A Prospective Study of Deep Vein Thrombosis after Major Abdominal Surgery in a Tertiary Level Hospital

This prospective study was conducted to find the rate of deep and risk factors associated with vein thrombosis following major abdominal surgery in Sylhet MAG Osmani Medical College Hospital from 1st November 2017 to 30th April 2018. Total 103 patients aged above 20 years both male and female who got admitted in Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet for their disease requiring routine and emergency major abdominal operation during the study period and fulfilling the inclusion and exclusion criteria were selected in this study. Informed written consent was obtained from the patients after full explanation of the purpose of the study. After full investigations and proper preparation of each patient for operative procedure major abdominal surgery were done. Peroperative findings were noted and post-operative period were followed up routinely. Duplex scanning was done on 3rd POD in all cases. The age of the patients ranged from 25 to 74 years with the mean age of 49.5±13.8 years. There were 60(58.3%) male and 43(41.7%) female. Deep vein thrombosis (DVT) developed in 5(4.9%) of cases and not developed in 98(95.1%) cases. All the five cases were confirmed by color duplex scan. DVT was detected in 2(3.3%) of the 60 males and 3(7.0%) of the 43 females undergoing major general surgical procedures. Among 63 patients in whom the duration of surgery was up to 2 hours, none developed DVT, while among the 40 patients in whom the duration of surgery lasted more than 2 hours, 5(12.5%) developed DVT. Among 23 patients in whom the surgery for malignancy was done, 4(17.4%) developed DVT, while among the 80 patients in whom surgery for non-malignancy, 1(1.2%) developed DVT. The Incidence of DVT in patients undergoing major abdominal surgery is 4.9%. Patients undergoing major abdominal surgery for malignancy and duration of operation greater than 2 hours have higher risk of developing DVT. But there is no significant increase in risk of development of DVT relation to age and sex; and also in patients on oral contraceptives, diabetes mellitus, obesity and smoking. Clinical findings alone cannot be relied upon for the diagnosis of DVT. The study has to be continued with larger sample size to get statistically significant results.

Prognostic factors relating to outcome of severe malaria among children in Bangladesh

This study was done in the Paediatric in-patient department of Chittagong Medical College Hospital (CMCH), Chittagong, Bangladesh to identify and quantify the prognostic factors associated with increased mortality in severe malaria (SM) cases. All the patients with parasitologically confirmed clinical syndromes of SM, admitted between June 1997 and May 1998, were included. A total of 53 consecutive cases were studied. Cerebral malaria (CM) was the commonest type of SM, observed in 36(68%) cases, second commonest type was severe anaemia 13(25%). More than one type of severe manifestations were present in 23(44%) cases. Overall case fatality rate (CFR) was 17% and it was 30% among those who had multi-organ manifestations. Important poor prognostic clinical variables were Blantrye coma score (BCS) score of 0 and 1 on day 1 (OR = 7.78) and day 2(OR = 40.0), multi-organ manifestations (OR = 6.8) and in-hospital complications (OR = 5.18). Important poor prognostic laboratory variables were day 2 parasite count > 50,000/cmm (OR = 5.5), blood glucose < 2.2 mmol/l (OR = 21.5) and raised CSF protein > 50 mg/dl (OR = 7.0). It can be concluded that certain clinical variables e.g. low BCS on day 1 & 2, multi-organ manifestations, in-hospital complications; and laboratory variables e.g. high parasite count, low blood glucose level, raised CSF protein levels are associated with increased mortality rate in SM cases.

Isolation of Vibrio-like group, EF-6, from patients with diarrhea

The Vibrio-like organism EF-6 was isolated from more than 500 patients with diarrhea in Bangladesh between October 1976 and June 1977. Bacteriological studies indicate that EF-6 is a member of the family Vibrionaceae and that it should be provisionally placed in the genus Vibrio. EF-6 was isolated from patients who had diarrhea, but was not conclusively implicated as the etiological agent. Pending further study, EF-6 should be considered a potential enteropathogen.

Foodborne outbreak of shigellosis caused by an unusual Shigella strain

A family outbreak of foodborne shigellosis caused by an unusual strain of Shigella is described. The strain was a mannitol-positive variant of Shigella dysenteriae and agglutinated in antiserum prepared against provisional serotype 3341-55.

Nutritional status: a determinant of severity of diarrhea in patients with cholera

The severity of diarrhea and nutritional status were measured in a prospective study of 97 patients hospitalized with cholera in Dacca, Bangladesh. Ninety-five percent of both adults and children were below their respective medians in weight as related to height; greater than 15% of each group showed second-degree protein-calorie malnutrition. Duration of diarrhea, but no volume of stool per hour, was prolonged by 30%-70% in those adults and children suffering from more severe malnutrition. The increased stool loss was unrelated to antibiotic usage, to presence of intestinal parasites, or to the refeeding diet given. It is suggested that the prolongation of diarrhea represents the continued effect of cholera toxin that is irreversibly bound to intestinal mucosal cells, the replacement of which would be retarded under conditions of poor nutrition.

Subclinical small-intestinal disease in East Pakistan

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