IBD) (n = 196) and Newcastle disease (ND) (n = 181) showed significantly (p < 0.01) higher rate of occurrence than infectious bronchitis (IB) (n = 6), avian leukosis (AL) (n = 6) and fowl pox (FP) (n = 4). Age-wise occurrence of IBD showed highest infection rate in growing stage (82.65%) in comparison to brooding (3.06%), pullet (6.12%) and adult layer (8.16%) chickens. Although more or less all age groups of chickens were affected by ND (1.66% to 50.83%) but it was found significantly (p < 0.01) highest in adult (50.83%) chickens. Infectious bronchitis was recorded only in adult chickens. Avian leukosis was found higher in pullet (66.67%) than the adult (33.33%) layer birds. Fowl pox also recorded only in pullet stage of chickens. Seasonal influence showed significantly (p < 0.01) highest occurrence of IBD during summer (44.39%) in comparison to rainy (30.61%) and winter (25.00%) seasons. Similarly ND was recorded more or less uniformly in all the three seasons of the year with significantly (p < 0.01) higher rate during summer (41.99%) season. Infectious bronchitis was recorded significantly (p < 0.01) higher in summer (63.66%) season while avian leukosis was recorded in winter (66.67%). Fowl pox was found equally in winter and summer seasons (50%). Although IBD was found with other concurrent infection e.g., dual (23.98%) and triple (2.55%) types of infection but highest occurrence was recorded as a single type (73.47%) of infection. ND was found with dual (44.75%), triple (7.18%) and fourth (1.10%) types of infection but specially single infection (46.96%) were associated with high mortality. IB was recorded highest in single infection (54.55%) in comparison to dual (9.09%), triple (18.18%) and fourth types (18.18%) of infection. Avian leukosis was recorded higher as a single infection (83.33%) than dual (16.67%) type of infection. Fowl pox was recorded equally (50%) as single and triple types of infection. It may be concluded that both the single and concurrent infection of viral diseases, greatly influenced by season and age associated with high mortality, should be considered during vaccination programme, diagnosis, prevention and control.

Nutritional parameters in children with cancer

The study was conducted in the Departments of Pediatric Haemato-Oncology, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh from January 2007 to May 2009. Total 44 children (34 males and 10 females) aged between 10 months and 12 years with newly diagnosed malignancy. Nutritional status of 44 children with newly diagnosed malignancy was evaluated by anthropometric, hematological results and biochemical parameters before initiating therapy and response to therapy was assessed during follow up. Malnutrition was seen in 56.8% children by weight for age criteria (WFA <-2z). Low hemoglobin was found in 82% children, 25% had low total proteins (<5.7g/dL), 20.5% low serum albumin (<3.2g/dL), 27.3% low serum transferrin (<210mg/dL) and 16.3% low serum iron (<60μg/dL). Mean anthropometric and biochemical parameters were higher among the survivors compared to non-survivors. Significant difference between the well nourished and the malnourished group was detected in the achievement of remission/response (69.5% vs. 38.1%), delays in therapy (8.7% vs. 38.1%) and mortality (30.5% vs. 61.9%). Complications like febrile neutropenia and bleeding were more in the malnourished group. A statistically significant higher incidence of infection was seen in children with serum iron <60μg/dL than those with higher values of serum iron (42.8% vs. 8%).

Laparoscopic versus open pyloromyotomy for infantile hypertropic pyloric stenosis: an early experience

This prospective comparative study was conducted with an initial experience in the Department of Pediatric Surgery, Dhaka Shishu (Children) Hospital during the period of December 2007 to January 2009, with the infants of 2-12 weeks age, diagnosed as Hypertrophic pyloric stenosis. Patients selection was done by simple random technique by means of lottery. For open pyloromyotomy conventional method & for laparoscopic pyloromyotomy three trocher techniques was applied. In this study, among 60 cases with infantile hypertrophic pyloric stenosis, 30 cases were finally selected for analysis irrespectively both in laparoscopic (Group A) & in open pyloromyotomy (Group B) group. Patients were studied under variables of operative time, required time of full feeds after operation, post operative hospital stay & both per and post operative complications. Regarding operative time, in Group A, mean±SD operating time (in minutes) was 61.59±51.73 whereas in Group B it was 28.33±8.40 & P value was 0.001. The result was statistically significant. The mean±SD time (in hours) of full feeds (ad libitum) was 35.00±31.70 hours in Group A compared to 28.95±10.99 hours in Group B and P value was found 0.342ns which was not statistically significant. On study of total length (in days) of post operative hospital stay, mean±SD was 3.09±2.25 & 2.58±1.15days in laparoscopic group & open pyloromyotomy group respectively. The p value was 0.355ns, which was statistically insignificant. Again, on study of complications, per operatively 6(19.5%) patients had developed haemorrage, 1(3.33%) had mucosal perforation & 4(13.36%) had developed duodenal serosal injury in laparoscopic group whereas only 1(3.33%) patient in open pyloromyotomy group had nothing else except simple hemorrhage. The p value (0.051ns) was also statistically insignificant. In regard to post operative complications, 2(6.6%) patients had developed wound hematoma, 2(6.6%) had wound infection, 1(3.33 %) had developed wound dehiscence and incisional hernia respectively in Group A. But in group B there was no subject with any complication. This result was also statistically insignificant. So, the overall study results denote that, laparoscopic pyloromyotomy would not be considered as a superior procedure or as safe as that of traditional open pyloromyotomy for the beginners.

Depression and its association with socio-demographic characteristics among type 2 diabetes mellitus patients of Bangladesh

Diabetes mellitus is being increasingly recognized as a serious global health problem and is frequently associated with co-morbid depression. A cross sectional study was conducted among 178 adult type 2 diabetes mellitus patients attending Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh to find out influence of socio-demographic characteristics for occurrence of depression among them. Data were collected through face-to-face interview. Depressive symptoms were measured using Centre for Epidemiological Studies Depression Scale. Proportion of depression was found 34.8% which included 20.2% with severe depression and 14.6% with mild to moderate depression. Both mild to moderate and severe depression were significantly more common in female, odds ratios were 2.72 (95% CI=1.13-6.53) and 5.94 (95% CI=2.49-14.20), respectively. Currently not married respondents were also suffered from higher depressive symptoms. For mild to moderate depression odds ratio was 4.38 (95% CI=1.46-13.18) and for severe depression odds ratio was 9.51 (95% CI=3.69-24.50). Among socio-demographic characteristics marital status was identified as the best predictor of depression, which was followed by education upto secondary level, female sex and primary education. Depression was identified as a significant health problem among adult type 2 diabetes mellitus patients. Its association with socio-demographic characteristics should be considered while planning therapeutic approaches for diabetic patients.

Intervention to increase detection of childhood tuberculosis in Bangladesh

BACKGROUND

Despite a well-functioning adult tuberculosis (TB) control programme, children with TB remain grossly under-detected in Bangladesh. It is conservatively estimated that annually around 21,000 children with TB go undetected, due to an almost exclusive focus on sputum smear-positive TB and the absence of training or guidelines in paediatric TB.

OBJECTIVE

To double child TB detection by increasing general awareness and training of health care workers at microscopy centres supported by the Damien Foundation (DF) Bangladesh.

METHODS

A cluster-randomised trial was carried out with provision of child TB guidelines, training and logistics support to staff of 18 microscopy centres, while 18 non-adjacent microscopy centres continued their usual practice and served as controls. Paediatric data on TB suspect referral and case detection were collected at baseline and during the intervention at both control and intervention sites.

RESULTS

Child TB case detection increased in both intervention and control microscopy centres, but the increase was three times the baseline in the intervention centres (from 3.8% to 12%) in comparison to less than double the baseline in the control centres (from 4.3% to 7%, P = 0.001).

CONCLUSION

Simple guidelines and training on child TB case detection, together with basic logistics support, can be integrated into the existing National TB Control Programme and improve service delivery to children in TB-endemic areas.

Symptomatic overlap in patients with diarrhea predominant irritable bowel syndrome and microscopic colitis in a sub group of Bangladeshi population

Microscopic Colitis (MC) and diarrhea predominant irritable bowel syndrome (IBS-D) has almost similar clinical feature but MC is diagnosed by histologic criteria and IBS is diagnosed by symptombased criteria. There is ongoing debate about the importance of biopsies from endoscopically normal colonic mucosa in the investigation of patients with IBS-D. Aim of this study was to assess the prevalence of MC in patient with IBS-D and to determine the distribution of MC in the colon. This observational study was conducted in department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2008 to December 2009. Patients were evaluated thoroughly & who meet Rome–II criteria with normal routine laboratory tests, were included in the study. Colonoscopy was done and biopsies were taken from the caecum, transverse colon, descending colon, and rectum. Out of total 60 patients, 22 had Lymphocytic Colitis (LC), 28 had nonspecific microscopic colitis (NSMC) and 10 had irritable bowel syndrome noninflamed (IBSNI). The distribution of LC was restricted to proximal colon in 15 patients, in the left colon in 2 patients and diffuses throughout the colon in 5 patients. There is considerable symptom overlap between the patients of IBS-D and patients with microscopic colitis. Without colonoscopic biopsy from multiple sites, possibility of MC cannot be excluded in patients with IBS-D and it can be said that clinical symptom based criteria for irritable bowel syndrome are not sufficient enough to rule out the diagnosis of microscopic colitis. DOI: http://dx.doi.org/10.3329/bmrcb.v38i1.10450 Bangladesh Med Res Counc Bull 2012; 38: 33-38

What cannot be measured cannot be done; risk factors for childhood tuberculosis: a case control study

Childhood tuberculosis is one of the major causes of childhood mortality and morbidity though much neglected within our National Tuberculosis Control Program. This case control study was carried out to identify the risk factors for tuberculosis among children. Cases (n=95) and controls (n=94) were selected from Directly Observed Treatment Short Course (DOTS) centers of four upazillas of Dhaka and Gazipur districts. Cases were childhood tuberculosis patient, who were test positive by sputum microscopy from January to May, 2011 and controls were children who visited DOTS laboratory suspecting tuberculosis infection but were sputum negative. Both cases and controls were selected from the sputum examination registers and were traced at home for exposure data. The study showed more girls were infected than boys. Several socio demographic and environmental factors were found to be associated with the development of childhood tuberculosis. Logistic regression model was constructed to find out the important predictors which revealed age, education of the respondents, indoor environment and contact pattern were significantly associated with childhood tuberculosis. Children more than 14 years of age had 6.25 times higher risk of developing childhood tuberculosis; (Odds ratio=6.25; 95% CI for OR=2.00 to 19.55), Children completed primary education had 3.12 times lower risk of developing childhood tuberculosis, (Odds ratio=.32; 95% CI for OR=.10 to 1.00). Those who resided in better in-house environment had 4.35 times lower risk of developing childhood tuberculosis (Odds ratio=.23; 95% CI for OR=.06 to .95) and children came in contact with source tuberculosis cases who were their relatives or neighbors were 5.26 times lower risk of developing childhood tuberculosis than being in contact with family members with TB (Odds ratio=.19; 95% CI for OR=.07 to .49). Contact Screening should be incorporated in National TB program for early detection and effective treatment of tuberculosis. Improvement of indoor environment and ventilation status of the bedroom might reduce the risk of developing childhood tuberculosis. DOI: http://dx.doi.org/10.3329/bmrcb.v38i1.10449 Bangladesh Med Res Counc Bull 2012; 38: 27-32

Non-Hodgkin's lymphoma is a pathological lead point causing large gut (colo-colic varity) intussusception

Intussusception secondary to Primary Non-Hodgkin lymphoma presenting colo-colic variety is a very rare clinical entity and sometimes causing diagnostic dilemma due to non-specific, varied & wide spectrum presentation. In this study, a 9 years female child presented with recurrent, intermittent, colicky abdominal pain with occasional bilious vomiting, along with a left illiac fossa swelling & occasional per rectal bleeding and constipation for 3 months was clinically diagnosed as a case of recurrent obstructing intussusception. At laparotomy, a colo-colic intussusception with prolapsed intussusception was marked & finally on histopathology, she was diagnosed as a case of colo-colic variety of intussusception due to primary Non-Hodgkin lymphoma- a pathological lead point in mid transverse colon. After uneventful recovery of post operative period she was treated with combination chemotherapy accordingly & follow up was given up to 5 years. She had been found alright without any recurrence or organ involvement. The study focused on the avoidance of unusual delay in diagnosis as well as in proper management of rare variants of intussusception.

Predictive value of urine cultures in evaluation of bacterial colonization of ureteral stents

To evaluate the predictive value of urine cultures in the assessment of ureteral stent colonization and to investigate the frequency of double J stent colonization and stent associated bacteriuria. This observational study was conducted in the department of Urology, Dhaka Medical College Hospital from December 2006 to March 2009. A total of 100 patients (mean age 39.2 ± 9.9 years, range 18-60 years, 69 male and 31 female) needing internal ureteral stent placement for different sorts of urinary tract operations were included in the study. Sterile urine samples were obtained from each patient before stenting and all patients had been given short-term prophylactic antibiotic (5-12 days). On the day of stent removal midstream urine were obtained from all patients for microbiological culture. Stents removed by aseptic precaution. Proximal and distal tip segments (3-5 cm) were also sent for culture. The lowest and highest durations of stenting were 10 and 86 days respectively (median 35 days). Both bacteriuria and bacterial colonization was significantly higher as duration of stenting increases (p=0.045 and p<0.001). E. coli was the most common microorganism isolated from both urine and stent culture. However, colonization rate of stents was much higher (45%) than positive urine cultures (21%) indicating that urine culture is less sensitive to diagnose stent colonization (k-value = 0.49). The study concludes that bacterial colonization significantly increases with indwelling time of stent and sterile culture of urine does not rule out that the stent itself is colonized.

Early diagnosis of neonatal septicemia by hematologic scoring system, C-reactive protein and serum haptoglobin

Neonatal septicemia is one of the major health problems throughout the world. Infections are frequent and important cause of morbidity and mortality in neonatal period. The objective of the present study was to find out the role of hematologic scoring system (HSS), C-reactive protein (CRP) and haptoglobin in the early diagnosis of neonatal septicemia. This is a descriptive consisted of 100 neonates admitted at neonatal ICU, BSMMU, who were clinically suspected sepsis. The hematological parameter, C-reactive protein and haptoglobin were measured in all cases. Blood culture was done as the gold standard for diagnosis of neonatal septicemia. There were 12 out of 100 neonates (12%) who had culture proven sepsis and they were predominantly preterm and very low birth weight. On evaluation of various hematological parameters total leukocyte count, total neutrophil count, immature to total neutrophil ratio (>0.2), immature to mature neutrophil ratio (>0.3), total immature count, platelet count were found to have optimal sensitivities and negative predictive values. Using these values hematologic scoring system (HSS) was formulated according to Rodwell et al. Score ≥4 was found sensitivity of 100%, specificity of 60%. C-reactive protein (CRP) had sensitivity of 75%, specificity of 74%. Haptoglobin was not found significant (p<0.05) with sepsis and sensitivity was very low. But Combination of score ≥4 and CRP showed sensitivity of 75%, specificity 85%, positive predictive value (PPV) 41% and negative positive value (NPV) 96%. HSS and CRP are useful test to differentiate the septicemic from non septicemic neonates and also provide a effective guideline to make decisions regarding judicious use of antibiotic therapy. But haptoglobin level was not found useful for screening of sepsis.

Serum hyaluronic acid as a predictor of fibrosis in chronic hepatitis B and C virus infection

Chronic hepatitis B and C virus infection can lead to cirrhosis and hepatocellular carcinoma. Several studies investigated the diagnostic and prognostic value of some biochemical markers to detect the hepatic fibrosis and found a correlation between serum markers and hepatic fibrosis. Among them serum hyaluronic acid (HA) has been identified as a potential marker of fibrosis or cirrhosis in different studies. A prospective study in 60 subjects was conducted to evaluate the association between serum HA and hepatic fibrosis. Thirty consecutive patients with chronic HBV or HCV infection undergoing liver biopsy were studied. Sera were obtained for HA using enzyme linked protein binding assay. Patients with hepatic fibrosis had higher serum HA concentration compared with healthy subjects (236.65 ± 227.07 vs. 23.32 ± 14.22 respectively, p<0.001). Correlation was found between high serum HA concentration and increasing degree of hepatic fibrosis (R-0.322 and p<0.041). This study had shown a good correlation between serum HA and different stages of hepatic fibrosis. So serum HA may be used as a useful marker of hepatic fibrosis.

An assessment of the long-term health outcome of renal transplant recipients in Ireland

BACKGROUND

Renal transplantation remains the preferred method of renal replacement therapy in terms of patient survival, quality of life and cost. However, patients have a high risk of complications ranging from rejection episodes, infection and cancer, amongst others.

AIMS AND METHODS

In this study, we sought to determine the long-term health outcomes and preventive health measures undertaken for the 1,536 living renal transplant patients in Ireland using a self-reported questionnaire. Outcomes were divided into categories, namely, general health information, allograft-related information, immunosuppression-related complications and preventive health measures.

RESULTS

The results demonstrate a high rate of cardiovascular, neoplastic and infectious complications in our transplant patients. Moreover, preventive health measures are often not undertaken by patients and lifestyle choices can be poor.

CONCLUSIONS

This study highlights the work needed by the transplantation community to improve patient education, adjust immunosuppression where necessary and aggressively manage patient risk factors.

Serum transaminase level changes in dengue fever and its correlation with disease severity

It was observed that liver enzymes are elevated in dengue fever. In this study our aims were to determine the changes in serum transaminases in dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) and to find out the relation of transaminase level changes with the disease severity. This cross sectional, prospective hospital based observational study was carried out in the department of Gastrointestinal Hepatobiliary and Pancreatic diseases and Internal Medicine department of BIRDEM Hospital, Dhaka. Patients are classified into 3 groups depending on clinical & laboratory findings: Group 1 dengue fever (DF), Group 2 dengue hemorrhagic fever & Group 3 dengue shock syndrome. A total of 240 cases were taken in this study who fulfilled the selection criteria. Out of whom 125 male and 115 female patients. DF was 157(65.4%) & DHF was 83(34.6%). Aminotransferases [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] were significantly raised in DHF cases compared to those of classical dengue fever (AST 84.5±42.4 in DF vs. 507±106.8 IU/L in DHF and ALT 59.9±31.3 in DF vs. 234±30.6 IU/L in DHF). The rise of AST is far greater than ALT in both DF and DHF. Dengue fever is usually associated with mild to moderate elevations of aminotransferase levels. The increase in aminotransferases, mainly AST has been associated with disease severity and serves as an early indicator of dengue infection.

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.

Detection of biofilm formation among the isolates of staphylococcus epidermidis by modified microtiter- plate test

The present study was done to detect biofilm formation among the strains of Staphylococcus epidermidis isolated from different clinical specimens and healthy controls in the department of Microbiology, Mymensingh Medical College between July 2007 to June 2008. A total of 62 Staphylococcus epidermidis isolates were identified by standard microbiological technique. Among them 32 S. epidermidis were isolated from cases and 30 were from healthy controls. Antimicrobial susceptibility of the isolates was carried out by disk diffusion method as per recommendation of Clinical and Laboratory Standard Institute 2007. Biofilm production was detected by Modified microtiter-plate test. Out of 32 clinical isolates of S. epidermidis, 13 strains found to produce biofilm. On the other hand out of 30 S. epidermidis from healthy controls, only 5 strains produced biofilm. So detection rate of biofilm production of S. epidermidis by Modified microtiter plate test in clinical isolates was significantly higher than that of control group.

Study on association of cutaneous tuberculosis with pulmonary tuberculosis

BACKGROUND

Tuberculosis continues to be a health problem in many countries. There may be simultaneous multiple organ involvement. Diagnosis of one organ disease may lead to missing off diagnosis of other organ involvement.

OBJECTIVES

The present study was done to analyze the association of cutaneous tuberculosis with pulmonary tuberculosis.

MATERIAL AND METHODS

Through purposive sampling a total of 23 patients of suspected cutaneous tuberculosis were primarily enrolled in this cross sectional study. History was taken and examinations were done to find out types of cutaneous lesions and to explore a pulmonary involvement. Investigations including CBC with ESR, Mantoux test and skin biopsy were done for each and every patient. Those who had cutaneous tuberculosis on histopathology chest x-ray were done to detect pulmonary lesions. After investigations 2 patients were excluded due to absence of tubercular infection. Finally 21 patients were included in this study. Data were collected in a predesigned structured questionnaire.

RESULTS

Out of 21 patients 16 (76.19%) were male and 5 (23.81%) were female with a male to female ratio of 3.2:1. Age range varies from 5-70 years with a mean of 29.76 +/- 1 8.2 years. MT was positive in 76.20% of patients. CXR showed 23.81% of the patients with cutaneous TB had simultaneous pulmonary involvement. The association is statistically significant (p < 0.05).

CONCLUSIONS

Patients with cutaneous tuberculosis may have pulmonary involvement in a statistically significant number. In any patient with cutaneous TB, meticulous systemic examinations and relevant investigations have to be done to explore pulmonary involvement.

Comparison of post operative morbidity between laparoscopic and open appendectomy in children

This prospective comparative study was conducted in the department of Pediatric Surgery, Dhaka Shishu (children) Hospital during the period of June 2007 to September 2008 with the children of <12 years, diagnosed as acute Appendicitis. Patient selection was done by simple random technique by means of lottery. For open Appendectomy (OA) conventional method & for Laparoscopic Appendectomy (LA) 3 trocher technique was applied. Data was analyzed with the help of SPSS version 10. In this study 60 cases with acute Appendicitis including both gender were studied by two groups, group-A include 30 cases for laparoscopic and group-B include 30 cases for open appendectomy. Postoperative pain was assessed in both groups by using FLACC scale and compared at 1st 6-hours, 24 hours, 72 hours, 96 hours & at day 7. At 1st 6-hours, most of the children 24(80%) of group A had moderate pain whereas 17(56.7%) children of group B had severe pain (p<0.001). At 24 hours most of the patient 17(56.7%) of group A had mild pain compared to 27 (90%) patients of group B had moderate pain (p<0.0001). At 48 hours in group A most of the children 23(76.7%) had mild pain compared to moderate pain in 18(60%) children of group B (p<0.0001). Subsequently at 72 hours and at 96 hours most of the patients of LA group were free of pain compared to OA group. At final follow-up on day 7, 29(96.7%) children of group A had no pain compared to 26(86.7%) of group B. Regarding analgesics requirement both qualitative & quantitative requirements of analgesics were less in LA group than OA group. About post operative wound infection in group A only 1(3.3%) case had developed post operative wound infection whereas in group B 7(23.3 %) cases had. The mean (+/-SD) of post operative length of hospital stay was 52.00+/-11.62 (range 48-96) hours for group A and 76.00+/-12.74 (range 48-96) hours for group B children (p<0.001). Laparoscopic Appendectomy is more effective, preferable & superior procedure than that of open Appendectomy to reduce the post operative morbidity in children undergone appendectomy for acute appendicitis.

Evaluation of bacterial colonization and bacteriuria secondary to internal ureteral stent

To assess the frequency of bacterial colonization on internal ureteral stent and stent associated bacteriuria in different periods of indwelling time, a total of 100 patients (mean age 39.2+/-9.9 years, range 18-60 years, 69 male and 31 female) needing internal ureteral stent placement for different sorts of urinary tract operation in the department of Urology, Dhaka Medical College Hospital from December 2006 to May 2008 were included in the study. Sterile urine samples were obtained from each patient before stenting and all patients had been given short-term prophylactic antibiotics (5-12 days). Midstream urine obtained from each patient on the day of stent removal and submitted for microbiological culture. Stent removed by aseptic precautions. Proximal and distal stent tip segments (3-5) were also sent for culture. The median duration of stenting was 35 days (10-86 days). Bacterial colonies were found in 45% of the stent. Colonization rate was 71.4% in stents removed after 6 weeks compared to 33.3% in 4-6 weeks and 23.5% before 4 weeks (p<0.001). Bacteriuria was found only in 21% patients. Escherichia coli was the common organism isolated from both stent and urine. The study concludes that bacterial colonization significantly increases with indwelling time of stent and absence of growth in urine culture does not rule out that the stent itself is colonized.

Biological Control of Alternaria Fruit Rot of Chili by Trichoderma Species under Field Conditions

Trichoderma strains were evaluated under field conditions to assay their efficacy in suppressing Alternaria fruit rot disease and promoting chili plant growth. The experiment was conducted at the Botanical Garden, Rajshahi University, Bangladesh from July 2006 to March 2007. Application of Trichoderma harzianum IMI 392432 significantly (p = 0.05) suppressed the disease compared to Alternaria tenuis (T2) treatment and improved both growth and yield. The treatment T4 (T. harzianum IMI-392432 + A. tenuis) was most effective in reducing disease percentage (72.27%) compared to A. tenuis (T1) treatment. The highest seed germination rate (85.56%) and the highest growth and yield (12.5 g/plant) was also recorded in the same treatment (T4), followed by T5 (T. harzianum IMI-392433 000000 + A. tenuis), T6 (T. harzianum IMI-392434 +A. tenuis), T2 (T. virens IMI-392430 + A. tenuis), and T3 (T. pseudokoningii IMI-392431 +A. tenuis) treatment, while single treatment with A. tenuis significantly decreased these values.

Blood pressure in relation to selected anthropometric measurements in senior citizens

This cross-sectional study was done to assess the blood pressure of the senior citizens in relation to the anthropometric measurements and indices. It was conducted among the Bangladeshi elderly citizens of selected areas of Dhaka city. Samples were selected by convenient technique. A pre-tested questionnaire and a check list were used for data collection. Data analysis was done by SPSS for Windows. Three areas of Dhaka city namely Nakhal Para, Badda and Mirpur were selected in this study. The study was conducted during January to June 2006. A total of 317 samples were studied. Mean age of the respondents was 67.1 years (+/-6.6 SD). Mean SBP and DBP measured were 126 mm of Hg (+/-20 SD) and 72 mm of Hg (+/-12 SD), respectively. Among them, 33.1% were hypertensive on BP measurement; amongst which 32.4% had both SBP and DBP raised; 55.2% had isolated systolic hypertension and 12.4% had DBP raised. Of them 44.8% were identified finally as hypertensive considering BP measurement and those taking antihypertensive medication. The majority were well nourished and at less health risk in terms of BMI, WC and WHR. There was a tendency of being hypertensive with overweight/obese (p<0.05), high WC (male p<0.05 and female p<0.01) and high WHR (female p<0.001). Percentage of hypertensive was higher among the seniors of the study areas especially among those who were overweight/obese or at health risk by WC/WHR.

Malarigen malaria Pf/Pv antigen rapid test: a simple and effective tool for diagnosis of malaria in the far-flung hilly areas of Bangladesh

Microscopic visualization of malarial parasites on thick and/or thin film is considered as "Gold Standard" for diagnosis of malaria. But it needs skilled microscopist as well as good laboratory set up, which are scarce in Chittagong Hill Tracts (CHT) in Bangladesh. A study was carried out to evaluate the efficacy of a newly introduced Rapid Diagnostic Test (RDT) device based on immunochromatographic test (ICT) format, for malarial parasite. This study was carried out at Balipara, a remote village 64 km away from Bandarban Hill District headquarters, during January 2007 to September 2007. A total 271 patients who reported to Sickbay of 37 Rifle Battalion, Balipara were tested by MALARIAGEN MALARIA Pf/Pv Antigen Rapid Test kit on the spot. Thick & thin blood films were prepared and stained by laboratory technician at the sick bay, properly labeled, preserved and sent to pathologist working at Armed Forces Medical College, Dhaka Cantonment, Dhaka for microscopy. Three (1.11%) cases were excluded as control band of RDT were negative or test band appeared after long incubation. Six (2.22%) were excluded for poor quality of staining blood film. Among 262 cases malarial parasites were detected in 74(28.24%). Of these 62(83.78%) were Plasmodium falciparum and 12(16.22%) were Plasmodium vivax. Parasite count ranged from 2500/mµL to 527500/mµL with mean 67400/mµL (+/-93400). Among 262 cases, 97(37.02%) were positive for malarial antigen(s) in RDT. Of these 74(76.29%) were P. falciparum and 23(23.71%) were P. vivax. Overall sensitivity and specificity of RDT for detection of malarial antigen(s) irrespective of their species were 95.95% and 86.71% respectively with positive and negative predictive value 73% & 98% respectively. Relative to microscopy, the device has shown sensitivity 94.6% and specificity 88.52% for detection of P. falciparum with positive and negative predictive value 72% and 98% respectively. The device sensitivity and specificity for detection of P. vivax were 100% and 93.1% with respective positive and negative predictive value 47% and 100%. Malariagen Malaria Pf/Pv Antigen Rapid Test (RDT) performs as a better sensor and discriminator of malarial parasites and their species and appears to be an acceptable tool for diagnosis of malaria in symptomatic patient.

Seroprevalence of human brucellosis among the population at risk in rural area

This study was performed to evaluate the seroprevalence of brucellosis among the risk group of population. A cross sectional study was carried out in the Department of Microbiology, Mymensingh Medical College in collaboration with the Department of Medicine under the Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, between the period from July 2007 to June 2008. A total of 210 samples were included in this study from risk group of population. A variety of serological tests have been applied for detection of antibodies against Brucella spp. Among the 210 subjects from risk group of population, 9(4.28%), 7(3.33%) and 7(3.33%) were positive for brucellosis by slide agglutination test, rose bengal plate agglutination test (RBPA) and standard tube agglutination test (STAT) respectively. Out of total specimen 10 positive and 29 negative serum as detected by slide agglutination, rose bengal plate agglutination test (RBPT) and STAT were also examined by Enzyme linked immunosorbent assay (ELISA) for detection of IgG. Among them, 10 were positive by ELISA IgG. Seroprevalence among occupational groups were 11.11% in veterinary personnel, 6.45% in dairy workers and 4.67% in animal farmers. This study indicated that brucellosis is not uncommon at rural area of Mymensingh region in Bangladesh. It was suggested to conduct community survey and to plan properly the measures of control and prevention.

Screening of Trichoderma Isolates as a Biological Control Agent against Ceratocystis paradoxa Causing Pineapple Disease of Sugarcane

In this study, dual culture, poison agar, and direct methods were used to assess the ability of Trichoderma virens IMI-392430, T. pseudokoningii IMI-392431, T. harzianum IMI-392432, T. harzianum IMI-392433, and T. harzianum IMI-392434 to control Ceratocystis paradoxa, which causes the pineapple disease of sugarcane. The highest percentage inhibition of radial growth (PIRG) values were observed with T. harzianum IMI-392432 using two dual culture methods, 63.80% in Method I and 80.82% in Method II. The minimum colony overgrowth time was observed with T. harzianum IMI-392432 and the maximum was observed with T. pseudokoningii IMI-392431. Different concentrations of different day-old metabolites of Trichoderma isolates were tested against mycelial growth of C. paradoxa. The highest PIRG (84.685%) exhibited at 80% concentration of 30-day-old metabolites of T. harzianum IMI-392432 using the modified bilayer poison agar method. In the direct assay method the maximum mycelial growth weight (PIGW) was observed at the same concentration and the same day-old metabolites of T. harzianum IMI-392432. This study showed that Trichoderma isolates have a good antagonistic effect on C. paradoxa mycelial growth and T. harzianum IMI-392432 has the most potential to control the pineapple disease pathogen.

Influence of fructose concentration on myocardial infarction in senile diabetic and non-diabetic patients

BACKGROUND

Fructose intake has been increased steadily during the past two decades. Fructose, like other reducing sugars can react with proteins, which may account for aging and myocardial infarction. Fructose participates in glycation (fructation) and AGE formation some 10 times faster than glucose. This study aims to determine the fructose concentration and correlate with antioxidant status in senile diabetic and non-diabetic patients with myocardial infarction.

METHODS

The study included one hundred twenty six subjects. Out of them 31 were normal senile subjects, 33 were senile diabetic patients without myocardial infarction, 32 were senile diabetic patients with myocardial infarction and 30 were senile non-diabetic patients with myocardial infarction. The patients were selected on clinical grounds from National Institute of Cardiovascular Diseases, Karachi and Jinnah Postgraduate Medical Centre, Karachi, Pakistan.

RESULTS

Serum fructose was significantly increased in senile diabetic patients with and without myocardial infarction and senile non-diabetic patients with myocardial infarction as compared with senile control subjects. Serum total antioxidant status was found to be significantly decreased in senile diabetic patients with and without myocardial infarction and senile non-diabetic patients with myocardial infarction as compared with senile control subjects. Fasting blood glucose, HbA (1C) and serum fructosamine were significantly increased in senile diabetic patients with or without myocardial infarction as compared with senile non-diabetic patients with myocardial infarction and senile control subjects. Negative significant correlation was observed between serum fructose and serum total antioxidant status in diabetic and non-diabetic patients with myocardial infarction. Positive significant correlation was observed between serum fructose and s-AGEs in diabetic and non-diabetic patients with myocardial infarction.

CONCLUSIONS

This study revealed that increased fructose concentration and decreased antioxidant status might have a role in the myocardial infarction.

The crystal polymorphism of calcium carbonate is determined by the matrix structure in quail eggs

Two calcified structures, the eggshell and sperm-associated body (SB), are present in the eggs of the Japanese quail, Coturnix japonica. X-ray diffractometry showed that calcium carbonates take the form of calcite in the eggshell and aragonite in the SB. The aim of the present study was to identify the factors that determine the morphology of calcium carbonate crystals. The matrix of EDTA-treated eggshell was a meshwork of vesicles, 200 to 500 nm in diameter, connected by fine fibers or fibrous sheets. The matrix of SB cortex was a radiation of rod-shaped projections approximately 130 nm in width. In vitro crystal formation was achieved by adding dissociated matrix substances to test solutions. When eggshell matrix material was added, formation of calcite crystals, which had many vesicular holes on their surface, was observed. When SB matrix material dissociated by sonication was added, rhombohedral calcite crystals formed at protein concentrations of 100 microg/mL or lower, and elongated and bundled crystals formed at concentrations of 150 microg/mL or higher. When SB matrix material dissociated by pipetting was added, aragonite crystals formed. These observations indicate that the matrix structure is the principal factor in determining the crystal polymorphism of calcium carbonate.

Study on the physico chemical properties of water of Mouri River, Khulna, Bangladesh

Water sample were collected from six different point of the Mouri River Khulna, Bangladesh with a regular intervals in the months of January-March 2002 for the analyzing different physicochemical parameters of the water. Total 22 different physicochemical parameters were investigated. Correlation and the t value among the parameters were also determined. In the present investigation the minimum and maximum value of water temperature, Transparency, Turbidity, TSS, TDS, Electric Conductivity, water pH, dissolve oxygen, free Carbon dioxide, Alkalinity, Acidity, Hardness, BOD, COD, Sulphate, Phosphate, Nitrite, Sodium, Calcium, Potassium, Manganese and Iron were noted as 21.6 and 32.2 degrees C; 15 and 66 cm; 16 and 22 NTU; 74 and 125 mg L(-1); 255 and 305 mg L(-1); 159 and 275 microS cm(-1); 1.10 mg L(-1) 8.18 mg L(-1); 7.5 and 8.3; 1.1 and 8.3 mg L(-1); 27.5 and 35.5 mg L(-1); 350 and 610 mg L(-1); 32.4 and 171 mg L(-1); 310 and 529 mg L(-1); 13 and 31 mg L(-1); 290 and 365 mg L(-1); 42046 and 57.35 mg L(-1); 4.89 and 11.46 mg L(-1); 0.54 and 1.82 mg L(-1); 16.8 and 33.9 mg L(-1); 1.5 and 6.9 mg L(-1); 49 and 94 mg L(-1); 31 and 59 mg L(-1); 2.6 and 3.8 mg L(-1), respectively. River water did not show any significant pollution during the present study. During the study period dissolved oxygen show direct relation with water temperature but inverse with BOD and COD.

Multifocal skeletal tuberculosis in children

Multifocal bone involvement is though rare but is reported from some countries where tuberculosis is endemic. Here we report a case of three years old boy was admitted in Bangabandhu Sheikh Mujib Medical University, Dhaka with the complaints of difficulty in walking ,low grade fever for six months, swelling over the back, elbow joint, knee joint and upper part of forearm and legs for two months. Family history of tuberculosis was positive. Mantoux test was 18 mm, ESR 85 mm in first hour, chest X-ray reveals right hilar lymphadenopathy, X-ray dorsolumber spine shows wedge shaped deformity in T11, L4 and with paravertebral collection from L2-L4. X-ray of legs, knee joint and forearms show multiple lytic lesions in shaft with periosteal reaction and cortical thickening. Ultrasonograph of whole abdomen shows psoas abscess. Culture of bone marrow aspirate reveals Mycobacterium tuberculosis. Patient was given an anti tubercular regimen with Rifampicin, Isoniazid, Pyrazinamide and Streptomycin for initial two months which to be followed by Rifampicin and Isoniazid for another 10 months.

Smoking and smokeless tobacco consumption: possible risk factors for coronary heart disease among young patients attending a tertiary care cardiac hospital in Bangladesh

OBJECTIVES

To determine the risk of coronary heart disease (CHD) associated with various types of tobacco consumption among young patients aged 20-49 years attending a tertiary care cardiac hospital in Bangladesh.

STUDY DESIGN

Case-control study.

METHODS

The study was undertaken at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. The study population comprised 69 cases with CHD and 138 controls without CHD from the emergency department of NICVD. Quantitative interviews were performed.

RESULTS

Most of the cases (79.7%) were either current or past consumers of some form of tobacco, compared with less than half of the controls (46.4%). The increased risk of CHD was approximately four fold in ever smokers [adjusted odds ratio (OR) 4.0, 95% confidence interval (CI) 1.7-9.5] and cases who had ever used smokeless tobacco (adjusted OR 4.0, 95% CI 2.0-8.1). Smokeless tobacco consumption was strongly associated with CHD after adjustment for smoking and other confounders.

CONCLUSION

This study found evidence for an association between various types of tobacco consumption and CHD, particularly for bidi smoking and different types of smokeless tobacco consumption. Policies should be made and implemented to combat bidi smoking and smokeless tobacco consumption, as well as cigarette smoking.