Platelet Count as a Severity of Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary disease (COPD) is a heterogenous respiratory disease characterized by a progressive, not fully reversible airflow limitation associated with an abnormal inflammatory response of the lung to noxious stimuli. It is a disease presenting with pulmonary inflammation as well as a systemic one. Measurement of inflammatory marker is difficult but platelet count estimation is easy and less costly. This descriptive, cross-sectional study was carried out at Department of Medicine, Mymensingh Medical college Hospital, Mymensingh, Bangladesh for a period of twelve months among fifty-nine COPD patients. Data were collected through interview, physical examination and laboratory investigations. Statistical analysis was performed using SPSS version 22.0 for consistency and completeness. Age range of the patients was 40 to 49 years with a mean of 56.3±10.9 years. Age group 40-49 years contained the highest number (19; 32.3%) of patients. Majority 57(96.6%) of the respondents were male. Thirty seven (62.7%) of patients were illiterate. Majority 56(94.9%) of patients resided in rural area, of them most 38(64.4%) were farmers. According to Spirometric measurement among 59 respondents of COPD patient, 3(5.1%) were in GOLD stage-I, 9(15.3%) in GOLD stage-II, 27(45.8%) in GOLD stage-III and 20(33.9%) in GOLD stage IV group. Mean platelet count (10³/μl), 241.6±86.5 was found in mild, whereas 315.0±47.7 in moderate, 337.2±76.3 in severe, and 412.4±67.5 in very severe group of COPD patients. So increase in platelet count is statistically significant in severity of COPD. In conclusion, platelet count measurement is less costly to categorize COPD and may be a diagnostic marker.

Stress Hyperglycemia and Stroke Outcome in Patients with Acute Stroke

Stroke is leading cause of death world wide, after coronary artery disease and cancer. A high proportion of patients suffering from an acute stress such as stroke or myocardial infarction may develop hyperglycemia, even in the absence of a preexisting diagnosis of diabetes. An observational comparative study was carried out at the Department of Neurology and Medicine, Mymensingh Medical College, Mymensingh, Bangladesh from July 2011 to June 2013 among purposively selected ninety-three patients with a view to assess the outcome of stress hyperglycemia on acute stroke. Data were collected through interview, physical examinations & laboratory investigations by using case record form. Statistical analysis was performed using SPSS (Statistical package for social science) version 17. The mean age of this study was 59.04±15.01 years in the hyperglycemic group and 62.06±13.81 years in the normoglycemic group. The male female ratio in the Hyperglycemic and normoglycemic group was 2.12:1 and 2.44:1 respectively. Smoker was 48.8% in the hyperglycemic group and 52% in the normoglycemic group. 70% of the Hyperglycemic group and 66% of the normoglycemic were found hypertensive. Mean±SD blood glucose level was found 11.86±0.58mmol/L in the Hyperglycemic group and 6.50±1.55mmol/L in the normoglycemic group. Mean HbAlc were 6.14±0.56 in hyperglycemic group and 5.29±0.54 in normoglycemic group. Stroke severity score were 21.79±11.85 in Hyperglycemic and 28.64±9.53 in normoglycemic group on admission. Functional outcome was measured on discharge & at the end of 4th weeks of every patient by Glasgo Outcome Scale (GOS). The study also suggests that stress hyperglycemia is an important risk factor of poor stroke outcome.

Association between Serum Apolipoprotein-B and Acute Ischaemic Stroke

Stroke is one of the leading causes of death and disability in developed as well as developing countries like Bangladesh. There is a crucial need to identify additional risk factors that are easily measurable and treatable in general population. Role of serum lipids, lipoproteins and lipoprotein related variables in the prediction of stroke is less clear. Abnormalities in plasma lipoproteins are the most firmly established and best understood risk factors for atherosclerosis and they are probable risk factors for ischaemic stroke, largely by their link to atherosclerosis. High serum apolipoprotein-B (Apo-B) levels may predict an increased risk for ischaemic stroke. Aim of the study was to evaluate the association between serum Apo-B level and acute ischaemic stroke and to measure and compare serum Apo-B level in ischaemic stroke and normal subjects. A cross-sectional comparative study was carried out in the department of Neurology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2013 to June 2015. A total number of 100 subjects within 18-70 years were considered for the study. Fifty (50) subjects with stroke (both clinically as well as CT scan of head or MRI of brain proven) were taken as the cases and 50 age and sex matched nearly healthy individuals without stroke were taken as the controls by using non-probability sampling procedure. Total cholesterol, HDL cholesterol and triglycerides were estimated by enzymatic method using Semiautoanalyser. LDL cholesterol was estimated by Friedewald formula. Apo-B was estimated by immunoturbidimetric method using Semiautoanalyser. Finally collected data were analyzed by using SPSS software Version 20. Student 't' test was used to compare the data between cases and controls. P value was set <0.05. Diagnostic validity tests were conducted to assess the diagnostic efficiency of Apo-B. Total cholesterol, LDL cholesterol and triglycerides are significantly increased in cases compared to controls. HDL-cholesterol was significantly decreased in cases compared to controls. Apo-B was significantly increased in cases compared to controls. The result was statistically significant. Apo-B may be used as predictors of ischaemic stroke components.

The Pattern of Serum Calcium, Phosphate and Parathyroid Hormone Levels in Pre-Diagnosed Chronic Kidney Disease Patients

Chronic kidney disease (CKD) is an international health problem affecting 5-10% of the world population. Patients with chronic kidney disease were known to have higher prevalence of changes in serum calcium, phosphate and parathyroid hormone in Western countries, but data on the impact of CKD on serum calcium, phosphate and parathyroid hormone in our country are scarce. This cross-sectional type of descriptive study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from March 2016 to September 2016. The aim of this study is to estimate serum calcium, phosphate and parathyroid hormone levels in chronic kidney disease (CKD) patients for early recognition of abnormalities, understanding of their patho-physiological consequences & planning management strategies to prevent their progression, thus reducing the morbidity & mortality. This study shows Hypocalcemia, hyperphosphataemia and elevated serum PTH levels are noted in later CKD stages & worsen with disease progression.

Prevalence of GERD in Type II Diabetes Mellitus Patients Admitted in A Tertiary Care Hospital of Bangladesh

Gastroesophageal reflux disease (GERD) is defined as symptoms or complications associated with regurgitation from the stomach and/or the duodenum to the esophagus. Patients with type II diabetes mellitus (DM) were known to have higher prevalence of GERD in the Western countries, but data on the impact of GERD on DM patients in our country are scarce. The aim of this cross-sectional study was to evaluate the presence of GERD in type II DM patients admitted at the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from April 2015 to September 2015. A total of 137 type II DM cases were purposively collected. Reflux Disease Questionnaire (RDQ) was used to check the presence of GERD. Patient's characteristics, laboratory data, face-to-face interview data were analyzed. Out of 137 type 2 DM patients 108 were suffering from GERD giving a prevalence rate of 78.8% which is quite high. Pathophysiological factors like age, sex, duration of DM, weight, waist circumference (WC) had no significant difference between GERD-DM and non-GERD-type II DM patients. Only hypertension and frequent eating fatty food were found to have significant differences between the two groups. From the study findings it could be said that the higher rate of GERD in patients with type II DM may be associated with lifestyle factor and some pathophysiological factors like hypertension. Psychiatric factors may also play role in contributing GERD. Further in-depth and large scale studies are necessary in our country in this regard.

High Wall Motion Score Index after Acute Myocardial Infarction is Associated with Worse In-Hospital Outcome

Myocardial Infarction is a major cause of death and disability worldwide. The incidence of coronary heart disease is high and second most cause of death after cancer. This prospective study conducted on 100 patients admitted with first attack of acute myocardial infarction in the department of Cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2012 to June 2013 who were observed 3 to 8 days of hospital stay without doing further echocardiography and evaluated the relationship between echocardiographic wall motion score index (WMSI) assessed within 24 hours of admission and in-hospital outcomes. Mean age was 53.24±10.17 years in WMSI <2 and 55.58±12.68 years in WMSI ≥2 groups; difference was statistically non-significant (p>0.05). In both groups, males were predominant sufferer. Male-female ratio was 3.55:1 and the difference was statistically non-significant (p>0.05). As a risk factor, smoking was significantly higher in both groups but the difference was not statistically significant (p>0.05) between groups. Hypertension was 34(49.28%) cases in WMSI <2 and 13(41.93%) cases in WMSI ≥2 group; difference was not statistically significant (p>0.05). Diabetes mellitus was 13(18.84%) cases in WMSI <2 and 16(51.61%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Dyslipidemia was 28(40.58%) cases in WMSI <2 group and 23(74.19%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Site of involvement of MI in WMSI <2 group were 39(56.52%) cases AMI (Anterior) and 30(43.48%) cases AMI (Inferior). In WMSI ≥2 group, AMI (Anterior) were 29(93.55%) and AMI (Inferior) were 02(6.45%). It revealed that AMI (anterior) was significantly higher in WMSI ≥2 group and AMI (Inferior) was significantly higher in WMSI <2 group. Heart failure class (Killip class) increases with the increasing of WMSI. In Killip class-I, 4(5.80%) were WMSI <2 and 01(3.23%) was WMSI ≥2 (p>0.05). In Killip class-II, 8(11.59%) were WMSI <2 and 02(6.45%) were WMSI ≥2 (p>0.05). In Killip class-III, 4(5.80%) were WMSI <2 and 13(41.94%) were WMSI ≥2 (p<0.05). In Killip class-IV, 2(2.89%) were WMSI <2 and 05(16.13%) were WMSI ≥2 (p<0.05) that was statistically significant. Arrhythmia was 14(20.29%) cases in WMSI <2 group and 13(41.94%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Death was 2(2.90%) cases in WMSI <2 and 07(22.58%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Early mortality rate was greater in patients with both WMSI ≥2 and a higher Killip's class. The higher the WMSI determined within 24 hours of admission, the worse the in-hospital outcome. Echocardiography is an affordable and readily available technique, which may be used to identify and stratify the risk following acute MI.

Impact of Adrenocortical Insufficiency on Clinical Parameters in Haemodynamically Stable Cirrhotic Patients with Ascites

Cirrhosis has many complications regardless of the aetiology. Complications include splenomegaly, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome and hepatocellular carcinoma and also linked to abnormalities in the endocrine system, including abnormal sex hormone metabolism, thyroid disease, osteoporosis, and, most recently identified, adrenal insufficiency. This prospective cohort study was done to evaluate the impact of adrenocortical insufficiency on clinical parameters in haemodynamically stable cirrhotic patients with ascites and had been performed at the inpatient of GHPD Department, BIRDEM, Dhaka, Bangladesh from April 2011 to March 2012. A total of fifty three (53) patients fulfilling inclusion criteria were included in the study. Patients were divided into two groups: Group A (patients of normal adrenal function) and Group B (patients of insufficient adrenal function) and those were followed up for the next 6 months. In Group A, the total number of patients was 25(47%) and in Group B it was 28(53%). Between two groups, mean age difference and gender difference were not statistically significant (p value was 0.278 and 0.933, respectively). Group B patients had significant higher CLD duration (p=0.004). Haematemesis and/or maelena was significantly lower in Group B at follow up (p=0.0001) due to significant higher number of band ligation in this group (p=0.009). Hepatic encephalopathy was significantly higher in Group B at enrollment (p=0.028) and at follow up (p<0.001). During the period of follow up, significant higher number of patients had developed hepatic encephalopathy in Group B compared to Group A (p<0.05). There was statistically significant higher number of patients had SBP (p=0.031) in Group B at follow up. During the period of follow up, only 1(4%) patient in Group A and 5(18%) patients in Group B died. There was no significant difference of number of death between two groups (p=0.196). Adrenal insufficient decompensated cirrhotic patients have higher morbidities.

Impact of Adrenocortical Insufficiency on Biochemical Parameters in Haemodynamically Stable Cirrhotic Patients with Ascites

Cirrhosis has many complications regardless of the aetiology. Among them, adrenal insufficiency is recently identified entity. A prospective cohort study was done to evaluate the biochemical impact of adrenocortical insufficiency in haemodynamically stable, non-septic, cirrhotic patients with ascites and had been performed at the inpatient of GHPD department, BIRDEM, Dhaka from April 2011 to March 2012. A total of fifty three (53) patients fulfilling inclusion criteria were included in the study. Patients were divided into two groups: Group A (patients of normal adrenal function) and Group B (patients of insufficient adrenal function) and those were followed up for the next 6 months. In Group A, the total number of patients was 25(47%) and in Group B it was 28(53%). Between two groups, mean age difference and gender difference were not statistically significant. (p value was 0.278 and 0.933, respectively). At enrollment, there was significant lower mean Hb concentration in Group B (p=0.008). There was no significant difference of means of WBC count and platelet count between two groups (p value was 0.829 and 0.333, respectively). There were significant abnormalities in serum bilirubin, serum albumin, INR, SBP, HRS, Serum Na concentration, TCO2 concentration in Group B patients at follow up after 6 months. Adrenal insufficient decompensated cirrhotic patients have higher biochemical abnormalities, thus higher morbidities.

Grading of perinatal asphyxia by clinical parameters and agreement between this grading and Sarnat & Sarnat stages without measures

A cross sectional study was done in Neonatal unit of Dhaka Shishu Hospital (DSH) to develop a grading system of perinatal asphyxia by clinical parameters, to show an agreement between this grading and Sarnat & Sarnat stages and to assess the outcome. Consecutive 60 cases of asphyxiated term newborn, aged between 0-48 hours were enrolled in this study who were classified according to new proposed scoring and Sarnat & Sarnat staging system simultaneously on same set up. All asphyxiated cases were managed as per protocol of neonatal unit of this hospital and followed up accordingly till 3 months of age. Out of 60 cases, sarnat stage-I cases were 16 of which all were mild according to proposed scoring system. Sarnat stage-II cases were 20 and among them 2 were mild, 16 were moderate and 2 were severe according to proposed scoring system. Sarnat stage-III cases were 24, among them 24 were severe according to proposed scoring system. The level of agreement between proposed scoring & Sarnat staging was 93.3% where kappa value was 0.899. Overall mortality of asphyxiated cases was 33.3%. About 42.9% of Sarnat stage-II and 80%(8) of Sarnat stage-III cases had neurological deficit whereas 50%(3) of moderate and 80%(4) of severely asphyxiated cases had neurological deficit on follow up at 3 months of age. Brief clinical grading system is more convenient & easier than that of Sarnat & Sarnat staging. But it is also equally as effective as Sarnat staging in classifying asphyxiated babies into different grades & to assess the outcome of perinatal asphyxia.

Bacterial Florae in Larvae of the Lake Fly Chironomus plumosus

Chironomus plumosus midge larvae were collected from Lake Winnebago, Wisconsin, for 10 weeks in the summer of 1985 and 10 weeks in the summer of 1986 in order to determine their bacterial floras. Altogether, 18 genera and 29 species of bacteria were found and identified. Some spirillum-like bacteria which were not isolated in culture were found by electron microscopy. Scanning electron micrographs of sectioned larvae revealed bacteria throughout the intestines. Gram-positive organisms were most prevalent in the larvae in the early part of the summer, and gram-negative organisms were most prevalent during the later part. Larvae accumulate bacteria within their intestines.

Isolation and Partial Characterization of Two Aeromonas hydrophila Bacteriophages

Two Aeromonas hydrophila bacteriophages, Aeh1 and Aeh2, were isolated from sewage. Both phages showed binal symmetry. The dimensions of A. hydrophila phages Aeh1 and Aeh2 differed from those of the other Aeromonas phages. Also, phage Aeh2 was the largest Aeromonas phage studied to date. Phage Aeh1 formed small, clear plaques, and phage Aeh2 formed turbid plaques with clear centers. Both phages were sensitive to chloroform treatment, being totally inactivated after treatment for 1 h at 60 degrees C at pH 3 and 11. However, the infectivity of Aeh1 phage stocks increased by approximately fivefold after they were treated at pH 10 for 1 h at 22 degrees C. Phages Aeh1 and Aeh2 were serologically unrelated and had latent periods of 39 and 52 min, respectively. The average burst sizes of phages Aeh1 and Aeh2 were 17 and 92 PFU per cell, respectively. Phage Aeh1 infected 13 of 22 A. hydrophila strains tested, whereas phage Aeh2 infected only its original host. Phage Aeh1 infected some A. hydrophila strains only at or below 37 degrees C. Neither phage infected the two A. (Plesiomonas) shigelloides strains used in this study.

Sensitivity, specificity and predictive values of immunochromatographic strip test in diagnosis of childhood kala-azar

In Bangladesh, the total population at risk for kala-azar exceeds 20 million (18%) living in 88 Thana (19%) of 27 districts (42%). A confirmatory diagnosis of visceral leishmaniasis (kala-azar) is done by demonstration of the parasite (LD body) in organ aspirates or tissue biopsy sample, an invasive procedure with relatively low sensitivity. To assess the diagnostic usefulness of ICT for antibody against the leishmanial antigen rK39 & its feasibility for use under field conditions (rural areas). An experimental study conducted during January, 2003 to July, 2003 in pediatrics department of MMCH including 60 confirmedly diagnosed KA cases & 60 controls having diseases other than KA. One drop of peripheral blood is applied to the nitrocellulose strip & 3 drops of test buffer is added to the dried blood. Observing 2 visible bands indicates presence of IgG anti-K39. The rK39 strip test was positive in 57 out of 60 confirmed KA case diagnosed by LD body demonstration in splenic or bone marrow aspirate. The estimated sensitivity was 95%. One control diagnosed as other than KA had positive strip test but negative aspirate smear. The estimated specificity of the strip test was 98.3%. The predictive value of a positive result is 98.3% & that of a negative result is 93.5%. rK39 strip test is highly sensitive & specific in our situation & it can be used as a simple & the best method for diagnosis of KA in rural areas.

Efficacy of azithromycin in the treatment of childhood typhoid Fever

An intervention study was carried out in Paediatric wards for a period of one year from January 2003 to December 2003 to determine the efficacy and safety of azithromycin in the treatment of uncomplicated childhood typhoid fever. A total of 50 cases were enrolled in the study. The inclusion criteria of the cases were: documented fever for more than 7 days plus two or more of the following clinical features: toxic appearance, abdominal tenderness, hepatomegaly, splenomegaly, diarrhoea, constipation and coated tongue plus positive Widal test and/or blood culture positivity. Patients who had complication like gastrointestinal tract (GIT) haemorrhage; intestinal perforation and/or shock were excluded from the study. Data were collected in a structured questionnaire. Azithromycin was given at a dose of 10mg/kg /day for a period of 07 days. The time to defervescence was 3.82+/-1.49 days. The minimum defervescence time was 02 days and maximum was 07 days. Clinical cure rate was 94%. No serious adverse effect was noted related to azithromycin therapy except nausea, vomiting, and jaundice. Prior treatment with antibiotics did not affect defervescence time (P>0.05). Pre-treatment febrile period has got positive and linear correlation with clinical response (r = +0.593). It was found that once daily administration of oral azithromycin for seven days in the treatment of uncomplicated typhoid fever was effective and reasonably safe.

Streptococcal antibodies among rural school children in Bangladesh

The upper limit of normal values of group A streptococcal antibodies should be known for a population concerned because it is influenced by many local conditions. As yet the reference value of the these antibodies has not been determined by using a quantitative method among Bangladeshi children. We determined the reference value of anti-streptolysin O and anti-deoxyribonuclease B among 361 apparently healthy rural Bangladeshi primary school children (aged 5 to 14 years, mean 9.2 years). Anti-streptolysin O was measured by an auto-analyzer and antideoxyribonuclease B was measured by microtitre method. The geometric mean titres for the entire group was 241 IU/ml and 222 IU/ml for anti-streptolysin O and anti-deoxyribonuclease B respectively. The upper limit of normal values (80th percentile) was 390 and 340 for anti-streptolysin O and anti-deoxyribonuclease B, respectively. These limits should be of value to physicians, epidemiologists and clinical laboratory personnel as well.

Reference value of immunoglobulins in healthy school children of Bangladesh

The reference value of immunoglobulins (Igs) should be known for a population concerned because it is influenced by many clinical and local conditions. As yet the reference value of the Igs have not been determined in Bangladeshi children. This study determined the reference value of Igs in apparently healthy 261 rural Bangladeshi primary school children (aged 5 to 14 years, mean 9.3 years). IgG, IgM and IgA were determined by an auto-analyzer. The mean (standard deviation) value of IgG was 1728 (344) mg/dl. The corresponding values for IgM and IgA were 200 (88) and 163 (63) mg/dl, respectively. The 95% reference value calculation in all subjects showed that the range for IgG was 1103 to 2524, IgM was 92 to 390, and IgA was 72 to 325 mg/dl. These values could be used to evaluate Ig status in children with a variety of clinical conditions.

Cardiovascular risk factors: distribution and prevalence in a rural population of Bangladesh

BACKGROUND

Little is known about the cardiovascular risk factors in the Bangladeshi population. We examined 'classic' risk factors, including central obesity, in a rural population.

METHODS

Non-biochemical variables were examined in 238 men and 272 women aged 18 years or more (mean +/- standard deviation 38.1 +/- 10.7 years in men and 36.0 +/- 9.8 in women). Fasting blood glucose and total cholesterol concentrations were determined in a sub-sample of 106 men and 135 women.

RESULTS

Men and women had a similar body mass index (20.4 +/- 3.1 vs 20.8 +/- 3.4 kg/m2), waist circumference (72.8 +/- 7.6 vs 71.4 +/- 8.7 cm), systolic blood pressure (118.4 +/- 13.7 vs 119.5 +/- 17.7 mmHg), diastolic blood pressure (75.9 +/- 9.9 vs 74.6 +/- 11.5 mmHg), total cholesterol (155.7 +/- 36.0 vs 162.0 +/- 35.2 mg/dl) and blood glucose level (89.0 +/- 14.9 vs 86.2 +/- 9.6 mg/dl. After categorization of these variables, the prevalence of thinness (body mass index < 18.5; 30.0 vs 30.3%), obesity (body mass index > or = 30; 0.8 vs 1.1%), hypertension (systolic blood pressure > or = 140 and/or diastolic blood pressure > or = 90 or medication; 9.8 vs 15.6%), hypercholesterolemia (total cholesterol > or = 240; 2.8 vs 3.0%) and diabetes mellitus (blood glucose > or = 126; 2.9 vs 0.7%) remained similar between the sexes. However, central obesity (waist circumference > or = 94 cm in men and > or = 80 cm in women) was less frequent (2.9 vs 16.8%; P = 0.001) in men. Overall, tobacco consumption (57.1 vs 23.2%; P = 0.001) and smoking (50.3% vs 2.9%; P = 0.001) were more frequent in men, but chewing tobacco consumption was similar (16.3 vs 21.4%; P = 0.095).

CONCLUSIONS

Our sample size is small, and larger studies are necessary for a more accurate description of the risk factors.

Erythrocyte sedimentation rate in healthy school children of Bangladesh

The reference value of erythrocyte sedimentation rate (ESR) should be established for a population concerned because it is influenced by many local conditions. It has not yet been determined in healthy children of Bangladesh. This study was done to determine the reference value of ESR in Bangladeshi children. ESR was determined in a sample of 413 'healthy' primary school students (259 boys and 154 girls, mean age 8.7 years). Ninety-five percent of them had ESR < or = 30 mm (Westergren 1 h). Our findings suggest that ESR value > 30 mm (Westergren 1 h) should be considered high in Bangladeshi primary school children.

Humoral immune response in a sample of Bangladeshi children with rheumatic fever

Several researchers have investigated cellular response, and antibody response to different antigens of group A beta-haemolytic streptococci, cardiac tissues and B cell alloantigen in rheumatic fever (RF). However, immunoglobulins (Ig) which may indicate general immune status did not receive attention. This study was done in the outpatient clinic of the National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, to compare Ig levels in subjects with and without RF who have had recent group A beta-haemolytic streptococcal infections. We have recruited 44 RF cases aged 5 to 20 years, and 44 subjects without RF were randomly matched for age and sex as controls. Convalescent blood samples were used to measure antistreptolysin O and IgG, IgM, and IgA levels. The cases, as compared with the controls, had significantly higher levels of antistreptolysin O (mean 399 versus 321 IU/ml), IgG (mean 2386 versus 1885 mg/dl), IgM (mean 286 versus 222 mg/dl) and IgA (mean 258 versus 184 mg/dl). It is not clearly known why the immune response is higher in the RF cases. We have to elucidate factors responsible for higher immune response in children with RF.

Association of angiotensin converting enzyme (ACE) gene polymorphism with hypertension in a Bangladeshi population

The association of angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism with hypertension has not been confirmed. Inconsistencies may be due to the differences of background population characteristics. Till date, there has been no report in Bangladeshi population. This study was to examine the association of ACE (I/D) polymorphism with hypertension. Fifty-one primary hypertensives and fifty-two normotensives were recruited from a hospital in Dhaka city. Height, weight and blood pressure were measured. ACE (I/D) genotypes was established using polymerase chain reaction protocol. The genotype and allele frequencies did not differ significantly (P > 0.05) between the groups. In logistic regression analysis, adjusted for age, sex and body mass index, the genotypes were not associated with hypertension (DD vs II: Adds ratio = 2.6, P = 0.34; ID vs II: 0.4, 0.23; ID + DD vs II: 0.8, 0.69). In this hospital-based sample of Bangladeshi people, significant association of ACE I/D genotype with hypertension was not observed.

Does rheumatic fever occur usually between the ages of 5 and 15 years?

It has long been considered that rheumatic fever usually occurs in children between the ages of 5 and 15 years. However, supporting data from the developing countries are insufficient. It is important to know the age of occurrence of rheumatic fever for clinical and public health purposes. To describe the age distribution of Bangladeshi subjects, we have reviewed the records of all patients who attended with acute rheumatic fever in the outpatient department of the National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, during June 1990 through November 1995. During this period 630 subjects were diagnosed to have acute rheumatic fever defined by the revised Jones criteria. Of them, 535 (84.9%) presented with first attack. Their age ranged from 3 to 30 years, and a skewness to the right of the age distribution was observed. Thus, we used percentile distribution to determine reference range of age. The 2.5 and 97.5 percentiles were 5 and 22 years, respectively. Their mean (standard deviation) and median age were 12.7 (4.4) and 12 years, respectively. Slightly more than 22% of subjects were older than 15 while less than 1% were younger than 5 years. This finding was supported by multiethnic data from other developing countries. The current analysis warrants reevaluation of the prevailing conviction for age of occurrence of rheumatic fever. In conclusion, the age reference range for occurrence of rheumatic fever in Bangladesh should be considered to be 5 to 22 years but not 5 to 15 years.

Nutritional factors associated with rheumatic fever

The determinants for a child with group A beta-haemolytic streptococcal throat infection (BHS infection) to develop rheumatic fever (RF) remain unclear. In this case-control study, we deal with BHS infected children to examine whether nutritional factors are related to RF. In a RF hospital in Dhaka (Bangladesh) we examined 218 consecutive out-patients who had antecedent BHS infection. Sixty of them met the updated Jones criteria for RF (cases) while 104 did not (controls). Fifty-four possible RF patients were excluded. We used anthropometric measurements and a food frequency questionnaire to assess nutritional factors. Higher risk of RF was observed for low height for age (odds ratio 3.82, 95% confidence interval 1.73-8.42); low weight for age (2.41, 1.12-5.57); low upper arm circumference for age (3.76, 1.87-7.89); and low consumption of eggs (3.81, 1.95-7.63), milk (2.60, 1.36-5.08), chicken (2.62, 1.35-5.21), pulses (1.98, 1.03-3.84), fruits 2.29, 1.20-4.45), and ruti (home-made bread) (3.15, 1.61-6.34). Reduced risk was observed for soybean oil consumption (0.28, 0.12-0.62). The significant association of upper arm circumference and eggs persisted after adjustment for multiple sociodemographic confounders. The association of ruti and soybean oil appeared to be suggestive (0.05 < p < 0.1). Protein-energy malnutrition is likely to be associated with RF. The protective effect of moderate consumption of eggs and soybean oil may support other published work which suggests that the anti-inflammatory substance present in these food items may prevent maturation of the rheumatic process.

Socio-economic deprivation associated with acute rheumatic fever. A hospital-based case-control study in Bangladesh

There are few studies on the relationship between socio-economic factors and rheumatic fever (RF) in the populations where the burden of both socio-economic deprivation and RF is still very high. The aim of this study is to assess the association between some socio-economic factors and RF by examining data available from a RF hospital in Bangladesh. We have reviewed the medical records of patients presenting with manifestations suggestive of RF during a 1-year period. From the patients who showed group A beta-haemolytic streptococcal upper respiratory infection (ABHS infection), 44 RF cases defined by the Jones criteria and 86 control subjects, who did not satisfy the criteria, were identified for analysis. The median age was 12 years and 60% were female. RF was significantly associated with low income (odds ratio [OR] 2.37; P = 0.04); poor living conditions: substandard (kacha) house (OR 2.93, P = 0.02); and poor nutritional status: low height for age (OR 2.68, P = 0.02). Multiple logistic regression analysis revealed an increased OR for kacha house (OR 3.18, P = 0.02) but the same estimate for low height for age (OR 2.68; P = 0.04). Our analysis shows that, among the patients presenting to the RF hospital with proven ABHS infection, acute RF is associated with socio-economic deprivation.

The reference value of erythrocyte sedimentation rate for differential diagnosis of rheumatic fever among Bangladeshi children

The aim of the present study is to determine the reference value of erythrocyte sedimentation rate for differential diagnosis of rheumatic fever in the National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, Bangladesh among patients with signs and symptoms which may be related to acute rheumatic fever. All medical records for the patients aged 5 to 20 years who attended the outpatient department of the hospital between July, 1994 and November, 1995 were reviewed. Fifty-three of 337 such patients had acute rheumatic fever defined by the updated Jones criteria. The performance of erythrocyte sedimentation rate test was evaluated by sensitivity, specificity, positive predictive value, and receiver operating characteristic curve. The findings of this study suggest that the lower limit for a positive test should be considered at 30 mm (Westergren 1 h) in this hospital.

Prevalence of streptococcal sorethroat in the school children of Dhaka

Beta Haemolytic Streptococcal (BHS) infections and their sequelae Rheumatic Fever (RF) and Glomerulonephritis (GN) have a world wide distribution and so pose an important health problem. Reports show that there is considerable variation in the number of isolations from different groups. Present study intended to find out the health status of the school children in relation to streptococcal throat infection, in Dhaka Cantonment. It was a cross sectional, observational study. During one year period total six hundred and one (601) children were examined from one school of Dhaka Cantonment. Prevalence of streptococcus was found to be 22% among the study population with highest rate (67%) for group-G among BHS positive cases. True streptococcal infection was found in 8.7% cases & 2.2% cases were true GABHS positive cases. GABHS was significantly higher in large size families. Females and children from lower socioeconomic group were at higher risk. Females and children of large families may require special attention regarding prevention of streptococcal infection and RF/RHD prevention programme.

Amino acid requirements of Aeromonas

Four of the 12 cultures of Aeromonas hydrophila, 5 of the 10 A. shigelloides, and 9 of the 10 A. salmonicida that were studied required arginine and lysine, among other amino acids, for their growth.

Human Rabies in Bangladesh – A Study of 684 Cases

This descriptive study in the Infectious Disease Hospital, Dhaka, on rabies was carried out to see the patterns of presentation, age group at risk, state of vaccination following animal exposure and the interval between animal exposure and the development of the disease. Of 684 cases of rabies from June 1999 to November 2003, majority (64.18%) of the victims were within 15 years of age. Male gender (76.75%) and rural people (86.40%) constituted the bulk of the cases. 80.26% of cases had WHO category III exposure. Most of the cases were not vaccinated (86.04%). Among 93 cases who received vaccine, only 9.67% took tissue culture vaccine and 90.3% were treated with nerve tissue vaccine. None of the 684 cases were treated with RIG. Dog was the principal animal responsible for 95.76% cases. 65.93% of the cases developed the disease between 31 to 100 days after the animal exposure. DOI = 10.3329/jom.v8i1.1370 J MEDICINE 2007; 8 : 3-6   

Climate of Bangladesh: An Analysis of Northwestern and Southwestern Part Using High Resolution Atmosphere-Ocean General Circulation Model (AOGCM)

The past, present and future climatic pattern (temperature and rainfall) of northwestern and southwestern part of Bangladesh was assessed based on the High Resolution Atmospheric-Ocean General Circulation Model (AOGCM) using the present rainfall and temperature data of the Bangladesh Meteorological Department (BMD). Climatology in Bangladesh is derived from 20 km mesh MRI-AGCM (Atmospheric General Circulation Model) calibrated with reference to the observed data for the period of 1979-2006. Then, projections for rainfall and temperature are made for near future (2015-2034) and future (2075-99). Two disaster prone areas (i) northwestern part (Shapahar & Porsha) and (ii) southwestern part (Kalapara & Amtoli) were selected as the study areas. AOGCM model was run for Bangladesh and also for study areas separately. The present mean temperature for Bangladesh was found to rise from the past, rises slightly, but in near future and future the rate of mean temperature rise is projected to be much more than the present rate (increase up to 4.34 °C/100 years), the rate is projected to be 5.39 °C/100 years in case of Shapahar and Porsha a while 4.37 °C/100 years in case of Kalapara and Amtoli. The present, near future and future average rainfall of Bangladesh appeared to fluctuate, but have shown a decreasing trend (decreases up to 1.96 mm/100 years). The mean average rainfall of Shapahar and Porsha presently decreases very slowly (not significant), but in near future and future will decrease slowly (0.66mm/100 years). In case of Kalapara, the average rainfall appears to decrease presently, near future and future will decrease up to 3.62 mm/100 years. The average rainfall of Amtoli appears to decrease @ 1.92mm/100 years but in near future appears to increase slightly and again decrease @ 3.27mm/100years in future. Keywords: Atmosphere-Ocean General Circulation Model (AOGCM); climatology; simulation; temperature; rainfall DOI: http://dx.doi.org/10.3329/agric.v9i1-2.9489 The Agriculturists 2011; 9(1&2): 143-154

Degradation of uric acid by certain aerobic bacteria

We have isolated and identified nine cultures of aerobic bacteria capable of growing on an elective medium containing uric acid as the only source of carbon, nitrogen, and energy. Four of these cultures were identified as Aerobacter aerogenes, two as Klebsiella pneumoniae, and the remainder as Serratia killiensis, Pseudomonas aeruginosa, and Bacillus species. Another culture identified as P. fluorescens required both glucose and uric acid for growth. When 23 laboratory stock cultures were inoculated into the uric acid medium, A. aerogenes, B. subtilis, Mycobacterium phlei, P. aeruginosa, and S. marcescens were able to grow. These five cultures also grew when the uric acid was replaced with adenine, guanine, hypoxanthine, xanthine, or allantoin, but growth was poor. In all of these media, including the uric acid medium, addition of glucose along with the nitrogenous compounds yielded good growth. Induction experiments demonstrated that the ability of A. aerogenes, K. pneumoniae, P. aeruginosa, P. fluorescens, S. kiliensis, S. marcescens, B. subtilis, and Bacillus sp. to degrade uric acid is an induced property. Of these organisms, only Bacillus sp. accumulated a small amount of intracellular uric acid.