Diameter of the lymphoid follicles in the vermiform appendix of Bangladeshi cadaver

Appendicitis is the most common clinical condition of the appendix. Many cases of acute appendicitis result from obstruction of the lumen of the appendix by lymphoid hyperplasia. The vermiform appendix is a worm-like, closed-ended, narrow, small tubular structure, projecting from posteromedial wall of cecum. It is an integral part of the Gut Associated Lymphoid Tissue (GALT) system. The lymphoid follicles of the vermiform appendix vary in respect to their number, diameter and location in different ages. This study was done to measure and establish the normal diameter with age related variation of the lymphoid follicles of vermiform appendix in Bangladeshi population. This descriptive cross sectional study was carried out in the Department of Anatomy, Sir Salimullah Medical College, Dhaka, from January 2008 to June 2009. Sixty (60) postmortem vermiform appendices of different age groups of Bangladeshi cadavers. For studying the diameter of lymphoid follicles in the vermiform appendix in relation to age, the collected samples were divided into five groups namely Group-A between age ranges 0-20 years, Group-B between age ranges 21-30 years, Group-C between age ranges 31-40 years, Group-D 41-50 years and Group-E age above 50 years. From each age group, six (6) fresh samples were selected for histological study. From each vermiform appendix three slides were prepared each from its base, middle part and near the tip and were stained with routine H & E stain. The normal diameter of the follicles of the vermiform appendix ranged from 0.40 mm to 0.66 mm. The highest average group diameter was 0.62±1.10mm in Group-A and the lowest value was 0.45±2.73mm in Group-E. It was obvious that the diameter decreased gradually with advancing age. The average normal diameter of the lymphoid follicles per histological section of vermiform appendix reduced with advancing age and showed a significant negative correlation with age (p<0.001). In the present study, the normal diameter of the lymphoid follicles of the vermiform appendix reduced significantly with advancing age.

Primary adrenal leiomyosarcoma in an adult female

Primary leiomyosarcoma of the adrenal gland is a rare tumour and we describe such a case in a 35 year old female who had dull pain in the left flank for 6 months. There was no weight loss or fever only mild tenderness was in the left subcostal region. She was normotensive and there was no evidence of virilization. CT scan revealed left adrenal mass, after adrenalectomy it was 8.5×7.5×6.2cm³ in size. There was no evidence of local extension or metastasis. Histopathology confirmed adrenal leiomyosarcome.

Peginterferon α-2a and rivabirin in the treatment of chronic hepatitis C

Peginterferon α-2a with ribavirin produces significantly higher sustained virological response (SVR) in comparison to conventional interferon monotherapy in patients with chronic hepatitis C virus (HCV) infection. We evaluated the efficacy and safety of peginterferon α-2a plus ribavirin combination in the treatment of chronic hepatitis C among Bangladeshi patients. A total of 64 patients were randomly selected in this study and were assigned for treatment with peginterferon α-2a 180μg once weekly plus ribavirin daily for 24 weeks in case of genotypes 2 and 3 infections and 48 weeks in case of genotypes 1 and 4 infections. Ribavirin was given 800mg in divided doses in case of genotypes 2 and 3 infections and 1000mg-1200 mg in case of genotypes 1 and 4 infections according to body weight daily(1000 mg in divided doses if body weight <75kg and 1200mg in divided doses if body weight >75kg). Efficacy was assessed by measurements of serum HCV-RNA and serum ALT. A higher proportion of patients (71.87%) who received peginterferon α-2a plus ribavirin had a sustained virological response. It is observed that genotype 3 (a and b) patients showed poor response (SVR-47.05%), where as genotypes 1(a,b), 3 and 4 mixed, 2b and 4 infections showed response rate of 100%. So it can be concluded that once weekly peginterferon α-2a plus daily ribavirin is effective in chronic HCV infection in Bangladesh and overall response rate is similar to that reported in other studies.

Does the HPV vaccination programme have implications for cervical screening programmes in the UK?

•

Women who did not take up the HPV vaccination were less likely to attend for cervical screening.

•

HPV vaccinated women who attended cervical screening had the lowest proportion of cytological abnormalities detected.

•

Social deprivation was the main factor-affecting uptake of both HPV vaccination and cervical screening.

In the UK, a national HPV immunisation programme was implemented in 2008 for girls aged 12–13 years. In addition a catch-up programme was implemented for older girls up to 18 years of age from 2009 to 2011, with an uptake rate of 49.4%. Information about future uptake of cervical screening according to vaccination statistics is important in order to understand the impact of the vaccination programme and implications for a national cervical screening programme. We analysed data on a cohort of women who had been offered the HPV vaccine in the catch-up programme and were invited for cervical screening between 2010 and 2012 in Wales (n = 30,882), in a record-linked database study, to describe the cervical screening uptake and clinical outcome according to HPV vaccination status.

In our cohort, 48.5% (n = 14,966) women had had HPV vaccination and 45.9% (n = 14,164) women attended for cervical screening. Women who were unvaccinated were less likely to attend cervical screening (adjusted OR 0.58; 95% CI (0.55, 0.61)). Of those who attended for screening, 13.9% of vaccinated women had abnormal cytology reported compared to 16.7% of women who were unvaccinated. Women who lived in areas with high levels of social deprivation were less likely to be vaccinated (Quintile 5 OR 0.48 95% CI (0.45, 0.52)) or attend cervical screening (Quintile 5 OR 0.70; 95% CI (0.65, 0.75)) compared to those who lived in the least deprived areas.

These data highlight the need for new strategies to address inequalities in cervical screening uptake and can inform further mathematical modelling work to clarify the impact of the HPV vaccination programme on future cervical cancer incidence.

Surgical management of rectourethral fistula in different situations

This study was done to see the outcome of repair of rectourethral fistula (RUF) in different situations between 2002 and 2009 in Chittagong and Dhaka Medical College Hospitals. We prospectively reviewed the records of all the patients who developed rectourethral fistula. Total 18 patients were included and in all cases faecal and urinary diversion was done preoperatively. In 4 patients fistulas size was <1cm where spontaneous closure of RUF occured after 6 months of diversion. In 8 patients repair of fistula was done through the perineal approach where excision of fistulas tract with anastomotic urethroplasty and repair of rectal wound was done. Out of these 8 patients tunica vaginalis flap was applied in 3 and dartos pedicle flap in 5 cases, in the remaining 6 patients transrectal York-Mason repair was done. Out of 6 patients of York-Mason repair, one developed recurrent fistula - which underwent repair with a graft through the perineal approach later on with good result. No patient developed urinary or faecal incontinence. In 2 patients leakage of urine was noted in post operative days in the perineal wound and catheter was kept for 3 weeks more. No one had erectile dysfunction. Both faecal & urinary diversion adds benefit to the outcome of the rectourethral fistula. Transrectal York-Mason repair is easier to do with less morbidity and complication while perineal approach with graft interposition may be done in cases where anastomotic urethroplasty is needed along with fistula repair.

Clinical, biochemical, virological and sonographic profile of incidentally detected asymptomatic HBsAg positive subjects, in Bangladesh

Chronic hepatitis B virus (HBV) is known to be the significant cause of Liver related morbidity and mortality, affecting 400 million people worldwide and a major public health problem in Bangladesh where carrier rates of HBV infection varies from 7.5 to 10%. In Bangladesh prevalence of asymptomatic HBV infection and incidentally detected HBsAg positive subjects were not well studied. The aim of this study is to evaluate the disease activity, replicative status of the virus and to find out the stages of chronic liver disease among incidentally detected asymptomatic HBsAg positive Bangladeshi subjects. Two hundred (200) incidentally detected healthy HBsAg positive subject were evaluated clinically, biochemically, serologically and ultrasonographically from January 2004 to June 2008. HBeAg was found positive in 17(8.5%), anti-HBe was positive in 174(87%), raised serum ALT (>45iu/L) in 45(22.5%), prothrombine time (PT) >3 sec of control in 33(16.5%). Ultrasonography showed coarse hepatic echotexture in 13(6.5%). Evidence of active viral replication and signs of chronic liver disease were observed among incidentally detected healthy HBsAg positive subjects. Such individuals should be followed up at regular interval to evaluate the replicative status of the virus and disease activity so that appropriate measures could be initiated in time.

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