Prevalence and Risk Factors of Hypertension among Government Employees Serving in Rangpur City, Bangladesh

Hypertension (HTN) is an important cause of cardiovascular mortality and the prevalence of hypertension is increasing particularly in middle- and low-income countries including Bangladesh. No data are available for the prevalence of hypertension among the government employees in Bangladesh. In this cross-sectional study, conducted from 30 October to 31 December 2016, 1219 government employees aging ≥18 years working in Rangpur city were evaluated for the presence of HTN and its risk factors. Socio-demographic and anthropometric data, data on the presence of various known risk factors of hypertension were collected. Hypertension was defined with systolic BP ≥140mmHg and/or diastolic BP ≥90mmHg or those getting treatment for hypertension. Statistical analysis was done by using SPSS version 23.0; odds of hypertension among subjects with risk factors were calculated and p ≤0.05 was considered to be statistically significant. The prevalence of hypertension was 38.3% among the study subjects. Significantly higher odds of having hypertension were observed in study subjects with the age groups of 35-49 (OR 2.12, 95% CI: 1.51-2.99, p<0.001) and ≥50 (OR: 4.96, 95% CI: 3.43-7.18, p<0.001) years than age group <35 years. Employees who were averagely satisfied and not satisfied for their jobs also had higher odds (OR: 1.38, 95% CI: 1.00-1.91, p=0.049 and OR: 1.48, 95% CI: 3.43-7.18, p=0.337) of having hypertension than fully satisfied ones. Having diabetes mellitus was found to increase the odds (OR 2.12, 95% CI: 1.51-2.99, p<0.001) of hypertension. Male gender, urban/suburban residence, not doing physical exercise, sedentary/light working habit, overweight/obesity also increased the odds of having hypertension though these were not statistically significant. There is a high burden of hypertension among the government employees in Rangpur city. Age, job satisfaction and diabetes were independent risk factors of hypertension.

Total Lip Reconstruction after Excision of Cancer with Composite Radial Forearm Palmaris Longus Tendon Free Flap

Reconstruction of total lip is a challenging task for a plastic surgeon. It becomes more complicated when there is loss of additional tissues like angle of mouth, buccal mucosa or floor of the mouth. Radial forearm flap with palmaris longus tendon provides an easier but reliable technique for three dimensional lip reconstructions with good functional and aesthetic outcome. In this short observational series we included 5 patients of total lip reconstruction and conducted at Sylhet MAG Osmani Medical College Hospital and Private Clinic of Sylhet, Bangladesh from January 2014 to December 2017. Among these one was a case of basal cell carcinoma of upper lip and rest was squamous cell carcinoma of lower lip. The mean age was 71 years. All the flaps survived and patients had normal speech and oral continence. Composite radial forearm flap with palmaris longus tendon is a good, reliable option for total lip reconstruction.

Outcome of Double Tension Band Wiring Method for the Treatment of Intercondylar Fractures of Humerus

Distal humeral fractures are relatively rare injuries that constitute approximately 2% of all fractures which occur due to high energy trauma in young males. Because they involve the articular surface and usually cause an instable elbow, surgical treatment is necessary for the recovery of elbow functions in the majority of cases. The principles of absolute stabilization and early mobilization in the elbow are of more importance than in any other joint. As the AO classification, nonunion and implant loosening is more common in type C fractures of the distal humerus involving the joint surface. Aim of this prospective study was to evaluate the outcome of "Double Tension Band wiring" method for the treatment of intercondylar fractures of humerus and was conducted in a tertiary hospital of Bangladesh from July 2017 to June 2019. Twenty five patients, all presenting with fresh fractures of the distal humerus, treated with double tension band wiring. These patients were prospectively evaluated over a period of at least 6 months. Fractures were classified according to Jupiter classification and AO classification of distal humeral fractures. Due to AO classification, total fractures were C1 fractures. Average age of the patients was 56.20 years (32-70 years). There were 20 males and 5 females. Out of 25 cases treated with this method, rigid fixation and union was achieved in all of them. The average tourniquet time was 69 minutes range was minimum 50 minutes and maximum 120 minutes. Radiological union was achieved at an average of 14.2 weeks (10-18 weeks). Average range of motion was 112.8 degrees (107-116). Excellent to good results were seen in almost 86% of cases as per the Mayo Elbow performance score at 6-month follow-up. Wound infection had been occurred in 2(8%) cases, ulnar nerve neuropathy had been occurred in 1 case, delayed union of olecranon process of ulna had been occurred in 1(4%) case, implant failure had been occurred in 2(8%) cases, heterotrophic ossification had been occurred in 2(8%) cases, varus valgus instability had been occurred in 1(4%) case, gun stock deformity had been occurred in 2(8%) cases. Double tension band wiring is a reliable, less demanding and cost effective method of fixation of intercondylar fractures of humerus.

Outcome of Bone Marrow Injection in Patient with Delayed Union and Non-Uninon of Long Bone Fracture

Bone marrow is a source of osteoprogenitor cells which are the most important factor of bone formation and healing of fracture. The aim of the study is to evaluate the outcome of bone marrow injection in the management of delayed union and non-union. This prospective study was performed in the department of Orthopaedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2017 to June 2019. In this study 21 patients with delayed union and non-union were treated by bone marrow injection. Bone marrow were aspirated from the anterior or posterior iliac crests then injected percutaneously into the fracture site. Full union was achieved in 15 cases, while failed in the others. No major complications were seen during or after the procedure. It is a safe, easy and a minimally invasive procedure compared to usual open bone graft especially for cases with high risk of anesthesia or risk of infection.

Antimicrobial Resistance Pattern and Genetic Characteristics of ESBL and Carbapenemase-producing Escherichia coli at a Tertiary Care Hospital in Bangladesh

Uropathogenic Escherichia coli is frequently resistant to different antibiotic leading to a critical condition of the patients. The purpose of the present study was to see antibiotic resistance pattern and genetic characteristics of ESBL and Carbapenemase-producing Escherichia coli. This cross sectional study was conducted in the Department of Microbiology at Mymensingh Medical College, Mymensingh, Bangladesh from October 2014 to December 2015. Patients presented with clinically diagnosed urinary tract infection at any age with both sexes who attended in the OPD of Mymensingh Medical College Hospital and the Doctors Diagnostic Centre in Mymensingh, Bangladesh was selected as study population. Non duplicate clinical isolates from urine were collected in full aseptic precaution for culture of bacteria. Escherichia coli were confirmed by PCR Stargetingadk. Antimicrobial susceptibility was measured by broth microdilution test. Minimum inhibitory concentrations against 18 antimicrobial agents were measured. Beta-lactamase genes were detected by multiplex PCR. For all the isolates showing resistance to imipenem and/or meropenem, presence of carbapenemase genes was confirmed by multiplex/uniplex PCR using primers. A total of 233 non-duplicate clinical isolates of Escherichia coli were collected from patients of which dominant phylogenetic group was B2 which was 78(33.5%) isolates of which 71 isolates were B2a and 7 isolates were B2b. Furthermore, Group A was in 29.6% isolates and Group D was in 26.6% isolates. E. coli showed significantly higher resistance rates to piperacillin, cephalosporins, and some other antimicrobials. Meropenem-resistance was detected in 8.2% of E. coli. The detection rate of blaTEM was 41.6% in E. coli. Carbapenemase genes were detected in 9(3.9%) isolates of E. coli and identified as genes encoding NDM-1, -5, and 7 and OXA-181. All the blaNDM-positive E. coli isolates carried also blaCTX-M-15, except for a group B1 isolate. E. coli is significantly higher resistance rates to piperacillin, cephalosporins, and some other antimicrobials and possesses different ESBL and carbapenemase genes.

Demography and Symptom Profile of Tetanus: A Cross-sectional Observation in an Infectious Disease Hospital of Bangladesh

Tetanus is a potentially preventable neurological infectious disorder with paucity of literature in Bangladesh. We aimed to see the demography and symptom profile of tetanus cases managed at the Infectious disease Hospital Sylhet. This hospital based cross-sectional descriptive study was conducted within the time period of January to December 2012 among 50 consecutive admitted patients in the Infectious Disease Hospital, Sylhet, Bangladesh who were diagnosed as a case of tetanus and fulfilling the inclusion criteria and exclusion criteria. Neonatal tetanus was considered as exclusion criteria and clinical diagnosis of tetanus was considered as the tetanus. Data were collected purposively with pretested predesigned questionnaire. Data were processed manually and analyzed with the help of SPSS Version 16.0. The mean±SD age was 33.00±16.8 years, ranging from 10 to 70 years. Among the 50 respondents, 72.0% were male, 50% from lower class, 34% were students and 30.0% had their educational status of primary level, 60.0% from rural social background. Trismus was found in 98.0% of the cases, rigidity in 96.0% cases, body ache in 94.0% cases, dysphagia in 92.0% cases, neck pain in 78.0% cases, dysarthria in 92.0% cases, reflex spasm in 66.0% cases, opisthotonus in 46.0% cases and urinary retention in 26.0% cases. In this study rural male people with lower socioeconomic status individuals were mostly affected with trismus, rigidity, body ache and dysphagia symptoms.

Next-generation sequencing reveals significant variations in bacterial compositions across the gastrointestinal tracts of the Indian major carps, rohu (Labeo rohita), catla (Catla catla) and mrigal (Cirrhinus cirrhosis)

Bacterial communities strongly influence the digestion, health and immune status of fish. This study investigates the microbial distribution of the anterior, middle and distal gut sections of three economically important carp species in Bangladesh, rohu, catla and mrigal (commonly known as Indian major carps), using 16S rRNA-based Illumina sequencing technology. The alpha-diversity measurement with one-way ANOVA indicated high species richness, Shannon and Simpson indices in the middle and distal gut, while the anterior gut of IMCs had the lowest diversity. At the phylum level, there was high abundance of Proteobacteria in the GITs of rohu and mrigal, whereas Fusobacteria was dominant in the anterior and middle guts of catla. At the genus level, diverse microbial communities were identified across the three GIT sections, with six indicator genera found in rohu, catla and mrigal, as revealed by linear discriminant analysis (LDA) at a 0·05 level of significance. Of the 218 genera identified, only 33 were common across the anterior, middle and distal guts of all three species. Bacterial diversity was significantly higher (P < 0·05) in mrigal, followed by catla and rohu, respectively. Alongside the common bacteria Aeromonas, Enterobacter and Serratia, the overwhelming abundance of Cetobacterium, Shewanella and Plesiomonas warrants further investigation. SIGNIFICANCE AND IMPACT OF THE STUDY: This study investigates the microbial communities of the gastrointestinal tracts (GITs) of three Indian major carp (IMC) species-rohu, catla and mrigal, obtained from a polyculture pond under the same feeding regime. Diverse microbial communities were found, with significantly different relative abundances and diversities of phyla and genera. The results provide valuable information on GIT microbial communities that may be useful for nutrition and health management in IMCs.

Comparative assessment of the physicochemical and biochemical properties of native and hybrid varieties of pumpkin seed and seed oil (Cucurbita maxima Linn.)

The hybrid variety of Cucurbita maxima is commercially available and frequently used as food in Bangladesh compared to the native variety. Although the seeds of Cucurbita maxima have nutritional and therapeutic values, people in Bangladesh typically throw them away as waste. If we can explore their physicochemical and biochemical properties, this will add new knowledge to nutrition and food science. Thus, in this study, we compare the physicochemical and biochemical properties of native and hybrid varieties of pumpkin seed and seed oil. Solvent extraction methods were used to obtain oil. The physicochemical properties of the extracted seed oils were examined by titration methods and proximate compositions of pumpkin seeds were determined using the standard method. Tocopherols were analyzed by HPLC and fatty acids were identified by GC/MS as N-acylpyrolidines. The specific gravity, refractive index, viscosity, acid value, saponification value, iodine value and ester values were determined and among them iodine values and acid values were significant (p < 0.05) at native but saponification and ester values were very highly significantly (p < 0.001) at hybrid. The comparative lipid content in the seed of native variety was higher than hybrid (p < 0.01) and protein contents were higher but not significant. However, crude fiber content was higher in the hybrid (p < 0.01). There was no significant differences of moisture, ash, sugar and starch contents in between the two varieties. The total tocopherol, contents were very high (p < 0.001) in native. In hybrid, saturated fatty acids -capric acid, myristic acids were more (p < 0.001) but in native unsaturated fatty acid linoleic and linolenic acids were predominant (p < 0.05). Owing to the considerable differences in the physicochemical composition, the fatty acids and other properties, this study may suggest that the both varieties of pumpkin seed oil may be an alternative good source of edible oil.

Evaluation of Corrosion and Tarnishing of Intra-oral Nickel Chromium and Gold-alloy Cast Crown

Although esthetic factors might limit by the presentation of materials used, all-metal complete cast crown should always be offered to patients requiring restoration of endodontically treated posterior tooth. The complete cast crown has the highest longevity of all fixed restorations. It could be used to rebuild a single tooth or a retainer for a fixed prosthesis. It involves all the axial walls as well as the occlusal surface of the tooth to be restored. All restorations are placed in the oral environment in contact with the gingival tissue. Thus clinicians must choose nontoxic or least toxic metal alloys, since any release of elements that might cause reactions. This study was designed to observe clinical responses of nickel chromium alloy and gold alloy cast crown and provide guidance to ascertain the best alloy for cast metal crown, which serves better functional restoration.

Mesenteric Fibromatosis: A Case Report

Fibromatosis of mesentery is a very rare disease and only a few cases have been reported. Here we report a case of 40 year old man admitted on 16 October, 2017 in the Department of Surgery (Unit-3) of Mymensingh Medical College Hospital with history of recurrent abdominal pain and progressively enlarging intra-abdominal lump for 2 years. Out of different diagnostic dilemmas, finally we came to the conclusion of its being a mass lesion primarily arising from the mesentery and involving the adjoining gut according to the report of CT abdomen. Laparotomy was performed and a lump measuring about 18 cm × 20 cm arising from mesentery was found, in which distal part of jejunum and proximal part of ileum were embedded. The mass was excised with incorporated gut loops and histopathology report revealed fibromatosis of mesentery.

Seizures in Down Syndrome: An Update

The prevalence of seizures in individuals with Down Syndrome (DS) is higher than in the general population. Rates of epilepsy in DS range from 1-13%. Forty percent of individuals develop seizures before 1 year of age and another 40% develop in their thirties or later. Boys have an earlier age of onset. The prevalence of epilepsy increases with age. Types of seizures are: 47% partial seizures, 32% infantile spasms and 21% generalized tonic-clonic seizures. Sex distribution for epilepsy in children with DS varies. Males have a younger age at onset. Trisomy 21 is common among epileptic children with DS but mosaicism or translocation has also been documented. The mechanisms underlying the increased seizure susceptibility in DS have not yet been completely explained. Seizures in infancy may be due to inherent structural brain abnormalities, like fewer inhibitory neurons, abnormal cortical lamination, persistent fetal dendritic morphology, underdeveloped synaptic profiles. Concentrations of carbonic anhydrase II are increased in the brains of young children with DS. It potentially increases seizure susceptibility. The pharmacological treatment of epilepsy in DS is same as that of other patients diagnosed with epilepsy. Individuals with DS have an unusually high number of side-effects from phenytoin. The diagnosis, classification and treatment of epilepsy in DS follow the guidelines applied to the general population. Review of literatures from 1960 to 2017 and electronically identified articles on epilepsy in Down syndrome in children in English are searched from internet and pub med to describe features of seizures in children with DS.

Microbiome patterns reveal the transmission of pathogenic bacteria in hilsa fish (Tenualosa ilisha) marketed for human consumption in Bangladesh

AIMS

This study conducted bacterial community, virulence and antibiogram profiling inside the hindgut and skin of freshly caught hilsa fish and those sold at markets.

METHODS AND RESULTS

The results of 16S rRNA-based high-throughput sequencing showed a higher number of bacterial genera in marketed fish samples than in fresh fish samples. The total operational taxonomic units, genus counts and diversity index were significantly higher (P > 0·05) in marketed fish, which also had abundant pathogenic bacterial groups. Skin samples had a lower profusion of pathogenic bacteria than gut samples. A total of 52 bacterial isolates from nine species were identified in this study, of which 25 were from a Chittagong market and 22 were from a Dhaka market, whereas only five were from fresh hilsa. The polymerase chain reaction amplification of 12 species-specific virulence genes in the 52 isolates, namely, aer, hly, chxA, toxB, rtxC, sfa, uge, norB, trx, toxA, ipaH, sigA and coa, indicated a high number of positive samples containing Vibrio cholerae, Aeromonas spp., Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus. Antibiogram profiling of these bacteria against 10 commercial antibiotics showed high-resistance patterns of the isolates against sulfamethoxazole, kanamycin, neomycin, ampicillin and tetracycline.

CONCLUSION

The results reveal the spread of multidrug-resistant bacteria in hilsa fish marketed for human consumption in Bangladesh.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study highlights the risk of spreading environmentally and clinically pathogenic bacteria in fish sold for human consumption in Bangladesh. Such bacteria come from aquatic pollution and poor handling, storage and transportation practices that may predispose fish to major outbreaks of infectious and waterborne diseases.

Elimination of spurious modes in full-vectorial finite element method based acoustic modal solution

Finite element method is a powerful technique for solving a wide range of engineering problems. However, the existence of the spurious solutions in full-vectorial finite element method has been a major problem for both acoustic and optic modal analyses. For emerging photonic devices exploiting light-sound interactions in high index contrast waveguides, this problem is a major limitation. A penalty function is introduced to remove these unwanted spurious modes in acoustic waveguides, which also identifies the acoustic modes more easily. Numerically simulated results also show considerably improved vector mode profiles. The proposed penalty method has been applied for the characterization of low index contrast single mode fiber and also for high index contrast silicon nanowire to demonstrate its effectiveness.

Management of Distal Third Comminuted Humerus Shaft Fracture by LCP Using Posterior Approach

Distal third comminuted humerus shaft fractures are challenging injuries to treat because of complex anatomy and fracture patterns. Functional bracing, operative treatment with intramedullary nails or conventional plates also has limitation of inadequate fixation in the distal third comminuted humerus shaft fractures. Locking compression plate (LCP) has been introduced to overcome this problem. Our aim of this study was to assess the effectiveness of osteosynthesis of distal third comminuted humerus shaft fractures by LCP using posterior approach. This prospective observational study was conducted from July 2015 to June 2018 at Mymensingh Medical College Hospital (MMCH) and National Institute of Traumatulogy & Orthopaedic Rehablitation (NITOR), Dhaka, Bangladesh. Thirty three patients were operated on for comminuted fractures of distal third humerus. Two cases were excluded from the evaluation of final out come due to their discontinued follow up. Treatment included open reduction and LCP fixation by posterior mid line approach. The range of motion of the shoulder and elbow were evaluated according to the criteria by modified Constant and Murley scoring system. Union was achieved in all the patients after a mean of 17 weeks (range 12-24 weeks). Deep infection, nonunion, malunion, implant failure or permanent nerve injury did not occur in any of the patients. Three patients had transient radial nerve palsy. Four patients developed superficial infections. All patients were relieved pain postoperatively. Shoulder range of motion was excellent in 20 patients & elbow range of motion was excellent in 21 patients. Functional out come were excellent in 11 & good in 16 patients which constituted 87% satisfactory results. Treatment with open reduction and LCP fixation by posterior approach is a safe and effective option in distal third comminuted humeral fractures.

Serum Calcium Level in Preeclamptic Patients of Bangladesh

Preeclampsia is one of the most frequent complication of pregnancy which manifested by hypertension during pregnancy for the first time after 20th weeks of gestation with proteinuria. The aim of the study was to estimate the changes in serum calcium level in preeclamptic patients when compared with normal pregnant women. The case control study was carried out in the Department of Biochemistry, Mymensingh Medical College, Mymensingh, Bangladesh in collaboration with the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2016 to June 2017. A total of 100 subjects were included. Among them 50 were subjects of preeclamptic patients as case and another 50 were apparently healthy normal pregnant women as control. The study revealed that serum calcium level was lower in preeclamptic women (case) as compared to healthy control subjects. The mean values of serum calcium levels were 7.63±0.42 and 8.12±0.94mg/dl in case and control group respectively. The difference in mean serum calcium were highly significant (p<0.001) when compared between case and control.

Evaluation of Fixation for Distal Humeral Diaphyseal Fracture by Locking Compression Plate

Treatment of extra-articular distal humeral shaft fractures with plating techniques is often difficult. The recent development of LCP has improved the surgical treatment of fractures by overcoming the few drawbacks of older fixators. The aim of this prospective observational study was to assess the effectiveness of osteosynthesis of extra-articular diaphyseal fractures of the distal third of the humerus using a single locking compression plate (LCP) and was conducted from July 2016 to June 2018 at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. Thirty (30) patients with closed fracture distal 3rd extra-articular humeral shaft fractures were treated by open reduction and internal fixation by locking compression plate. Two cases were excluded from the evaluation of final outcome due to their discontinued follow up. Detailed clinical conditions of all patients, technical difficulty with the implant, postoperative hospital stay period were recorded. Patients were followed up at 2nd week, 4th week, then 4 weekly upto 6 months. The patients were evaluated clinically and radiologically for outcomes. The progresses of healing as well as occurrence of complications were recorded. The range of motion of the shoulder and elbow were evaluated according to the criteria by Rommens grading. Functional evaluation was made according to the criteria by Modified Constant and Murley Scoring System. Union was achieved in all the patients after a mean of 15 weeks (range 12-20 weeks). There were no complications like deep infection, nonunion, malunion, implant failure, or nerve injury occurs in any of the patients. Two patients had transient radial nerve palsy. Two patients developed superficial infection. All patients were relieved pain postoperatively. Functional outcome were excellent in 10 patients, good in 15 patients which constituted 89% satisfactory results. The study has shown that the LCP is an effective, dependable solution for the management of distal third diaphyseal fractures of the humerus.

Diagnostic Accuracy of Refractory Shadowing from Uterine Leiomyomas: Sonographic-Pathologic Correlation

This cross sectional study was carried out in the Department of Radiology & Imaging, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh from July 2010 to June 2011 with a view to evaluate the diagnostic accuracy of refractory shadowing on transabdominal pelvic sonography for leiomyomas and in differentiating them from other pelvic masses. Histopathological examination of the surgically resected masses was taken as the standard diagnostic tool. A total number of 50 patients of pelvic masses were studied. It was observed that a pattern of sharp, discrete, shadow was typical of leiomyoma, which reduces diagnostic ambiguity. The mean age of the patients was 38 years. Mean size of the masses was 4.25±3.25cm. Taking histopathological examination as the Gold standard, accuracy of refractory shadowing on transabdominal sonography in diagnosis of leiomyoma was 65.1%. Specificity and sensitivity were 90.3% and 54.2% respectively. Positive predictive value was 92.9% and negative predictive value was 45.9%. Statistical analysis revealed strong association of refractory shadowing with diagnosis of leiomyomas (p<0.01).

Do It Better: Cross Mattress for Chest Drain Insertion Site Security Offers Quality Outcome in Chest Trauma Patients Required Tube Thoracostomy

We examined the hypothesis that the cross mattress for chest drain insertion site security is better than that of polypropylene horizontal mattress in chest trauma patient required tube thoracostomy at the Department of Casualty Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2016 to June 2016. Accordingly we prospectively studied 50 consecutive patients who needed chest tube insertion. In 25 consecutive cases chest drain insertion site was secured with polypropylene horizontal mattress technique (Control- Group A) and another 25 consecutive patients had a cross-mattress with non-absorbable suture materials (Experimental- Group B). All chest tubes were inserted into the triangle of safety to following the BTS guideline. A baseline x-ray chest was compared with post-procedure chest x-ray. Male preponderance and young adults were comprised in both the groups; mean age in Group A and Group B was 38.7±15.5 and 37.3±14.1 respectively. Haemo-pneumothorax was the most common cause of tube thoracostomy among the trauma victims. This study shows that, polypropylene horizontal mattress results in increased chest tube site infection 52% in Control Group vs. 12% in Experimental Group (p=0.002). Although there was similar incidence of blood loss between the groups, the length of Hospital stay was significantly higher in Control Group. We conclude that cross mattress for chest drain insertion site security showed a better clinical outcome, less wound complications and less hospitalization.

Laboratory Diagnostic Options and Challenges for Chikungunya Viruses

Background: Chikungunya infection is a Aedes mosquito transmitted viral disease caused by Chikungunya virus (CHIKV), a member of the Alphavirus genus. It is an important human pathogen that causes a syndrome characterized by fever, chills, headache and severe joint pain usually of the smaller joints, with or without swelling. Though the disease is almost self-limiting, during the recent outbreak CHIKV was also found to cause long-term arthralgia, neurological disease and even few fatalities. Despite the fact that CHIKV is associated with epidemics of unprecedented magnitude, only a few specific serological and molecular diagnostic tools are available.Objective: CHIKV diagnosis is essentially based on virus isolation, reverse transcription (RT)-PCR and ELISA assays. The gold standard of CHIKV diagnosis is culture, however, required facilities and skills are not available in any routine laboratory in the country. Highly sensitive and specific PCR assays for CHIKV have been developed and commercially available.Conclusion: Although the reagents and equipment are costly for widespread use RT-PCR is the method of choice for the early detection and confirmation of virus in clinical samples as most acutely infected patients seek medical attention within the first few days of illness when role of serology based diagnosis is minimum.Pulse Vol.10 January-December 2017 p.18-24

Simultaneous Detection and Differentiation of Chikungunya Virus and Dengue Virus in Blood at Clinical Presentation by Real Time RT-PCR

Background: Chikungunya viral infection in Bangladesh has marked 2017 summer with unprecedented magnitude for the first time. Chikungunya virus (CHIKV) and Dengue virus (DENV) are arboviruses that share the same Aedes mosquito vectors and thus overlap in their endemic areas.These two viruses cause similar clinical presentations, especially in the initial stages of infection. Because the outcomes and management strategies for these two viruses are different, early and accurate diagnosis is imperative. Early diagnosis is also important for surveillance and outbreak control.Objective: As virus isolation is not undergoing in the country and antigen based commercial detection assay is not available for CHIKV we used one step real time reverse transcriptase polymerase chain reaction (RT-PCR) method to detect and discriminate CHIKV and DENV in blood during suspicious clinical symptoms.Results: By this RT-PCR method we have detected 603 cases of CHIKV and 233 cases of DENV and thus facilitated rapid diagnosis and clinical management in the recent CHIKV outbreaks in the country.Conclusion: This is the first report about molecular detection and differentiation of CHIKV and DENV at time of clinical presentation and further show evidence of simultaneous outbreaks of both the viral infections in the country.Pulse Vol.10 January-December 2017 p.6-11

Investigation of methicillin-resistant Staphylococcus aureus among clinical isolates from humans and animals by culture methods and multiplex PCR

Background

Staphylococcus aureus is responsible for large numbers of hospital-related and community-acquired infections. In this study, we investigated the presence of S. aureus and methicillin-resistant S. aureus (MRSA) in 100 samples from animals (55 cattle, 36 dogs, and 9 cats) and 150 samples from hospitalized human patients. The samples were collected from healthy and diseased animals and from diseased humans and included milk, wound swab, pus, exudates, nasal swab and diabetic ulcer. Initially, S. aureus was isolated and identified by colony morphology, Gram staining, and biochemical tests (catalase and coagulase tests). The S. aureus-positive samples were examined by polymerase chain reaction (PCR) to determine their MRSA status.

Results

Of the 100 animal samples, 29 were positive for S. aureus. Four samples (13.8%) from dogs were MRSA-positive, but samples from cattle and cats were MRSA-negative. Of the 150 human samples we collected, 64 were S. aureus-positive and, of these, 34 (53.1%) were MRSA-positive. Most (28%) of the MRSA samples were isolated from surgical wound swabs, followed by the pus from skin infections (11%), exudates from diabetic ulcers (6%), exudates from burns (4%), and aural swabs (3%). By contrast, a low MRSA detection rate (n = 4) was seen in the non-human isolates, where all MRSA bacteria were isolated from nasal swabs from dogs. The antimicrobials susceptibility testing results showed that S. aureus isolates with mecA genes showed resistance to penicillin (100%), oxacillin (100%), erythromycin (73.5%), ciprofloxacin (70.6%), and gentamicin (67.7%). The lowest resistance was found against ceftazidime, and no vancomycin-resistant isolates were obtained.

Conclusions

We detected S. aureus and MRSA in both human and canine specimens. Isolates were found to be resistant to some of the antimicrobials available locally. MRSA carriage in humans and animals appears to be a great threat to effective antimicrobials treatment. The prudent use of antimicrobials will reduce the antimicrobial resistance. Our findings will help to find the most appropriate treatment and to reduce antimicrobial resistance in the future by implementing prudent use of antimicrobials. Further studies are required to better understand the epidemiology of MRSA human–animal inter-species transmission in Bangladesh.

Electronic supplementary material

The online version of this article (10.1186/s12917-018-1611-0) contains supplementary material, which is available to authorized users.

Anti-phospholipid Antibody Syndrome Presenting as Huge Ascites: A Case Report

Antiphospholipid Syndrome (APS) is characterized by arterial, venous or small vessel thromboses and/or pregnancy morbidity in the presence of persistently elevated titers of antiphospholipid antibodies. Since virtually any organ can be involved, the clinical presentation of APS is very varied. Abdominal manifestations are rare but may be life-threatening, and include Budd-Chiari Syndrome. We report the case of a 26-year-old woman with primary APS, on aspirin treatment, who presented to us at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh in March 2017 with ascites for which she had been receiving treatment for abdominal tuberculosis. Following clinical and laboratory evaluation, she was diagnosed as a case of Budd-Chiari Syndrome with portal hypertension and initiated treatment with warfarin. There should be a high index of clinical suspicion for Budd-Chiari as a cause of ascites in patients with APS, since early recognition and treatment can significantly improve patients' survival.

A Randomized Controlled Trial of Phenobarbital and Levetiracetam in Childhood Epilepsy

Levetiracetam has been introduced for the control of seizures besides phenobarbital as monotherapy in children with epilepsy. This study was aimed to compare the effectiveness of these two drugs for the control of seizures in epilepsy. This randomized controlled trial was done to assess the efficacy and tolerability of levetiracetam compared to phenobarbital in childhood epilepsy and was conducted in Institute of Pediatric Neurodisorder and Autism (IPNA), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh among children between 1 month to 15 years who were diagnosed as cases of epilepsy (idiopathic focal, generalized, focal with secondary generalization) according to ILAE to assess the effect of Levetiracetam (n=50) and Phenobarbital (n=68) from May 2015 to July 2016. The children were followed up for 12 months at 3 months interval to compare the seizure remission and side effects of Levetiracetam and Phenobarbital. The children in levetiracetam group was about 10 months older along with older age of onset of seizure (p=0.02) than those of phenobarbital group (p=0.03 and 0.02 respectively). GTCS was the most common type of seizure in both groups. During 3 months of intervention 55.8% patients of levetiracetam group achieved 50-75% seizure remission compared to 44.2% in phenobarbital group, at 6 months period 75-100% seizure remission observed among 57.4% patients of levetiracetam group compared to 42.6% of phenobarbital group (p=0.06), which continued to increase at 9 months in levetiracetam (n=33, 55.9%) compared to phenobarbital (n=26, 44.1%) and this value is statistically significant (p=0.05). No further improvement observed at 12 months follow up. Behavioral problem was reported among 4 patients of phenobarbital group without any evidence of cognitive deterioration, only 3 patients of levetiracetam experienced irritability, but no children of both group discontinued treatment due to side effects. Levetiracetam mono-therapy is more effective in controlling seizures in focal, generalized and focal with secondary generalization epilepsy compared to phenobarbital with minimum side effects.

Management of Post Traumatic Kyphotic Deformity in Thoracolumbar Spine: Conservative versus Operative Treatment

Local post traumatic kyphosis may impair spinal sagittal balance and result in seven disability and programmed neurological deficit. In operative group the mean±SD fracture kyphosis was 34.21±3.7 at the time of admission and mean±SD kyphosis was 17.64±3.20 at the time of final follow up. In conservative group the mean±SD kyphosis was 32.96±4.06 at the time of admission and mean±SD kyphosis was 40.28±4.72 at the time of final follow up. It is interesting to note that in conservative group kyphosis increased (7.3) during final follow up but decreased (16.57) in operative group during final follow up due to spinal instrumentation and post-lateral fusion. Local post traumatic kyphosis may impair spinal sagittal balance and result in severe disability and progressive neurological deficit. Objective of the study is to find out the better option in the management of post traumatic kyphotic deformity in thoracolumbar Spain injury. The quasi-experimental study was carried out at the National Institute of Traumatology & Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh from January 2006 to December 2008. A total number of 40 patients with post traumatic thoracolumbar spine injuries with kyphotic deformity selected purposively. Out of 40 cases 1 patient missed from final follow up. Rest of 39 patients was included in this study. All patients were admitted within 3 weeks of injury. Most were referred from peripheral hospital & some were admitted in emergency and outpatient department of NITOR. Among those 25 patients were conservatively treated and 14 were operatively treated. In operative group the mean±SD fracture kyphosis was 34.21±3.7 at the time of admission and mean±SD kyphosis was 17.64±3.20 at the time of final follow up. In conservative group the mean±SD kyphosis was 32.96±4.06 at the time of admission and mean±SD kyphosis was 40.28±4.72 at the time of final follow up. It is to note that in conservative group kyphosis increased (7.3) during final follow up but decreased (16.57) in operative group during final follow up due to spinal instrumentation and post-lateral fusion.

Exploring the status of disaster risk reduction focusing coping strategies in Rangpur division of Bangladesh

Bangladesh is a low laying country where disaster events are common phenomena almost every year. Same as coastal areas of Bangladesh, the northern areas are now suffering huge events of floods, droughts and riverbank erosion. The main purpose of this study is to determine the practice of disaster coping strategies by the people in the study areas. The study was carried out at Rajibpur sub-district under Kurigram district, Saghatta sub-district under Gaibandha district, Gangachara sub-district under Rangpur district, Aditmari sub-district under Lalmonirhat district and Dimla sub-district under Nilphamari district. Data were collected from a sample of 300 respondents from 5 subdistricts by using interview schedules 12 January 2017 to 19 March 2018. About 80% respondents are dependent on the TV or Radio news for pre-disaster warning and forecasting as well as more than this population loses their property above BDT 50000 in every year due to disaster damage. During flood, the respondents maintain some scoping materials like raising plinth, making scaffold, using moveable cooking materials, taking loan from the Mahajan and sold their non-productive assets. Most of the respondents from various study area follow these kinds of measures and about 63.33% respondents use bamboo or wood for their cooking purpose during flood. About 40% respondents from these study areas are suffered of shelter due to riverbank erosion and they migrate here and there for better life. More than two third of the respondents have no opportunity to get any kind of help or relief from the GOs and NGOs. They are now depending on their own coping strategies. They badly need a new coping strategy for reducing the damage of flood or riverbank erosion. Disaster forecasting, early warning system and community-based flood management can save many lives and properties. For effective disaster management strategies, it could be applied early warning systems and adequate training as pre-disaster strategy and availability of relief and other inputs at acceptable price and loan with flexible conditions as post-disaster strategy. Progressive Agriculture 29 (3): 195-204, 2018