Urosepsis and Bacteriuria in Patients Undergoing TRUS-Guided Prostate Biopsy

A prostate gland biopsy is a test to remove small sample of prostate tissue to be examined under a microscope. A biopsy may be done when a blood test shows a high level of prostate-specific antigen (PSA) or after a digital rectal examination finds an abnormal prostate or a lump. Transrectal ultrasound (TRUS) guided biopsy is a commonly performed procedure for the detection of prostate cancer. It is associated with serious complication like urosepsis. Although the incidence of post-TRUS urosepsis is low, when it occurs it is typically serious and leads to hospitalization. Antibiotics are used prior, during and after the procedure to prevent infections as a result of TRUS biopsy. Ciprofloxacin is being used as antibiotic of choice for a long time. Antibiotic prophylaxis may prevent such complications. This cross-sectional descriptive type of observational study was taken place in Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2010 to December 2011 among purposively selected 70 patients with an aim to determine the urosepsis and bacteriuria after TRUS guided prostate biopsy. Patients attending the Urology OPD in DMCH having of LUTS and other non-specific symptoms were evaluated by history, physical examination including digital rectal examination (DRE) and necessary investigations like serum PSA to identify the potential candidates. Patients with abnormal DRE findings and increased PSA level were included in this study and those who had any painful anal and rectal condition, bleeding diathesis, anticoagulant therapy and any known allergy to lidocaine, previously undergone prostrate biopsy and those who refused to give the informed consent were excluded from this study. Data were collected on variables of interest using a structured case record form. Data were processed and analyzed using Statistical package for social science (SPSS), version 17.0. Frequency of bacteriuria and urosepsis was measured according to urine and blood culture report. Sensitivity pattern was also seen. According to this study, the frequency of bacteriuria and urosepsis was 17.1% and 5.7% respectively. Most common uropathogen was E coli both in urine and blood culture. Organisms (100.0%) were found resistant to ciprofloxacin and amoxicillin. Most of the pathogens were sensitive to tobramycin, gentamycin and cefipime. A potentially dangerous ciprofloxacin resistant organism (ESBL producing E. coli) was found positive in 25.0% of culture positive patients.

National Clinical Guidance for the Management of Cardiovascular Intervention in the COVID-19 Pandemic: From Bangladesh Society of Cardiovascular Interventions (BSCI)

Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.

Combined edge crispiness and statistical differencing for deblocking JPEG compressed images

In this work, a new approach is proposed that deals with blocking effects in JPEG compressed images. High-frequency details of the coded images are mainly contaminated by quantization noise. Preserving the image details and reducing the effect of quantization noise as much as possible can improve the ability of any enhancing method. To achieve this goal along with the removal of the blocking effect, the high-frequency components of the image are first extracted by high pass filtering. The result is then scaled by a factor that depends on the compression ratio and subtracted from the observed image. This result is used to design an adaptive filter that depends on the statistical behavior of the preprocessed image. The adaptive filter is applied to the resultant image. The result shows high SNR, significant improvement in the separation between blocking noise and image features, and effective reduction of image blurring. Other steps are required to preserve the global and local edges of the processed image, remove blocking noise, and ensure smoothness without blurring. These steps are dedicated to remove blocking artifacts and to enhance feature regularities. The evaluation of this approach in comparison with other techniques is carried out both subjectively and qualitatively.

Cytological clues of bone marrow findings in Kala-Azar

A case-control study was done on 77 cases in divided groups in order to test the sensitivity and specificity of new diagnostic morphologic criteria for visceral leishmaniasis. We found cytological findings other rather than the presence of intracytoplasmic Leishman Donovan bodies, i.e., the following interrelated items: 1) hypolymphopoiesis; 2) dyserythropoiesis; 3) blebbing of the granulocytic series and exfoliation of the blebs as "granular stippling;" and 4) various-sized damaged of the activated macrophages to apoptotic ones and cytoplasmic blebbing of the parasitophorous vacuoles and exfoliation of them as empty "basophilic bare cells." These two latter findings were based on our own observations over the past few years. Statistical analysis showed that these new criteria have more efficacy in diagnosis than previous ones; the differences were statistically significant. Findings obtained from this study could increase the values of diagnostic histopathological methods for detecting visceral leishmaniasis.