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.

Clinical and Laboratory Characteristics of an Acute Chikungunya Outbreak in Bangladesh in 2017

From April to September 2017, Bangladesh experienced a huge outbreak of acute Chikungunya virus infection in Dhaka. This series describes the clinical and laboratory features of a large number of cases (690; 399 confirmed and 291 probable) suffered during that period. This observational study was carried out at Dhaka Medical College Hospital, Bangladesh. The median age of the patients at presentation was 38 years (IQR 30–50) with a male (57.3%) predominance. Hypertension and diabetes were the most common comorbidities. The mean (±SD) duration of fever was 3.7 (±1.4) days. Other common manifestations were arthralgia (99.2%), maculopapular rash (50.2%), morning stiffness (49.7%), joint swelling (48.5%), and headache (37.6%). Cases were confirmed by anti-chikungunya IgG (173; 43.3%), IgM (165; 42.3%), and reverse transcription polymerase chain reaction (44; 11.0%). Important laboratory findings include high erythrocyte sedimentation rate (156; 22.6%), raised serum glutamic pyruvic transaminase (73; 10.5%), random blood sugar (54; 7.8%), leukopenia (72; 10.4%), thrombocytopenia (41; 5.9%), and others. The oligo-articular (453; 66.1%) variety of joint involvement was significantly more common compared with the poly-articular (237; 34.5%) variety. Commonly involved joints were the wrist (371; 54.1%), small joints of the hand (321; 46.8%), ankle (251; 36.6%), knee (240; 35.0%), and elbow (228; 33.2%). Eleven cases were found to be complicated with neurological involvement and two of them died. Another patient died due to myocarditis. Public health experts, clinicians, and policymakers could use the results of this study to construct the future strategy tackling chikungunya in Bangladesh and other epidemic countries.

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.

Prevalence of risk factors for non-communicable diseases in Bangladesh: Results from STEPS survey 2010

Background

Nationally representative data on noncommunicable disease (NCD) risk factors are lacking in Bangladesh. This study was done to determine the prevalence of common risk factors for major NCDs among men and women of rural and urban areas of Bangladesh.

Materials and Methods

This survey was done with 9,275 individuals aged 25 years or older randomly drawn from all over the country. Information on diet, physical activity, tobacco and alcohol, and treatment history for hypertension and diabetes were collected. Height, weight, waist circumference, and blood pressure (BP) were measured.

Results

There were 4,312 men and 4,963 women with the mean age of 42 years (standard deviation 13 years). Half of them (54%) used tobacco in some form, <1% consumed alcohol within the past 30 days, 92% did not consume adequate fruit and vegetables (five servings or more), and 35% had low physical activity level [<600 metabolic equivalent (MET) min per week]. Documented diabetes was found in 4% of the participants. Seventeen percent were overweight [body mass index (BMI) ≥25 kg/m²] and 21% had abdominal obesity (men ≥94, women ≥80 cm). Overall, 21% people had hypertension (blood pressure ≥140/90 mmHg or medication). Physical inactivity, alcohol intake, hypertension, obesity, and diabetes were more prevalent in urban areas, as opposed to tobacco. Tobacco intake showed a decreasing gradient, but hypertension, obesity, diabetes, and low physical activity showed an increasing gradient across the wealth quartiles.

Conclusion

Risk factors are widely prevalent in Bangladeshi people across sexes and across both rural and urban areas of residences. NCD prevention through risk factor control, and early detection and treatment of hypertension and diabetes are warranted.

Assessment of in vivo genotoxicity of citrated-coated silver nanoparticles via transcriptomic analysis of rabbit liver tissue

Background

Silver nanoparticles (AgNPs) are widely used in industrial and household applications, arousing concern regarding their safety in humans. The risks posed by stabilizer-coated AgNPs continue to be unclear, and assessing their toxicity is for an understanding of the safety issues involved in their use in various applications.

Purpose

We aimed to investigated the long-term toxicity of citrate-coated silver nanoparticles (cAgNPs) in liver tissue using several toxicity tests and transcriptomic analysis at 7 and 28 days after a single intravenous injection into rabbit ear veins (n=4).

Materials and methods

The cAgNPs used in this study were in the form of a 20% (w/v) aqueous solution, and their size was 7.9±0.95 nm, measured using transmission electron microscopy. The animal experiments were performed based on the principles of good laboratory practice.

Results

Our results showed that the structure and function of liver tissue were disrupted due to a single exposure to cAgNPs. In addition, in vivo comet assay showed unrepaired genotoxicity in liver tissue until 4 weeks after a single injection, suggesting a potential carcinogenic effect of cAgNPs. In our transcriptomic analysis, a total of 244 genes were found to have differential expression at 28 days after a single cAgNP injection. Carefully curated pathway analysis of these genes using Pathway Studio and Ingenuity Pathway Analysis tools revealed major molecular networks responding to cAgNP exposure and indicated a high correlation of the genes with inflammation, hepatotoxicity, and cancer. Molecular validation suggested potential biomarkers for assessing the toxicity of accumulated cAgNPs.

Conclusion

Our investigation highlights the risk associated with a single cAgNP exposure with unrepaired damage persisting for at least a month.

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.