Association of Serum Vitamin D (25OHD) Level with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Acute exacerbations of COPD is characterized by a change in the patients baseline dyspnoea, cough and/or sputum that is beyond normal day to day differences and guides to a change in standard medications in a patient with COPD. Vitamin D influences the innate & adaptive immune system, and exerts pleiotropic antimicrobial and anti-inflammatory responses. Vitamin D deficiency is frequent among COPD patients but its contributory role in disease exacerbations is widely debated. This study was aimed to assess relationship between reduced serum vitamin D (25-OHD) level with COPD severity and acute exacerbation. This observational cross-sectional study was carried out in the department of Respiratory Medicine, NIDCH, Mohakhali, Dhaka, Bangladesh from October 2016 to September 2017. Consecutive 80 hospital admitted patients with acute exacerbation of chronic obstructive pulmonary disease diagnosed on the basis of clinical history & pulmonary function tests and 78 age & sex matched controls were investigated for serum vitamin D (25-OHD) level. Among the COPD patients, 37% had Vitamin D deficiency (<20ng/ml) and 28.75% had Vitamin D insufficiency (20-29ng/ml). Mean vitamin D (25-OHD) level of COPD patients (25.82±10.62ngm/ml) was found to be significantly lower than healthy controls (32.57±11.32ngm/ml). Vitamin D deficiency was found, by Pearson correlation test, to be significantly associated with severity of COPD. Multivariate analysis showed that age (in years), FEV1 (percent predicted), frequent exacerbators (≥2 in the last year), and smoking (>40 pack year) were significantly associated with Vitamin D deficiency. Acute exacerbation of chronic obstructive pulmonary disease patients was found to have vitamin D deficiency and vitamin D deficiency was significantly associated with severity of COPD. Vitamin D deficiency was also associated with frequent disease exacerbation.

Prolonged therapy with the anticonvulsant carbamazepine leads to increased plasma clearance of fentanyl

OBJECTIVES

Fentanyl is a potent analgesic that accounts for an increasing number of overdose deaths in the United States. This study tested whether altered pharmacokinetics plays a pivotal role in the increased fentanyl dose requirements in patients receiving the enzyme-inducing anticonvulsant, carbamazepine.

METHODS

Neurosurgical patients receiving carbamazepine for >6 weeks (N = 11) or no carbamazepine (N = 6, controls) received a single bolus dose of fentanyl (200 μg) intravenously. Plasma was collected before and for up to 9 h after the bolus. Fentanyl concentrations were measured using liquid chromatography-mass spectrometry. Pharmacokinetic variables were derived from plasma concentration-time curves best fitted to a two-compartment model.

KEY FINDINGS

Fentanyl clearance was significantly higher in the carbamazepine group compared to controls (mean ± SD: 20.1 ± 6.8 vs 13.2 ± 4.8 ml/min per kg, P < 0.05), and area under the plasma concentration curve (AUC) was significantly lower (150 ± 65 vs 233 ± 70 ng/ml × min, P < 0.02). Volume of distribution was larger in the carbamazepine group, but the difference was not statistically significant (5.4 ± 3.1 vs 3.6 ± 1.2 l/kg, P > 0.15). The terminal elimination half-life did not differ between the two groups.

CONCLUSIONS

Chronic carbamazepine therapy leads to increased fentanyl clearance and decreased AUC, which may result in decreased duration of therapeutic plasma concentrations of fentanyl and an increased dose requirement. Assuming that carbamazepine does not change fentanyl pharmacodynamics, patients on chronic carbamazepine therapy may require more frequent or higher fentanyl doses to maintain therapeutic plasma concentrations.

Transmigrated and Impacted Upper 2nd Premolar Associated with Dentigerous Cyst

A male patient about 45 years old came to my private clinic "The Dental Aid", Dhanmondi, Dhaka, Bangladesh last year (February 2016) with the complaint of pain at right palatal premolar region. On clinical examination we found the absence of upper left 2nd premolar from the series of dentition but on the right side premolars are present. The oral mucosa was intact and normal in color. There was no caries, dental pocket or any other pathology in the teeth of both jaws. On palpation we found soft area on the right palatal side at the premolar area. We took intraoral peri-apical radiograph and found impacted left 2nd premolar whose crown was encircled by radiolucent area at the palatal side. Here, we present a rare case of transmigrated and impacted left 2nd maxillary premolar associated with dentigerous cyst. The cyst was successfully treated under general anaesthesia by enucleation along with extraction of the involved maxillary transposed and impacted left second premolar.

Distribution of HPV-16 and HPV-18 from the Patients Attending At Mymensingh Medical College Hospital by Newly Developed Oncoprotein Detection Assay

Cervical cancer is one of cause of death in women in many developing countries. Persistent infection with Human Papilloma Virus (HPV), primarily high risk types 16 and 18, is recognized as a causal and essential factor for the development of cervical cancer. The objective of this cross sectional observational study is to detect the distribution of HPV-16 and HPV-18 among Onco E6 positive cases. Following universal safety precautions a total of 180 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology Department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2016 to December 2016. Laboratory work was done in the department of Microbiology, Mymensingh Medical College. E6 strip test is an immunochromatographic test based on the detection of HPV-E6 oncoprotein in cervical swab samples. Onco E6 cervical test was done on 180cases. Among them 60% were VIA positive and 120% were VIA negative. From this VIA positive cases 12(16.25%) were On E6 cervical test positive and from VIA negative cases 3(2.5%) were positive by this On E6 cervical test. From this 12 Onco E6 cervical test positive cases 10(%) were HPV-16 and 2(%) were HPV-18 and from VIA negative cases 3 were only HPV-16 by this test. Histopathological test done on 35 suspected cases and out of 08 cervical carcinoma cases 07 were positive by this Onco E6 cervical test which was also HPV-16 type. It may be concluded that HPV-16 is most prevalent type to cause cervical cancer and by this newly developed protein detection assay will be helpful to reduce over treatment and save many lives.

Molecular Diagnosis of Human Papilloma Virus by PCR

Cervical cancer is a major world health problem and the fourth most leading cause of death in women around the world. High risk HPV DNA has been shown to be present in 99.7% of cervical cancers worldwide. So detection of HPV DNA by PCR may help in early detection and management of cervical cancer. This cross sectional observational study was done to detect L1 antigen gene of HPV from cervical swab by nested PCR. Following universal safety precautions a total of 141 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology department of MMCH from January 2015 to December 2015. Laboratory work was done in the department of Microbiology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh HPV DNA was tested among 141 VIA positive women aged between 20-70 years by nested PCR method. DNA was extracted by phenol-chloroform extraction method. Two pairs of consensus primers MY09-MY11 and GP5-GP6 were used in a nested PCR assay. Histopathological examination was done on 66 samples in the Department of Pathology, MMC, Mymensingh, Bangladesh. A total of 36.9% (52/141) cases were positive for HPV DNA by nested PCR. On Histopathological diagnosis PCR was positive in 42.9% chronic cervicitis, 21.2% CIN cases and 90.9% cervical carcinoma cases. Based on the findings of the study, it may be concluded that the HPV DNA testing has opened the door for an alternative surveillance mechanism to routine cytological screening. Detection of HPV may play an important role in diagnosis and clinical prognosis of precancerous lesions. So PCR may be done for all VIA positive cases for screening of cervical cancer.

Growth performance of local and genetically improved chicken of Bangladesh

The experiment was conducted to compare the growth performance among four genotypes of indigenous chicken namely Non-descriptive Native (ND), genetically Improved Native (IN), Hilly (HC) and Naked Neck (NN) of Bangladesh under free-range rearing system.  A total of 288 day old chicks (DOC) from four genotypes were divided into four treatments having eight replications of each for a period of 12 weeks under free-range system with supplementation of commercial broiler diet. During first 4 weeks, all chicks were kept together, whereas chicks of ND was brooded in the same room but separated by a partition. At 5 weeks of age chicks were randomly distributed to the selected farmers. Growth parameters were recorded to determine the comparative growth performance among four genotypes of chicken. The highest body weight (1110.76 g/bird) was achieved by HC, followed by IN (900.63 g/bird) and NN (831.13 g/bird) at 12 weeks of age. The lowest body weight (734.13 g/bird) however was found in ND chicken. During the growing period under free range rearing (5-12 weeks), HC group consumed the highest amount of feed (2697.02 g/bird) with an average FCR of 3.06 while the lowest feed consumption (2666.13 g/bird) with the highest FCR of 4.90 was observed in ND. IN consumed (2674.63 g/bird) feed with an average FCR of 3.92 and BLRI improved NN consumed (2668.13 g/bird) feed with an average FCR of 4.19. Live weight gains in all the four genotypes of indigenous chicken were changed almost in a similar pattern. Significant differences were observed in live weight, dressing percentage, breast meat, drumstick, thigh meat among the four genotypes of chicken. The HC was superior to other genotypes of indigenous chicken including ND in terms of growth performance, meat yield characteristics and net returns. Bang. J. Anim. Sci. 2018. 47 (2):76-84

Sputum smear microscopy in the Xpert® MTB/RIF era

A balanced perspective is advocated for the assessment and application of the most recent and the oldest diagnostic methods for pulmonary tuberculosis (TB)-the molecular Xpert^® MTB/RIF assay and microscopy for acid-fast bacilli. We discuss their respective merits and shortcomings and identify threats that may hamper their use in TB control. Neither test on its own provides all the information needed for diagnosis and treatment monitoring. Considering all aspects important for both individual patient care and disease control, neither seems 'better' than the other. The required advancement of microscopy had already been hampered before the introduction of the GeneXpert technology by unsuccessful and probably misguided attempts to decentralise culture-based diagnosis and drug susceptibility testing. It seems evident that systematic replacement of microscopy by Xpert is not a viable option for the foreseeable future. Instead, the two methods should complement each other to arrive at a comprehensive, accessible and continuous service for a maximum number of patients. This will intrinsically prioritise targeting the most potent transmitters with the worst prognosis, simultaneously offering optimised prospects for efficient TB control. New microscopy and Xpert applications are expected to ultimately make control programmes independent of culture-based methods in diagnosis, treatment monitoring and outcome assessment.

Twenty years of rifampicin resistance surveillance in Bangladesh: periodic vs. continuous monitoring

OBJECTIVE

To analyse 20 years of tuberculosis (TB) drug resistance surveillance, comparing conventional periodic random drug resistance surveys with continuous monitoring, in Damien Foundation-supported districts of Bangladesh.

DESIGN

Retrospective study of data on TB drug resistance from five periodic surveys among newly registered patients vs. continuous monitoring of retreatment patients from 1996 to 2016.

RESULTS

Periodic surveys and continuous monitoring showed similar trends in rifampicin (RMP) resistance; with all smear-positives registered as denominator, prevalence in new cases was found to be at approximately the same level as incidence in retreatment cases. Changes in trends observed using continuous monitoring preceded those detected in periodic surveys by a few years. The accurate interpretation of trend changes requires detailed knowledge of changes in treatment regimens, referral criteria, testing methods and operational factors.

CONCLUSION

Low rates of resistance to RMP, isoniazid and the fluoroquinolones were maintained over the two decades, indicating excellent TB programme performance, including highly active standard first- and second-line treatment regimens. Continuous monitoring is feasible, but requires rigorous application of referral guidelines and data maintenance. Contrary to random surveys, continuous monitoring provides early indications of programme performance, essential for individual patient management, and is more efficient and cost-effective.

Off-Label Medication in Children: Responsibilities of Pediatrician and Neonatologist

Use of drug in pediatrics and neonatology should be rational. There are clinical situations when the use of unlicensed medicines or use of medicines outside the terms of license (i.e., 'off-label') may be judged by prescriber in the best interest of the patient. Off-label prescribing is clinically appropriate when the benefits outweigh the potential risks. Such practice is particularly common in pediatrics and neonatology where development of age-appropriate formulations is difficult. Before going to prescribe a drug on off-label basis, the clinician should be satisfied that an alternative medicine would not meet the patient's needs. The clinician should be satisfied that there is sufficient evidence base safety and efficacy on off-label drug use. Communication with legal guardian with sufficient information about proposed treatment is needed. The clinician has a responsibility to monitor the off-label use of drug. He should submit a report on suspected adverse drug reactions if he observes to the authorized body.

Electrophoretic Patterns of Human Rotavirus Strain Prevailing Among Children

Rotavirus gastroenteritis is a major cause of severe dehydrating diarrhea in children worldwide. Group A rotavirus causes approximately 40% of hospitalization for diarrhea among under 5 years children. Polyacrylamide gel electrophoresis (PAGE) and silver staining was applied to detect rotavirus dsRNA from acute diarrheic stool of 776 hospitalized children below five years. The study was conducted in Mymensingh district, Bangladesh from January 2013 to December 2014. Among 776 stool specimens tested 368(47.4%) were positive by PAGE. Among 368 positive 341(92.5%) showed clearly stained electrophoretic patterns of viral RNA which enabled their classification into different electropherotypes. The rate of infection was highest in children of 7-12 months of age and infection rate was more in winter. RNA profiles of the analyzed specimens, 164/341 (48%) were long and 177/341 (52%) were short patterns. Mixed electropherotypes (2%) among 368 were also detected. Electropherotyping technique could be an applied excellent method for studying genomic variation, tracing mixed infections, detecting atypical rotaviruses.

Comparison of Two Laboratory Methods of Preservation for Preclinical Preparation of Bovine Aortic Heart Valve Suitable for Human Use

The present experimental study was carried out as an experimental study in the department of Cardiac Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2011 to May 2013 to see which preservation techniques give us morphologically and histologically suitable xenograft heart valve for clinical use. We reviewed 20 bovine aortic valves in 2 years. Each of 10 samples was grouped as glutaraldehyde (1.5%) preservation and cryopreservation (-180°C). After collecting each specimen, sterilization of valve was done in low concentration of sterile antibiotic solution (CLPVA). Then 10 dissected valves were immersed each in 250ml of 1.5% glutaraldehyde solution at 4°C. Another 10 dissected valves were placed in a solution of 100ml 10% DMSO and suspended in vapor phase of liquid nitrogen at -180°C. Then after 4 weeks, the valves were examined for naked eye (color change, shrinkage, swelling, pliability, stiffness of leaflet) and histological (endothelial cells, leaflet extracellular matrix preservation, fibroblast preservation, inflammation, necrosis and other pathological conditions on valve leaflet) examination. Statistical analysis showed that morphological changes were not significant in both groups but in histological examination, cryopreservation showed effective preservation of fibroblast and extracellular matrix than glutaraldehyde preservation.

Clinical and Radiological Evaluation of Children Aged 2 Months to 5 Years with Severe Pneumonia According to WHO Guideline

Pneumonia is the leading cause of morbidity and mortality in children less than 5 years of age in developing countries like Bangladesh. Although WHO guideline classified severe pneumonia by symptoms and signs of the patients, radiological and laboratory investigations were not studied well. There was increasing number of cases of bronchiolitis which meet the criteria of WHO classified severe pneumonia are reported. The objective of the study was to assess the clinical and radiological parameters of severe pneumonia in 2 months to 59 months hospitalized children according to WHO guideline. This cross sectional study was conducted in pediatrics department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July, 2015 to December 2015. Total 150 patients were included in this cross sectional study according to their clinical symptoms. Firstly, the chest x-ray was done in all the patients and radiographs were reviewed by an expert radiologist who was blind about the cases. Then the patients were classified as pneumonia and bronchiolitis according to the clinical features and radiology findings. Majority of the patients 83(55.3%) were between 2-6 months of age and mean age was 7.52±8.87. Maximum 105(70%) patients were male and 45(30%) were female. Most of them 70(47%) came from low middle class family. Regarding clinical features, all patients 150 had cough and chest indrawing. Ronchi found in 135(90%) patients, difficult breathing and fast breathing found in 130(87%) patients, crepitation in 122(81%) patients, wheeze in 93(62%) patients, dull on percussion in 36(21%) patients, bronchial breath sound in 25(17%) patients. Regarding radiological features, lobar consolidation was found in 18(12%) patients, patchy opacities in 42(28%) patients, which were radiological findings of pneumonia, while hyperinflation of lung present in 90(60%) patients, increased translucency in 82(54.6%), increased interstitial marking in 88(58.6%) patients, which were radiological findings of bronchiolitis. A total of 60(40%) admitted cases were diagnosed as pneumonia and 90(60%) cases diagnosed as bronchiolitis radiologically, which were predominant in WHO classified severe pneumonia (p<0.05). Wheeze was present in case of hyperinflation of lung in 78(83.8%), increased translucency in 67(72%) and increased interstitial marking in 70(75.2%) patients among radiological bronchiolitis (n=90). From above results we can concluded that Bronchiolitis was predominant among WHO guideline classified severe pneumonia.

Comparison of Serum Electrolytes Abnormality and Renal Function Status in Asphyxiated and Normal Baby in a Tertiary Level Hospital

Complication of perinatal asphyxia is a major cause of neonatal mortality & morbidity in developing countries. This comparative cross sectional study was conducted in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from May 2012 to September 2012 to determine electrolytes & renal function status in perinatal asphyxia & their impact on outcome. Thirty term normal birth weight babies with perinatal asphyxia in neonatal ward were included as a case group and thirty term normal birth weight neonates of same gestational age, without perinatal asphyxia in the department of Gynae & Obs were enrolled as a control group. Necessary information was collected by clinical examination; investigation and close follow up according to predetermined plan. There was no significant different in sex distribution, number of Antenatal care (ANC), number of gravidum of mother and mode of delivery between two groups. Among perinatal Asphyxia group most common risk factor was prolonged labor. Electrolyte abnormalities were documented (16) 53.3% cases. Among 16 electrolyte abnormalities isolated hyponatremia was found in 6(37.5%) cases, hyponatremia with hyperkalaemia 1(6.25%) case, hyponatremia with hypokalaemia in 1(6.25%) case, isolated hypokalaemia in 3(18.75%) cases and isolated hyperkalaemia in 5(31.25%) cases. None case had hypernatremia. On the other hand in control group Hypokalaemia was 3(10%) cases Hyperkalaemia 1(33.33%) case and none had Hyponatraemia. Among total cases 6 (20%) had renal impairment. Serum creatinine level was higher in case group. Twenty percent (20%) case initial value >1.5mg/dl, 20% 1.2-1.5mg/dl and17% had 0.3-0.8mg/dl. On the other hand in control group 83 % had 0.3-0.8 mg/dl & none hade above 1.1 mg/dl. Among case group 8 were died (27%). There was no death in control group. Among 8 neonatal death cases 3(37.5%) had normal electrolytes, isolated hyponatraemia were in 2(25%) cases, hyponatraemia with Hyperkalaemia in 1(6.25%) case and Isolated Hyperkalaemia in 2(25%) cases. Among those death 3(37.5%) had renal impairment. Case fatality was significantly associated with renal failure 50%, isolated Hyponatraemia 33.33%, Isolated hyperkalaemia 40%, Hyperkalaemia with Hyponatremia 100%. Hospital stay was also prolonged among alive case with abnormal electrolytes. So, we can conclude that electrolyte & renal impairments are significantly associated with morbidity & mortality of perinatal Asphyxia.

Effect of foliar application of iron and zinc on nutrient uptake and grain yield of wheat under different irrigation regimes

A field experiment was carried out to study the zinc-iron relationship in wheat (BARI Gom-26) plant grown under water stress condition in the field near net house of Soil Science Division, BARI, Joydebpur, Gazipur, during November 2015 to March 2016. The experiment was designed in a split plot on sixteen treatments comprising four irrigation treatments (regular irrigation, stopping irrigation at crown root initiation, stopping irrigation at booting stage and stopping irrigation at grain filling stage) and four foliar application of zinc and iron (control, 0.05% of zinc, 0.05% of iron and 0.05% of zinc +0.05% of iron). Zinc sulphate monohydrate (ZnSO4. H2O) and ferrous sulphate (FeSO4. H2O) were used as a source of Zn and Fe. The highest yield (4.01 t ha-1) was recorded in stopping irrigation at grain filling stage which was identical with regular irrigation. Water stress at crown root initiation stage had the most negative effect on growth and yield. Foliar application of zinc and iron played a major role on yield and yield components of wheat at later stages of growth. The results obtained from the present research showed that iron and zinc spray increased grain yield and quality of wheat and improved the effects caused by drought stress.Bangladesh J. Agril. Res. 43(3): 395-406, September 2018

Bt Eggplant Project in Bangladesh: History, Present Status, and Future Direction

The purpose of this article is to provide information on the history, accomplishments, and future direction of the Bt brinjal (eggplant) program in Bangladesh, formerly under the Agricultural Biotechnology Support Project II, now the South Asia Eggplant Improvement Partnership (SAEIP). The India-based Maharashtra Hybrid Seed Company (Mahyco) developed an eggplant expressing Cry1Ac (EE-1) for control of the eggplant fruit and shoot borer (EFSB). In a partnership among Mahyco, USAID, Sathguru Management Consultants and Cornell University EE-1 was provided to the Bangladesh Agricultural Research Institute (BARI) who bred it into local varieties. After regulatory approval, four varieties were distributed to 20 farmers who harvested Bt brinjal in 2014. Adoption in subsequent years has increased rapidly so that, in 2018, 27,012 farmers used this technology. This article provides background information on the process leading up to current adoption levels, the level of control of EFSB achieved and the economic benefits of Bt brinjal. Efforts on stewardship, farmer training and communication are discussed. In order to ensure the long-term future of the partnership, we discuss the need to enhance involvement of the private sector in the production and stewardship of Bt eggplant. Bt brinjal is the first genetically engineered crop to be commercially released in Bangladesh, and other GE crops are in the pipeline. Hence, success of the Bt brinjal partnership is likely to affect the future of other GE crops in Bangladesh, as well as other parts of the world where biotechnology is needed for food security and environmental safety.

Clinical Characteristics and Haematological Parameters Associated With Visceral Leishmaniasis in Bangladeshi Individuals

Visceral leishmaniasis (VL) also known as kala-azar (KA) is the most severe form of leishmaniasis and can be fatal in the absence of treatment. KA is highly endemic in Mymensingh region of Bangladesh. Although estimating the true incidence of VL may be difficult. The objective of the study was to evaluate clinico-haematological parameters in different groups of leishmaniasis cases. It was a cross-sectional descriptive type of study and was conducted in a research centre of Mymensingh, Bangladesh from February 2016 to January 2017. A total of 90 cases who were rk-39 strip test positive from five divisions of Bangladesh admitted to Research Centre were included for clinical and haematological parameters. All the cases were categorized into five different groups depending on the clinical case definition and Real Time PCR (RT-PCR) was performed using buffy coat preparation. The age of the study subjects ranged from 3 to 80 years. Mymensingh was the highest affected division (60%) and primary kala azar (PKA) cases were more than half of the study subjects. Fever was the most common feature (100%) in PKA, relapse kala azar (R-KA) and treatment failure kala azar (TF-KA) followed by splenomegaly (70.2%) in PKA, loss of appetite (62.9%) in R-KA, and skin pigmentation was observed (100%) in PKDL cases. Anaemia was present in 62.7%, leucopenia in 57.6% and thrombocytopenia in 61.7% PKA cases. Pancytopenia was observed in a total of 33 cases from all groups. There were no significant changes in serum bilirubin, SGPT and serum creatinine level. RT-PCR was performed in all cases and found positive in 30 (63.8%) PKA, 16 (59.3%) R-KA, 2 (100%) TF-KA and 2 (50%) R-KA associated with PKDL cases. Overall, VL cases were positive in 62.5% (50/80) and no PKDL cases were detected by buffy-coat RT-PCR. In endemic areas, the magnitude of the problem and limited resources of a developing country like ours, clinical characteristics and hematological parameters may also play important role for diagnosis of the clinical cases.

Evaluation of Surgical Site Infection among Post Cesarean Patients in Mymensingh Medical College Hospital

Surgical site infection (SSI) in postnatal period is a noteworthy misery for the mother as well as the family increasing both hospital stay and hospital expenses. SSI in post cesarean patients has not been well documented in study area despite considerable number of cesarean section performed and the relatively common occurrence of SSI. Hence this cross sectional observational study was intended in the department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital, Mymensingh (MMCH), Bangladesh among 100 patients to assess the risk factors of incisional SSI after cesarean section from March 2012 to February 2013. The patients diagnosed as SSI were enrolled purposively. Age, status of antenatal checkup, indication of operation, duration of operation, thickness of subcutaneous fat, character and bacteriological study of wound discharge, post operative day of detection of wound infection, status of hemoglobin were considered as major variables. Among the patients 96% underwent emergency cesarean section which were done 40% due to obstructed labour, 35% had prolonged labour and 26% had PROM more than 24 hours. Most of the infections (50%) were detected on 5th post operative day. Duration of operation was more than one hour in 35% cases, 65% patient's subcutaneous fat thickness was more than 2cm. Regarding wound discharge, 65% were serosanguinous. Organisms from wound swab were detected in 55% cases. Among those 85% infection occurred by Staphylococcus and 15% by E. coli. Moderate to severe anaemia was diagnosed in 75% patients. Maximum (80%) patients were not under regular antenatal check up. Finally it was revealed that emergency CS, obstructed labour, prolonged ruptured membrane, prolong duration of operation, anaemia, irregular antenatal check up are possible considerable risk factors for surgical site infection. Obstetrician should meticulously follow surgical safety checklist and ensure the essential safety steps into their normal operative workflow specially during handling the patients with risk factors. Encourage for regular ANC & improvement of host factor also should consider as remedial measures.

Prevalence of Intestinal Parasites in Raw Vegetables Consumed by Inhabitants of Mymensingh City

Uncooked vegetables are an important part of a healthy diet in different parts of the world. The present descriptive cross sectional type of study was carried out to determine the parasitological contamination of vegetables sold at markets of Mymensingh city of Bangladesh. Parasitological examinations were performed in material derived from 200 specimens of 10 different vegetables to detect intestinal parasites in the department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2015 to July 2016. Each sample was washed with 5 liter distilled water, then washing fluid was centrifuged and resulting sediment was collected for iodine and normal saline wet mount slide preparation to detect human pathogenic intestinal parasites by microscopic examination. Out of 200 vegetable samples, 123(61.5%) were contaminated with different species of parasites. The vegetables red amaranth had the highest contamination rate of 18/20 (90%) followed by jute leaf 17/20 (85%), coriander leaf 15/20 (75%), onion 14/20 (70%), lady's finger 14/20 (70%), radish 13/20 (65%), green pepper 12/20 (60%), carrot 12/20 (60%), cucumber 5/20 (25%), tomato 3/20 (15%). Among the contaminating parasites Ascaris lumbricoides (egg) 36.5% was the most prevalent followed by Strongyloides stercoralis (larva) 35.5%, Entamoeba histolytica ( trophozoite and different cystic stages) 8.5%, Hook worm (egg and larva) 6.5% , Balantidium coli (trophozoite) 4.0%, Enterobius vermicularis (egg) 3.5%, Trichuris trichiura (egg) 1.5%, Giardia lamblia (cyst) 1.0%. To our knowledge, it was the first base line study pursued in Bangladesh. Contamination of raw vegetables from markets with pathogenic parasites would increase the risk of disease to the population that consumes or works with these products. So improperly washed raw eaten vegetables should be considered a potential risk for contracting parasites, particularly helminthes in Mymensingh city.

Automatic diagnosis of tuberculosis disease based on Plasmonic ELISA and color-based image classification

Tuberculosis (TB) remains one of the most devastating infectious diseases and its treatment efficiency is majorly influenced by the stage at which infection with the TB bacterium is diagnosed. The available methods for TB diagnosis are either time consuming, costly or not efficient. This study employs a signal generation mechanism for biosensing, known as Plasmonic ELISA, and computational intelligence to facilitate automatic diagnosis of TB. Plasmonic ELISA enables the detection of a few molecules of analyte by the incorporation of smart nanomaterials for better sensitivity of the developed detection system. The computational system uses k-means clustering and thresholding for image segmentation. This paper presents the results of the classification performance of the Plasmonic ELISA imaging data by using various types of classifiers. The five-fold cross-validation results show high accuracy rate (>97%) in classifying TB images using the entire data set. Future work will focus on developing an intelligent mobile-enabled expert system to diagnose TB in real-time. The intelligent system will be clinically validated and tested in collaboration with healthcare providers in Malaysia.

A P2P Botnet detection scheme based on decision tree and adaptive multilayer neural networks

In recent years, Botnets have been adopted as a popular method to carry and spread many malicious codes on the Internet. These malicious codes pave the way to execute many fraudulent activities including spam mail, distributed denial-of-service attacks and click fraud. While many Botnets are set up using centralized communication architecture, the peer-to-peer (P2P) Botnets can adopt a decentralized architecture using an overlay network for exchanging command and control data making their detection even more difficult. This work presents a method of P2P Bot detection based on an adaptive multilayer feed-forward neural network in cooperation with decision trees. A classification and regression tree is applied as a feature selection technique to select relevant features. With these features, a multilayer feed-forward neural network training model is created using a resilient back-propagation learning algorithm. A comparison of feature set selection based on the decision tree, principal component analysis and the ReliefF algorithm indicated that the neural network model with features selection based on decision tree has a better identification accuracy along with lower rates of false positives. The usefulness of the proposed approach is demonstrated by conducting experiments on real network traffic datasets. In these experiments, an average detection rate of 99.08 % with false positive rate of 0.75 % was observed.

Comparison of Outcome of Eclamptic Patient Following Vaginal Delivery versus Caeserian Delivery by Spinal Anaesthesia

Eclampsia is a common problem in pregnancy in Bangladesh. It is a severe form of preeclampsia which affects 5 to 7% of pregnancies is a significant cause of maternal & neonatal morbidity & mortality. Pre-eclampsia when complicated with generalized tonic-clonic convulsions and/or coma is called eclampsia. The term eclampsia is derived from a Greek word, meaning "like a flash of lightening". It may occur quite abruptly, without any warning manifestations. Eclampsia is a major cause of maternal mortality & morbidity as well as foetal loss worldwide, particularly in the third world. Appropriate measures & effective treatment of eclamptic patient in proper time reduce maternal mortality & morbidity. The mainstay of treatment of eclampsia is delivery of the foetus. Two methods are usually applied for delivery of foetus in eclampsia i.e. vaginal delivery & caesarean delivery. This study was done in the department of Gynae & Obs and department of Anaesthesiology, Mymensingh Medical College Hospital from 1st January 2016 to 30th June 2016 to observe the incidence, complications (morbidity) & mortality of eclamptic patients & which method (vaginal delivery versus caesarean delivery by spinal anaesthesia) is safe, better for the eclamptic patients as well as foetal mortality. Successful vaginal delivery is dependant on complex interactions of three variables (3 P) that is power (uterine contraction), passenger (foetus) & passage (birth canal) but power is less effective in eclamptic patient than normal partuents. Vaginal delivery requires prolong times compared with cesarean delivery. Anaesthetic technique is also an important factor for maternal mortality & morbidity of caesarean delivery. Spinal anaesthesia is widely regarded as a reasonable anaesthetic option for caesarean delivery in eclamptic patients. Currently the safety of spinal anaesthesia is well established and it can provide better obstetrical outcome when chosen properly. In this observation caesarean delivery by spinal anesthesia is safer, less complications, less maternal & neonatal mortality than vaginal delivery in eclamptic patients.

Surgical Management of a Critical Ischemic Mitral Regurgitation Patient

Functional ischemic mitral regurgitation is strongly associated with poor outcomes in patient with coronary artery disease. The best management for mitral regurgitation at the time of coronary revascularization remains controversial. We report, a case of 58 years-old men admitted to GKNM hospital, Coimbatore, Tamil Nadu, India with chest pain and respiratory distress for last 6 hours during my fellowship training in that hospital. ECG showed acute antero-septal MI. The transthoracic echocardiogram revealed severe left ventricular dysfunction with moderate mitral regurgitation. Coronary angiogram revealed triple vessels disease. We planned for early CABG. But the patient suddenly developed severe respiratory distress with ventricular tachycardia. Patient managed with the support of invasive ventilation and IABP. After that, CABG along with mitral valve repair was done under cardiopulmonary bypass. The patient showed excellent symptomatic improvement during his early post-operative period. Mitral valve repair along with CABG may be a preferable treatment option for patient with Ischemic heart disease with moderate mitral regurgitation.

Heavy metal accumulation in leafy vegetables grown in industrial areas under varying levels of pollution

The concentration of lead (Pb), cadmium (Cd), nickel (Ni), cobalt (Co) and chromium (Cr) in three popular leafy vegetables such as spinach (Spinacia oleracea), red amaranth (Amaranthus tricolor) and amaranth (Amaranthus oleraseus) and that in the respective soils were assessed. These crops and soils were collected from two industrial areas (Kalakoir and Zorun, Konabari, Gazipur), and one non-industrial area (Bangladesh Agricultural Research Institute-BARI) under Gazipur district. The concentration of heavy metal in different parts of plant followed the roots>leaves>stem and in soils the order was Kalakoir (pollution)> Zorun (medium pollution) > BARI (low/non-pollution). In all three leafy vegetables similar trend of metal contents was observed i.e. Ni>Cr>Pb>Co>Cd. In the highly pollution area (Kalakoir) the Pb and Ni concentration was found in the order of amaranth>spinach>red amaranth. The Cd concentration was in the order of spinach>amaranth>red amaranth whereas for Cd it was amaranth>red amaranth>spinach and for Cr it was red amaranth>amaranth>spinach. The Pb, Cd, Ni, Co and Cr concentrations in the studied vegetables grown in the low polluted area were below the maximum acceptable levels proposed by the Joint FAO/WHO Expert Committee on Food Additives, except, Cd in spinach and amaranth. However, the higher concentrations of Pb, Cd, Ni, Co and Cr in vegetables grown in the industrial areas indicates that industrial discharge causes heavy metals contamination of soil and eventually their accumulation in plants.Bangladesh J. Agril. Res. 43(1): 39-51, March 2018

Immediate Outcome of Preterm Neonates with Respiratory Distress Syndrome Required Mechanical Ventilation

Since its inception, the neonatal mechanical ventilator has been considered an essential tool for managing preterm neonates with Respiratory Distress Syndrome (RDS) and is still regarded as an integral component in the neonatal respiratory care continuum. Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. This clinical intervention study was done to analyze immediate outcome of preterm neonates with RDS required mechanical ventilation and conducted on preterm neonates with RDS required mechanical ventilation from July 2014 to June 2015. Total of 31 preterm neonates with RDS were mechanically ventilated during the study period, of which 77.42% (N=24) survived. The survival rate was highest among 30- <34 weeks (100%) gestational age (GA) group and lowest in 27- <30 weeks (56%) GA, (p=0.0036). The neonates with Birth Weight (BW) 1500gm -1800gm were higher rate of recovery which was 100% and gradually declined in 1000-1499gm (93.75%) and 800-999gm (33.33%) BW groups (p=0.00083). In this study most of the neonates were male (61.29%) but recovery rate was relatively better among baby girls (83.33%) than baby boys (73.68%) (p=0.53). RDS with surfactant therapy was better outcome than non surfactant group & survival of neonates who got surfactant were 93.33% & non surfactant neonates were 62.50%, (p=0.040). Majority (71.43%) of RDS with surfactant therapy recovered earlier <7 days than non surfactant therapy neonates (30.00%) and most of non surfactant neonates (70.00%) required prolonged ventilator support >7days (p=0.045). During the period of ventilation a total 17(54.84%) neonates developed different complications, of which ventilator associated pneumonia was (16.13%), sepsis (16.13%), pneumothorax (9.68%), pulmonary hemorrhage (6.45%) and intraventricular hemorrhage (6.45%) and among them 10 neonates recovered. No complications encountered in 14(45.16%) neonates, all of them survived, (p=0.0064). All (N=31) preterm neonates were candidate for surfactant therapy but only 15 neonates got surfactant therapy, remaining (N=16) did not get for their financial issue. As mechanical ventilation with surfactant therapy reduces the neonatal mortality; hence, facilities for neonatal ventilation and cost effective surfactant therapy should be included in the regional and central hospitals providing intensive care for neonates.

Distribution Pattern and Outcome of the Patients in the Intensive Care Unit of Bangabandhu Sheikh Mujib Medical University: A Short Term Analysis

The aim of the study was to describe the characteristics of patients admitted to intensive care unit and their outcome in Bangabandhu Sheikh Mujib Medical University, Bangladesh. This retrospective, descriptive study was conducted in the intensive care unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2016 to June 2016. Data was retrieved from hospital records of all admitted patients regarding age, gender, admission source, reason for admission, length of ICU stay, requirement of mechanical ventilation, number of organ failure and their outcome. During this study period, the total number of patients admitted was 225; most of them were males (148, 65.7%). Among the 225 patients, the highest number of admission was comprised of intracranial haemorrhage (22.6%), followed by sepsis (12.4%), acute respiratory distress syndrome (10.2%), acute renal failure (9.3%) malignancy (8.8%) and ischemic stroke (8.0%). Mean age of the patient was 54±18 years and mean length of ICU stay was 6.8±3 days. Out of 225 patients, 87 expired (38.6%). Majority of the patients required mechanical ventilation (69.3%) and had multi organ failure (59.8%). Most of the expiries were due to intracranial haemorrhage (24.1%); followed by acute respiratory distress syndrome (12.6%), malignancy (12.6%) and sepsis (11.4%). Elderly age (>65 years), requirement of mechanical ventilation and multiorgan failure had significant relationship (p<0.05) with overall ICU mortality. Intracranial haemorrhage, sepsis, acute respiratory distress syndrome were the main reasons for admissions in ICU, while mortality was highest for intracranial haemorrhage. Developing a well equipped neurological ICU with adequately trained staff will help to improve the outcome of patients.