Women's Overall Satisfaction with Childbirth Experience in a Tertiary Level Hospital of Bangladesh

Women's satisfaction with care in labour is a positive indicator for the woman herself, as well as healthcare organization as a whole. This study was aimed to find out the women's satisfaction with their childbirth. It also tried to identify significant differences across various mode of delivery and satisfaction related to women's childbirth experience. It was a descriptive type of cross-sectional study conducted among 278 post-natal mother who give live birth at government tertiary hospital namely Mymensingh Medical College Hospital, Bangladesh. The study was conducted in the department of Obstetrics and Gynaecology during the period of January 2020 to December 2020. Data were collected from the respondents by face to face interview using a self-administered semi-structured questionnaire including Salmon's Item List. Level of overall satisfaction with childbirth was assessed by Salomon's Item List. Data analysis was carried out by SPSS version 25.0. The dimension of physical discomfort, emotional distress and fulfilment had a Cronbach's alpha of 0.746, 0.966 and 0.982 respectively. The internal consistency of each dimension was found to be acceptable and reliable. The mean scores of the dimensions in Salmon's Item List for Fulfilment, Emotional distress and Physical discomfort was found to be 69.20, 50.85 and 50.40 respectively. Higher total scores indicate a more positive evaluation of the childbirth experience and lower scores indicate a more negative evaluation. In this study the Overall mean scores of the three dimensions was 50.75. The mean scores of 'fulfillment' was higher in normal vaginal delivery (NVD) and scores of both "emotional distress" and "physical discomfort" were higher in lower uterine cesarean section (LUCS). Among all the three dimensions, mean scores of 'fulfillment' was higher in NVD indicating more satisfaction with NVD than LUCS and instrumental delivery. On the other hand, scores of "physical discomfort" and "emotional distress" were lower in NVD indicating less satisfaction with NVD than LUCS.

Co-application of biochar and compost with decreased N fertilizer reduced annual ammonia emissions in wetland rice

Ammonia (NH3) emission from rice fields is a dominant nitrogen (N) loss pathway causing negative impacts on farm profitability and the environment. Reducing N fertilizer application to compensate for N inputs in organic amendments was evaluated for effects on N loss via volatilization, rice yields and post-harvest soil properties in an annual irrigated rice (Boro) – pre-monsoon rice (Aus) – monsoon (Aman) rice sequence. That experiment was conducted using the integrated plant nutrition system (IPNS; nutrient contents in organic amendments were subtracted from the full recommended fertilizer dose i.e., RD of chemical fertilizers) where six treatments with four replications were applied in each season: (T1) no fertilizer (control), (T2) RD, (T3) poultry manure biochar (3 t ha−1; pyrolyzed at 450°C) + decreased dose of recommended fertilizer (DRD), (T4) rice husk ash (3 t ha−1) + DRD, (T5) compost (3 t ha−1) + DRD, and (T6) compost (1.5 t ha−1)+ biochar (1.5 t ha−1) + DRD. The N loss via volatilization varied twofold among seasons being 16% in irrigated rice and 29% in the pre-monsoon rice crop. In irrigated rice, T6 had significantly lower NH3 emissions than all other treatments, except the control while in pre-monsoon and monsoon seasons, T6 and T3 were alike. Pooling the three seasons together, biochar (T3) or biochar plus compost (T6) reduced NH3 loss via volatilization by 36-37% while compost alone (T5) reduced NH3 loss by 23% relative to RD. Biochar (T3) and biochar plus compost mixture (T6) reduced yield-scaled NH3 emissions by 40 and 47% relative to the RD of chemical fertilizer (T2). The organic amendments with IPNS reduced the quantity of N fertilizer application by 65, 7, 24, and 45% in T3, T4, T5, and T6 treatments, respectively, while rice yields and soil chemical properties in all seasons were similar to the RD. This study suggests that incorporation of biochar alone or co-applied with compost and decrease of N fertilizer on an IPNS basis in rice-based cropping systems can reduce N application rates and NH3 emissions without harming yield or soil quality.

Gut biomolecules (I-FABP, TFF3 and lipocalin-2) are associated with linear growth and biomarkers of environmental enteric dysfunction (EED) in Bangladeshi children

In the current world, a major challenge to diagnose environmental enteric dysfunction (EED) is the lack of validated non-invasive biomarkers. Intestine derived molecules, including intestinal fatty acid binding protein (I-FABP), trefoil factor-3 (TFF3), lactoferrin, lipocalin-2 (LCN2), and mucin-2, have been reported as indicators of intestinal inflammation and gut health. Therefore, we aimed to investigate the levels of these bio-molecules as biomarkers of EED among under-2 children in Bangladesh. A total of 140 children were recruited in a case–control design. All the biomarkers were measured by ELISA. Spearman’s rank correlation was performed to see the correlation between the biomarkers and the EED score. Moreover, multivariable linear regression was performed to investigate the association of biomarkers with length-for-age z-score (LAZ). TFF3 correlates positively with myeloperoxidase (r = 0.26, p < 0.05) and EED score (r = 0.17, p < 0.05). Likewise, LCN2 correlates positively with myeloperoxidase (r = 0.37, p < 0.05), neopterin (r = 0.33, p < 0.05) and EED score (r = 0.31, p < 0.05). Moreover, multivariable linear regression revealed a negative association of I-FABP with LAZ of the study participants. Our results imply that TFF3 and LCN2 might be promising biomarkers to diagnose intestinal inflammation and EED, while I-FABP is negatively associated with linear growth of Bangladeshi children.

Tracking Side Effects of the COVID-19 Vaccine in Mymensingh District of Bangladesh

The Coronavirus disease 2019 (COVID-19) has turned into a worldwide human tragedy and economic devastation. There had an intensive search for an effective drug against the coronavirus but not led to any breakthrough agents. Only one choice was left namely an effective and safe vaccine. Many people are ambivalent regarding corona vaccines because they also fear possible side effects from vaccination. This study was designed to track the side effects after first and second dose of the Oxford-AstraZeneca vaccines used in Mymensingh district of Bangladesh. This cross-sectional descriptive type of observational study was conducted in Mymensingh Medical College, Mymensingh, Bangladesh during the period of five months from 1 February, 2021 to 30 June, 2021 among 293 purposively selected vaccine recipients who received two doses of the Oxford-AstraZeneca vaccines. Data were collected by face to face interview of the selected vaccine recipients using a semi-structured questionnaire. Data were inputted into SPSS version 26.0. Qualitative data were summarized by percentage and quantitative data were summarized by mean and standard deviation. Necessary bivariate and multivariate analysis was done. Mean age of the respondents was 40.3 years with a standard deviation of ±8.7 years. Among the vaccine recipients female were 159(54.3%) and male were 134(45.7%). The most of the vaccine recipients were graduate and master 256(87.3%) and more than half of the vaccine recipients (156, 53.2%) were government service holder. The most of the vaccine recipients (242, 86.0%) were from urban area and 263(89.8%) vaccine recipients were non-smoker. Sixty eight (23.2%) of the vaccine recipients had different types of co-morbidities. It was found that 217(74.1%) vaccine recipients had side effects after first dose while 162(55.3%) had side effects after second dose. The difference in occurrence of side effects of first and second dose was statistically highly significant (p<0.001). Pain on the injection site was present in 172(58.7%) vaccine recipients after first dose and in 142 (48.5%) after second dose. Fever was prevalent in 98 (33.4%) after first dose and in 61 (20.8) after second dose. Headache was in 61(20.8%) and in 22(7.5%) after first and second dose respectively. Thirty one (10.6%) vaccine recipients had loose motion after first dose and 26(8.9%) had this after second dose. First dose of vaccination caused nausea in 28(9.6%) and second dose caused it in 16(5.5%) vaccine recipients. Joint pain was prevalent in 24(8.2%) after first dose and in 15(5.1%) after second dose. Rash was present in 9(3.1%) and in 3(1.0%) after first and second dose respectively. Cough was present in 5(1.7%) after first dose and in 2(0.7%) after second dose. Each 2(0.7%) had history of fainting and bodyache and 1(0.3%) reported intense weakness after first dose only. Side effects of first dose of AstraZeneca vaccine were more prevalent in female (124, 78.0%) than male (93, 69.4%). The side effects of second dose of AstraZeneca vaccine were also more prevalent in female (103, 64.8%) than male (59, 44.0%). The study results revealed that 217(74.1%) vaccine recipients had side effects after first dose while 162(55.3%) had side effects on second dose of the Oxford-AstraZeneca vaccine. Commonly experienced side effects were pain in the injection site, fever, headache, diarrhoea and joint pain. Most of the people tolerated these side effects and did not use any medicine.

Vaccination against COVID-19 in Bangladesh: Perception and Attitude of Healthcare Workers in COVID-dedicated Hospitals

Healthcare professionals are the crucial and influencing source of information for vaccines and their communication among patients and communities that can accelerate successful vaccination in a country. This cross-sectional study was one of the first and foremost ones in Bangladesh to observe the basic perception and attitudes towards vaccination against COVID-19 among the healthcare workers (HCWs) - doctors, interns, nurses, ward boys, cleaners, and medical technologists of major COVID-dedicated hospitals. The cross-sectional questionnaire-based study was conducted in February 2021 among 550 HCWs to assess the perception and attitude towards vaccination against COVID-19. The study participants were targeted as the priority group for COVID-19 vaccination, working in two major COVID-dedicated hospitals, Holy Family Red Crescent Medical College Hospital (HF-center), and Sheikh Russel National Gastro-liver Institute and Hospital (SR-center) in Dhaka, Bangladesh during the pandemic. The questionnaire was structured with a three-point scale of responses from 'true', 'false', and 'do not know'. The responses were calculated on point-score as +1 for the correct response, -1 for the wrong response, and 0 for 'do not know' with an overall highest and the lowest possible score of +5 to -5. Absolute (n) and relative frequencies (%) were presented for qualitative variables, while quantitative variables were presented as mean (± standard deviation). Chi-square test was done for univariate analysis of qualitative variables and Student's t-test for quantitative variables. With the 95.27% response rate, including 204 males and 320 were female and the male: female ratio was 1: 1.56. The majority of the participants were doctors (45.8%) followed by nurses (27.9%), and MLSS (26.3%) respectively. The respondents were between 18 to 64 years of age with a mean of 36.17±10.94 years. Most of the respondents (95.99%) responded correctly about the cost-free availability of a vaccine against COVID-19 in the country, 87.40% preferred vaccination as safe and effective. Again 29.77% HCWs think the vaccine might not be safe or effective due to emergency authorization. Only 38.93% of respondents could respond correctly about the necessity of vaccines for children, 31.10% think the vaccination was not required instead of natural immunity. The positive perception and attitude of the frontline HCWs in COVID-dedicated hospitals in Bangladesh are crucial which will positively influence motivation and wide acceptance among the general population for the attainment of the nationwide vaccination program, and adopt effective strategic modification to minimize the gaps for a low-middle income country like Bangladesh with its resource constrain.

Hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh

Hemoprotozoans are important pathogens of animals and humans, among which some species have zoonotic significance. The prevalence of different hemoprotozoa and Anaplasma spp. in larger mammals have been reported from different regions of the world. But, very few studies have been conducted to estimate the prevalence of hemoprotozoa in rodents and shrews of South-East Asia. The study assessed the prevalence of hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh. Blood samples (n=451) were collected from rodents and shrews between June 2011 and June 2013 and July-December 2015 from 4 land gradients of Bangladesh. Giemsa-stained blood smears revealed that 13% of animals were harboring hemoprotozoa (4.7% Babesia spp., 0.67% Plasmodium spp.), and Anaplasma spp. (7.5%). The study may serve as a guide for future hemoparasitic research of rodents and shrews.

MEASUREMENT OF EXTREMITY DOSES OF NUCLEAR ENERGY WORKER BY USING RING DOSIMETER

Finger doses can serve as a guide to suggest any needed modification in work practice to minimise radiation doses to the extremities. In the present study, radiation doses at the base of the middle finger of both hands of 20 nuclear energy workers handling 99mTc-labelled compounds,125I and131I during various diagnostic and therapeutic procedures in nuclear medicine were measured. The laboratory assessments were carried out by means of thermoluminescence ring dosimetry in Health Physics Division, Atomic Energy Center, Dhaka. The recorded extremity doses were then compared to their routinely monitored whole-body doses. The average annual finger doses recorded in this study were found to be 10.7 ± 8.2 and 12.7 ± 12.9 mSv, respectively, for the left- and right-hand fingers, which are at least 12-fold higher than the average whole-body dose. There was, however, no extreme case found of health hazard to the workers' hand, which exceeds maximum dose limit 500 mSv/year given by the International Commission on Radiological Protection. On comparing the average annual finger doses at different labs, significantly higher average dose was recorded at isotope-dispensing lab (19.6 ± 12.6 mSv/year) and then followed by gamma camera lab (13.2 ± 12.1 mSv/year) and radioimmunoassay lab (7.0 ± 5.5 mSv/year). These observations are fairly in good agreement with the reported results. The observations of the present study, therefore, may be implemented for the betterment of safety for the occupational workers in nuclear medicine facilities.

Mapping QTLs underpin nutrition components in aromatic rice germplasm

As rice is an important staple food globally, research for development and enhancement of its nutritional value it is an imperative task. Identification of nutrient enriched rice germplasm and exploiting them for breeding programme is the easiest way to develop better quality rice. In this study, we analyzed 113 aromatic rice germplasm in order to identify quantitative trait loci (QTL) underpinning nutrition components and determined by measuring the normal frequency distribution for Fe, Zn, amylose, and protein content in those rice germplasm. Comparatively, the germplasm Radhuni pagal, Kalobakri, Thakurbhog (26.6 ppm) and Hatisail exhibited the highest mean values for Fe (16.9 ppm), Zn (34.1 ppm), amylose (26.6 ppm) and protein content (11.0 ppm), respectively. Moreover, a significant linear relationship (R2 = 0.693) was observed between Fe and Zn contents. Cluster analysis based on Mahalanobis D2 distances revealed four major clusters of 113 rice germplasm, with cluster III containing a maximum 37 germplasm and a maximum inter-cluster distance between clusters III and IV. The 45 polymorphic SSRs and four trait associations exhibited eight significant quantitative trait loci (QTL) located on eight different chromosomes using composite interval mapping (CIM). The highly significant QTL (variance 7.89%, LOD 2.02) for protein content (QTL.pro.1) was observed on chromosome 1 at 94.9cM position. Also, four QTLs for amylose content were observed with the highly significant QTL.amy.8 located on chromosome 8 exhibiting 7.2% variance with LOD 1.83. Only one QTL (QTL.Fe.9) for Fe content was located on chromosome 9 (LOD 1.24), and two (QTL.Zn.4 and QTL.Zn.5) for Zn on chromosome 4 (LOD 1.71) and 5 (LOD 1.18), respectively. Overall, germplasm from clusters III and IV might offer higher heterotic response with the identified QTLs playing a significant role in any rice biofortification breeding program and released with development of new varieties.

Knowledge and Attitude Regarding National Tobacco Control Law and Practice of Tobacco Smoking among Bangladesh Police

Tobacco is an important public health problem of Bangladesh having both high production and consumption. Police are engaged in enforcement of the tobacco control law. For effective enforcement of national tobacco control law (NTCL), they should have sound knowledge of tobacco control law and their attitude to the tobacco control law must be a positive one. The objective of the study was to explore the status of knowledge and attitude regarding national tobacco control law and practice of tobacco smoking among Bangladesh Police. The descriptive cross sectional study was conducted among 440 members of Bangladesh Police during the period of March 2015 to November 2015. Police personnel of different ranks were interviewed randomly using a semi-structured questionnaire from the selected SP offices, police lines, police stations and police camps. Among the respondents 414(94.1%) were male and 26(5.9%) were female. About half (214, 48.6%) of the respondents never smoked in life, while 226(51.4%) smoked in life even one or two puffs. There was no female among the ever smokers. One quarter (114, 25.9%) of the respondents ever smoked but quitted and 112(25.4%) respondents were currently smoker. Among the current smokers 31(7.0%) were occasional, while 81 (18.4%) were daily smoker. It was observed that there was lack of knowledge among police personnel regarding various rules and clauses of national tobacco control law. Most of the respondents (434, 98.6%) showed positive attitude regarding rationality of prohibition of smoking in public places and public transports. The most of the respondents (418, 95.0%) agreed that there should not be any advertisement of tobacco products in cinema hall, radio and television channel. A highest majority (377, 85.7%) of the respondents gave their opinion that Government should increase taxes on tobacco products. Most of the respondents (433, 94.4%) opined against the selling of tobacco products to the minor. Almost every respondent (436, 99.1%) wanted proper implementation of tobacco control law. Nearly half of the respondents (213, 48.4%) thought that smoking among police was one of the obstacles in effective implementation of tobacco control law. An overwhelming majority of the respondents (435, 98.9%) agreed that police personnel should not smoke tobacco for keeping their health and fitness and thereby for better performance. Almost all respondents (436, 99.1%) gave a positive opinion that police personnel may be a role model for the public by not smoking tobacco. Most of the respondents (427, 97.1%) think that orientation or training program on tobacco control law should be arranged for police personnel. More than one fourth (25.5%) of the police personnel in Bangladesh are currently smokers and this should be intervened. Smoke-free police station initiative is started but not being 100% implemented. Lack of knowledge regarding various rules and clauses of NTCL was sufficient enough to draw intervention in this regard. Positive attitude of police personnel towards NTCL and smoke free police station initiative will help to implement tobacco control law properly.

An Overview on Epidemiology of Tuberculosis

Tuberculosis (TB) is a progressive granulomatous infectious disease caused by the gram positive, acid fast bacilli classified under the genus Mycobacterium. Tuberculosis in human is mostly by Mycobacterium tuberculosis and primarily affects lungs causing pulmonary tuberculosis. It can also affect intestine, meninges, bones, joints, lymph nodes, skin and other tissues of the body causing extra-pulmonary tuberculosis. Human TB is transmitted mainly through droplet infection and droplet nuclei. Infection of human with M. avium and M. africanum is very rare. M. microti is not known to cause TB in human, while M. bovis has a wider host range. Human may be infected by M. bovis through milk and milk products or meat of an infected animal. It is estimated that in some developing countries up to 10% of human tuberculosis is due to bovine TB. Tuberculosis causes more than 2 million deaths annually and the death toll is worsened by the emergence of drug resistant Mycobacterium tuberculosis. The South East Asia Region accounts for 39% of global burden of TB in terms of incidence. It is estimated that about 3.4 million new cases of TB continue to occur each year in this region, most of them in India, Bangladesh, Indonesia, Myanmar and Thailand. Tuberculosis is a social disease with medical aspects. It has also been described as a barometer of social welfare. The social factors include poor quality of life, poor housing, overcrowding, population explosion, under-nutrition, smoking, alcohol abuse, lack of education, large families, early marriages, lack of awareness regarding cause and transmission of TB. These factors are interrelated and contribute to the occurrence and transmission of tuberculosis. It is estimated that approximately 10% of total TB is occurred in children. Childhood deaths from TB are usually caused by tuberculous meningitis or disseminated disease. The number of individuals infected with both HIV and TB is increasing worldwide. The HIV affects the body's immune system and enhances the speed at which TB progresses from a innocuous infection to life threatening condition. TB is a major cause of death of HIV positive individuals. Diabetes has been shown to be an independent risk factor for tuberculosis in community based studies from south India and multiple studies globally. It is suggested that diabetes accounts for 14.8% of all tuberculosis and 20.8% of smear positive TB. Understanding of epidemiology of tuberculosis is essential for its effective control. This review tried to summarize the epidemiological aspects of tuberculosis in global, regional and Bangladesh perspectives. For this review article, data available in books and at the official websites of WHO, MBDC, NTP, DGHS, The Ministry of Health and Family Welfare, Government of Bangladesh were consulted through PubMed central and Google scholar search engines. This paper has been written with an aim to offer general education to health professionals, policy makers, patients and the public.

Prevalence of clinical and subclinical caprine mastitis of northern region in Bangladesh

Mastitis is a multifactorial and infectious disease of the udder of dairy animals. Infected animals suffer from pain and fever and causing damage in udder and changes in milk. The aim of this work was to determine the prevalence of clinical and sub-clinical caprine mastitis associated with bacterial pathogens during the period from January to June, 2017. A total of 120 lactating goats were randomly selected from different villages of Dinajpur district and 240 milk samples from each udder half were aseptically collected. The udders were examined and screened for the evidence of clinical and subclinical mastitis by clinical examination of udders and examining milk samples. Subclinical mastitis was detected by California Mastitis Test (CMT). Milk samples of all clinical and subclinical mastitis goats were cultured in/on bacteriological media for isolation and characterization of responsible bacterial pathogens. The overall prevalence of clinical and subclinical mastitis in goats was found to be 11.67% and 38.75%, respectively. Bacteriological examination of mastitic milk samples of caprine revealed Staphylococcus spp. (32.5%) as the major pathogen followed by Escherichia coli (22.5%), Pseudomonas spp. (12.5%), Klebsiella spp. (12.5%) and Bacillus spp. (5%). Results of this study indicated that about 50% of caprine udder were infected with mastitis (38.75%), which may render lowering milk production and mortality of goats and kids. It needs to screen milk sample of lactating goats by CMT, identify mastitic goats with infected bacteria, evaluate antibiotic sensitivity and design control strategy accordingly.Progressive Agriculture 29 (2): 127-138, 2018

IN-VITRO EFFICACY OF VERENDA (Ricinus communis) LEAVES EXTRACT AGAINST TICKS IN CATTLE

Tick infestation is commonly found in every commercial cattle farm and domestically reared cattle. Farm generally used acaricides to treat tick infestation; however finding new, cheap and alternative source of acaricides is a prime concern. Here, we investigated the in-vitro efficacy of verenda (Ricinus communis) leaves extracts to treat tick infestation. We prepared aqueous, methanolic and ethanolic extract of verenda leaves to apply on ticks. A total of 90 ticks (both hard ticks and soft ticks) was collected from cattle in local area of Mymensingh region and divided into 3 treatment groups: A (aqueous), B (ethanol), C (methanol) and D (control). All groups were sub-divided into 3 sub-groups on the basis of concentration of 1%, 2% and 3% treatments. Ticks were treated with different concentration of extract and observation of tick was performed 12, 24 and 36 hours interval. The whole experiment was repeated thrice. Our data suggests 3% methanolic extract confer highest efficacy against ticks and verenda leaves extract could be used alternatively as acaricides.

Quantitative Analysis of Nucleic Acid Extraction Methods for Vibrio cholerae Using Real-time PCR and Conventional PCR

The devastating diarrheal disease cholera is caused by the bacterium Vibrio cholerae. Nucleic acid extraction is the primary step for several molecular detection approaches. In order to identify the sources of cholera illness, an efficient, fast and easy DNA extraction method for toxigenic Vibrio cholerae is desired which can be applied on diverse type of samples. This methodology developmental setup study was performed in the Environmental Microbiology Lab, Department of Microbiology, University of Dhaka, Bangladesh from March 2015 to May 2015 attempted to compare three DNA extraction methods for efficient detection and quantification of Vibrio cholerae. Three nucleic acid extraction methods: (Boiled template, Phenol: Chloroform: Isoamyl alcohol, QiaAmp® mini kit), were assessed for four, routinely tested, templates: crude culture, suspension in water, phosphate buffer saline (PBS), and food by conventional and real time PCR targeting the toxin-coding ctxA gene. Finally, the results were compared in context of processing time and overall cost. Cycle threshold (Ct) values were within acceptable parameters by real time PCR (5 to 35 cycles). All the three extraction methods produced sufficient yield of DNA and copy number for detection by real time and conventional PCR. The boiled template method for water samples yielded low amount of DNA in comparison to the other methods, and is therefore sensitive to detect by non-quantitative, conventional PCR only. Despite an overall low detectability from water samples, our comparison reveals that the boiled template method is the most suitable method for high quality and quantity pathogenic DNA particularly in light of limited access to expensive kits and reagents, time constraints, and high sample load.

Clinicopathological Assessment of Colorectal Carcinoma in Mymensingh Medical College Hospital, Bangladesh

Colorectal carcinoma (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer death in both men and women in the US. It is mainly a disease of the developed countries with a western culture, yet the disease is not uncommon in developing countries. There is substantial geographical variation in the incidence and demographic characteristics of the disease. Variations are also observed in the risk factors, mode of presentation, sub site distribution and stage of the disease at presentation. This cross-sectional, descriptive study was intended to explore the age and sex distribution, pattern of presentation, sites and histological types of colorectal carcinoma. This cross-sectional, descriptive study was conducted in the department of surgery, Mymensingh Medical College Hospital, Bangladesh from October 2011 to September 2012. Purposively selected sixty patients irrespective of age and sex with histologically proven colorectal cancer were included in the study. A pre-tested, structured case record form was used for collection of data. Most of the patients (80.0%) were above 50 years of age. Mean age was 60.83 years with an SD of 11.2 years. Male to female ratio was almost equal (1.3:1). Positive family history was present in 3.3% cases. More than half of the patients (53.3%) were smokers, 76.7% patients had the history of taking fresh fruits irregularly. Pain in abdomen was the leading symptom followed by alteration of bowel habit and weight loss. Anaemia was found in 71.6% patients followed by wasting in 70.0% cases. Proctosigmoidoscopy was the principal diagnostic modality (61.7%) followed by double contrast barium enema (30.0%). Patients with rectal growth were detected by digital rectal examination (23.3%). Rectum was the principal site of cancer (36.7%) followed by sigmoid colon (33.3%). Cancer in caecum and ascending colon were in 15.0% and 6.7% patients respectively. Adenocarcinoma was the principal histological type (88.0%) and 36.7% were well differentiated carcinoma. Majority of the patients (63.3%) were in advanced stage (stage III and stage IV). Some forms of palliative surgical treatment were offered to all colorectal cancer patients in the study. Postoperative outcome was uneventful in most of the patients. However, there was wound infection in (13.3%) patients. Colorectal cancer was found mainly in elderly. Male and females were affected almost equally. Smoking was the most commonly found risk factor. Colorectal carcinoma involved rectum and sigmoid colon in majority of the patients. Adenocarcinoma was the principal histological type and the most of which were well differentiated. Majority of the patients were diagnosed at an advanced stage and palliative treatment was offered to them. Postoperative period was uneventful in most of them. Policies should be taken to promote health education & screening programmes which will lead to early diagnosis, affordable and effective treatment and better prognosis.

Retinoic acid prevents synaptic deficiencies induced by alcohol exposure during gastrulation in zebrafish embryos

In this study, we examined the effects of alcohol exposure during gastrulation on zebrafish embryos, specifically focusing on excitatory synaptic activity associated with neurons (Mauthner cells) that are born during gastrulation. Furthermore, we determined whether co-treatment of alcohol and retinoic acid (RA) could prevent the effects of alcohol exposure during gastrulation. We exposed zebrafish embryos to ethanol (150mM), RA (1nM), or a combination of RA (1nM) plus ethanol (150mM) for 5.5h from 5.25h post fertilization (hpf) to 10.75 hpf (gastrulation). Ethanol treatment resulted in altered hatching rates, survivability and body lengths. Immunohistochemical analysis of Mauthner cells (M-cells) suggested that ethanol treatment resulted in smaller M-cell bodies and thinner axons, while electrophysiological recordings of AMPA miniature excitatory postsynaptic currents (mEPSCs) associated with M-cells showed that ethanol treated animals had a significantly reduced mEPSC frequency. Other mEPSC parameters such as amplitude, rise times and decay kinetics were not altered by exposure to alcohol. Locomotor studies showed that ethanol treatment resulted in altered C-bend escape responses. For instance, the C-bends of alcohol-treated fish were larger than control embryos. Thus, ethanol treatment during gastrulation altered a range of features in embryonic zebrafish. Importantly, co-treatment with RA prevented all of the effects of ethanol including survivability, body length, M-cell morphology, AMPA mEPSC frequency and escape response movements. Together these findings show that ethanol exposure during the brief period of gastrulation has a significant effect on neuronal morphology and activity, and that this can be prevented with RA co-treatment.

Evaluation of Pelvic Lymphadenectomy during Radical Hysterectomy for Cervical Cancer

Cervical cancer is the most common cancer in women in developing countries comprising 20-30% of female cancer. More than 70% of cervical cancer patients of Bangladesh attend in hospital in inoperable stages (IIB, III & IV). Only 30% cases can be treated by primary surgery. This prospective cross-sectional study was conducted by Gynaecologic Oncology Division of the Department of Obstetrics & Gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from November 2011 to May 2012. The objectives of this study were to evaluate the number of pelvic lymph nodes removed, to determine the rate of pelvic lymph node involvement & also to evaluate the relationship between parametrial invasion and pelvic lymph node metastasis. During this period 105 cases underwent type III radical hysterectomy with bilateral pelvic lymph nodes dissection. Majority of the patients (60%) were in the age group of 31-50 years. Regarding histological type, most of the cases were invasive squamous cell carcinoma (85%), followed by adenocarcinoma (9%) and adenosquamous type (2%). According to grading of the tumours, grade I, II, III were 45%, 43%, 8% respectively and in 3% cases grading could not be identified.

Optimization and Validation of Real Time PCR Assays for Absolute Quantification of toxigenic Vibrio cholerae and Escherichia coli

Quantitative real-time PCR (qPCR) is a dynamic and cogent assay for the detection and quantification of specified nucleic acid sequences and is more accurate compared to both traditional culture based techniques and 'end point' conventional PCR. Serial dilution of bacterial cell culture provides information on colony forming unit (CFU) counts. This is crucial for obtaining optimal standard curves representative of DNA concentration. This approach eliminates variation in the standard curves caused by loss of DNA by serial dilution of nucleic acid elute. In this study, an assay was developed to detect and quantify DNA by real-time PCR for two pathogenic species, Escherichia coli (E. coli) and Vibrio cholerae (V. cholerae). In order to generate a standard curve, total bacterial DNA was diluted in a 10-fold series and each sample was adjusted to an estimated cell count. The starting bacterial DNA concentration was 11ng/µL. An individual E. coli cell has approximately 5.16 femtograms of DNA. Therefore, 11 ng/µL of DNA would indicate 2.48×10⁷cells. Both SYBR Green and TaqMan assays were validated for uidA region in E. coli and ctxA region in V. cholerae, respectively and was based on previously published assays for this standard curve experiment. PCR efficiency for uidA gene and ctxA gene were obtained 103.8% and 99.21%, respectively. Analysis of Variance (ANOVA) and coefficient of variation (CV %) indicated that standard curve generated by genomic DNA dilution had higher repeatability. Although not statistically significant, low F ratios indicated that there was some variation in CT values when genomic DNA dilution was compared to dilution of cell suspension in media. Different water samples spiked with pure cultures of E. coli and V. cholerae were used as unknown samples. The standard curve constructed by the serial dilution of genomic DNA exhibited greater efficiency when compared to that of the standard curve obtained from serial dilution of cell suspension since in the former method DNA is not lost during extraction from culture dilutions.

Determination of Insulin Secretory Defect and Insulin Sensitivity in Type 2 Diabetic Subjects in Bangladesh

Diabetes mellitus (DM) is defined as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. This study was undertaken to explore the basic defect in type 2 diabetes patients in Bangladesh. This was an observational study with case control design, was conducted in the Biomedical Research Group, Research Division, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine Metabolic Disorders (BIRDEM), Dhaka, Bangladesh, during the period of July 2008 to June 2009. A total of 153 subjects were included in study of which 63 belonged to type 2 diabetes mellitus group and 90 were healthy controls. Fasting and 2 hours postprandial blood glucose, serum insulin, HOMA%B, HOMA%S, QuickI, Glucose /insulin ratio, TG were measured and age, BMI, WHR were recorded. Waist-hip ratio (WHR), was significantly higher in T2DM as compared to control subjects [WHR, mean±SD, 0.94±0.12 vs. 0.88±0.06, p<0.001]; Glucose and insulin ratio of T2DM was significantly higher as compared to control subject [Glu: Ins, Median (range) of 0.54 (0.17-2.33) vs. 0.37(0.06-1.52)]. Insulin secretion (HOMA%B) was significantly lower in diabetic as compared to control subjects [HOMA%B, median (range), 71(4.90-391) vs. 180(59-634) p<0.001]; The quantitative insulin sensitivity check Index (QUICKI) of diabetic subjects were significantly higher as compared to control [QUICKI median (range) 39.90(4.80-138.10) vs. 0.55(0.36-0.85), <0.001]. Triglyceride (TG) and cholesterol (Chol) were significantly higher [(mg/dl), (mean±SD), TG (142±80.14) vs. (142±80.14); Chol (189±50.76) vs. (172±45), p=0.029] in T2DM as compared to control subjects. Those with diabetes showed significant association with insulin secretory defect (HOMA%B, p=0.006) and insulin resistance as assessed by GINR (p<0.001) and QuickI (p<0.001) but not by HOMA%S (p=0.127). The present data suggest that both insulin secretory defect and insulin sensitivity are present in T2 diabetic subjects of Bangladesh.

Attitude and practice of cervical cancer screening among the women of Bangladesh

Cervical cancer is the second most common cancer in women worldwide, but 80% of cancer occurs in developing countries. Bangladesh, like other developing countries faces a burden of diseases, in spite of having established screening program. This cross-sectional study was done to determine the knowledge, attitude and practice of cervical cancer screening among the women attending outpatient department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Two hundred women were enrolled in this study by purposive sampling. All the information was collected in a pre-designed structured questionnaire by an interviewer. Data were analyzed using statistical program SPSS version 17.0. About 12% of women had good knowledge regarding cervical cancer screening. Seventy eight percent of women did not ever have a screening test and 78.5% of women had no access to the facility of having a screening test. Seventy five percent of women had never been suggested by a doctor to have a screening test. The more the participants' age, low level of education and poor knowledge, the less the practice of cervical cancer screening (p<0.05). The most common reason cited for not having screening test was the lack of information. The women studied here demonstrated a very low coverage of the screening test and a poor knowledge regarding its utility. Improving the awareness is imperative for better implementation of cervical cancer screening program in Bangladesh.

Miliary nodules in a patient of allergic bronchopulmonary aspergilosis

Allergic bronchopulmonary aspergilosis (ABPA) is immunological pulmonary disease caused by hypersensitivity of aspergillus fumigatus usually occurs in patients with chronic asthma, cystic fibrosis and bronchiactasis. This disease may present with divers radiological presentation like; fleeting pulmonary opacities, bronchiactasis, mucoid impaction, perihilar opacity (hailer lymphadenopathy), and lung mass or pleural effusion. We describe the case of a 30 year old housewife who presented with progressive dysponea, low grade fever, dry cough, weight loss and miliary nodule in chest radiograph and high-resolution CT (HRCT) in a tertiary level hospital of Bangladesh. A diagnosis of ABPA was established on the basis of sputum routine microscopy and culture examination for fungus (Aspergillus).

Clinical and haemato-pathological characteristics of adult acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia (ALL) is a heterogeneous group of disorders. It varies with respect to the morphologic, cytogenetic, molecular and immunologic features of the neoplastic cells reflecting the variable clinical-pathologic presentations and outcome of the patients. The aim of the study was to observe the clinical and haemato-pathological characteristics in newly diagnosed adult ALL patients. A total number of 61 patients morphologically diagnosed as acute lymphoblastic leukaemia aged 15 and above assigned for this observational study. The study was carried out in the Department of Haematology, BSMMU from January 2007 to December 2008. Among 61 patients, aged 15 to 80 years with median age 25 years, 79% were male and 21% were female. Most of the patients presented with anaemia (67%), fever (66%), lymphadenopathy (64%) and splenomegaly (57%). Other common clinical findings were hepatomegaly (39%), bone tenderness (44%) and bleeding manifestations (34%). Among haemato-pathological findings 67% patients had Hb level ≤10gm/dl, 46% patients had WBC count ≥30×10⁹/L, 67% patients had platelet count ≤100×10⁹/L, 93% patients had blast in peripheral blood and 61% patients had ≥90 % blasts in the bone marrow at the time of diagnosis. In this study adult ALL patients were analyzed only for their clinical and haemato-pathological characteristics. But their biologic characteristics were not analyzed due to lack of availability of facility. A progressive understanding of the biologic and genetic characteristics of ALL will allow us to identify different prognostic subgroups with specific molecular and cellular features. All the necessary measures have to be developed in our country in order to identify prognostically distinct subgroups of patients.

Pattern of poisoning in a tertiary level hospital

This cross sectional observational study was carried out in the Department of Medicine, Mymensingh Medical College Hospital over a period of 4 months from January 2012 to April 2012 to assess the clinico-epidemiological condition of different types of poisoning and to evaluate immediate hospital outcome. Suspected case of poisoning aged 12 years or above of either sex was included. Patients of paediatric age group, having other co-morbid condition and died before clinical evaluation were excluded. This study revealed that rural people (76.9%), aging 20-30 years (46.3%) were mostly affected in poisoning. Patients belong to low socioeconomic group (65.3%), illiterate (26.5%) and educated up to primary level (29.9%) were mostly identified. Regarding the occupation this study showed student (30.6%) and farmer (25.2%) were predominantly involved. In this series organophosphorus compound (63.9%) poisoning was in the top of the list followed by benzodiazepine (6.8%). Suicidal attempt (81.6%) was found as a motive of poisoning in maximum cases. Among the precipitating factors quarrel with spouse, girl or boy friend (46.9%) were significant in number. In this study outcome was measured as complete recovery (92.5%) and death (3.4%).

Diagnostic evaluation of supraclavicular lymphadenopathy

Patients presented with the supraclavicular lymphadenopathy in the medicine department have a strong suspicion of serious illness like tuberculosis, sarcoidosis, toxoplasmosis and malignancy of lymphnode, blood, lung, upper GIT, breast, ovary, testes, and other sites of body. This prospective type of observational study carried out in the indoor and out patient department of medicine of Mymensingh Medical College Hospital over a period of 6 month from April 2011 to September 2011 to diagnose the causes of supraclavicular lymphadenopathy. Patient of either sex, 18 years or above presented with supraclavicular lymphadenopathy were included. Biopsy or FNAC were done. The study showed that mean age of the patient of supraclavicular lymphadenopathy that finally diagnosed as malignant was 49.7 years and that of non malignant was 33.7 years. Male patient have suffered more (60%) from malignant disease than that of female patient (40%). Discrete, hard, non tender either fixed or non fixed supraclavicular lymphadenopathy was found malignant (18 of 18 cases, 100%) and discrete, firm, tender lymphnode were found non malignant (5 of 5 cases, 100%). Increased frequency (11 of 28, 39.3%) of granulomatous inflammation from the tuberculoid lymphadenitis were found among the patient undergone supraclavicular lymphnode biopsy. FNAC result was also of simillar type and finally it was found that frequency of tuberculosis (20 of 53, 37.7%) was highest and bronchial carcima was the second most frequent diagnosis (14 of 53, 26.4%). This study showed that supraclavicular lymphadenopathy is associated mostly with serious disease like tuberculosis and malignancy.

Relation of different grades of esophageal varices with Child-Pugh classes in cirrhosis of liver

This cross-sectional observational study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh over a period of 6 months from October 2011 to April 2012 and was carried out to evaluate the relation of different grades of esophageal varices with Child-Pugh classes of cirrhosis of liver patients. A total 37 patients were included. Child-Pugh score and esophageal varices of each patient were noted. Relation was carried out using the Chi-square test through determining the association of different variables. P value <0.05 was considered significant. Among 37 patients, 27(73%) were male and 10(27%) were female and their frequency of age were found, 7(18.9%) from 18-38 years, 18(48.7%) from 39-59 years and 12(32.4%) from 60 years of age and above. The etiology of liver cirrhosis revealed 18(48.7%) hepatitis B virus, 3(8.1%) hepatitis C virus and 16(43.2%) others causes. Child-Pugh classes were observed 3(8.2%) Class A, 17(45.9%) Class B and 17(45.9%) Class C and grades of esophageal varies were 13(35.1%) F1, 20(54.1%) F2 and 4(10.8%) F3 patients among total. A statistically significant positive relation was found that higher grade of esophageal varices was seen in the more advanced class of Child-Pugh classes with a p value 0.001.

Fasting glycaemic and lipidaemic status in acute coronary syndrome patients within 24 hours of onset of chest pain

This is a descriptive type of cross sectional study done in Mymensingh Medical College Hospital during the period of June 2008 to November 2009 to estimate and analyze the fasting blood glucose (FBG) and fasting lipid profile of acute coronary syndrome (ACS) patients within 24 hours of onset of chest pain. Total 50 patients of either sex diagnosed as acute coronary syndrome whose fasting blood sample would have been collected within 24 hours of chest pain were included. Among 50 patients 42(84%) were male and 8(16%) were female. Age range was 30-80 years with a mean ± SD of 50.74 ± 12.05 years. Among 50 ACS patients, 9 patients (18%) suffered from unstable angina (US), 2(4%) from non-ST segment elevation myocardial infarction (NSTEMI) and 39(78%) suffered from ST segment elevation myocardial infarction (STEMI). Study results revealed 41(82%) patients had euglycemia (70-110 mg/dl), 2(4%) patients had impaired fasting glucose (IFG) (110-125 mg/dl), and 7(14%) patients had hyperglycemia (>126 mg/dl). Dyslipidemia found in 38(76%) patients. Among them total cholesterol (TC) >200mg/dl in 14(28%), decreased level of HDL-C (< 40 mg/dl in male and <50mg/dl in female) in 22(44%), increased level LDL-C ≥ 130 mg/dl in 13(26%), and TG >150 mg/dl was found in 16(32%) patients.

Occurrence and determinants of postpartum maternal morbidities and disabilities among women in Matlab, Bangladesh

The burden of maternal ill-health includes not only the levels of maternal mortality and complications during pregnancy and around the time of delivery but also extends to the standard postpartum period of 42 days with consequences of obstetric complications and poor management at delivery. There is a dearth of reliable data on these postpartum maternal morbidities and disabilities in developing countries, and more research is warranted to investigate these and further strengthen the existing safe motherhood programmes to respond to these conditions. This study aims at identifying the consequences of pregnancy and delivery in the postpartum period, their association with acute obstetric complications, the sociodemographic characteristics of women, mode and place of delivery, nutritional status of the mother, and outcomes of birth. From among women who delivered between 2007 and 2008 in the icddr,b service area in Matlab, we prospectively recruited all women identified with complicated births (n=295); a perinatal mortality (n=182); and caesarean-section delivery without any maternal indication (n=147). A random sample of 538 women with uncomplicated births, who delivered at home or in a facility, was taken as the control. All subjects were clinically examined at 6-9 weeks for postpartum morbidities and disabilities. Postpartum women who had suffered obstetric complications during birth and delivered in a hospital were more likely to suffer from hypertension [adjusted odds ratio (AOR)=3.44; 95% confidence interval (CI)=1.14-10.36], haemorrhoids (AOR=1.73; 95% CI=1.11-3.09), and moderate to severe anaemia (AOR=7.11; 95% CI=2.03-4.88) than women with uncomplicated normal deliveries. Yet, women who had complicated births were less likely to have perineal tears (AOR=0.05; 95% CI=0.02-0.14) and genital prolapse (AOR=0.22; 95% CI=0.06-0.76) than those with uncomplicated normal deliveries. Genital infections were more common amongst women experiencing a perinatal death than those with uncomplicated normal births (AOR=1.92; 95% CI=1.18-3.14). Perineal tears were significantly higher (AOR=3.53; 95% CI=2.32-5.37) among those who had delivery at home than those giving birth in a hospital. Any woman may suffer a postpartum morbidity or disability. The increased likelihood of having hypertension, haemorrhoids, or anaemia among women with obstetric complications at birth needs specific intervention. A higher quality of maternal healthcare services generally might alleviate the suffering from perineal tears and prolapse amongst those with a normal uncomplicated delivery.

Clinical profile of periodic paralysis

This cross sectional descriptive study was done to find out common clinical presentations, etiologies and laboratory investigation abnormalities in patients of periodic paralysis. Study was carried out in 30 patients with an age range from 8 to 70 years who were enrolled from July 2008 to June 2009 in Mymensingh Medical College Hospital (MMCH) medicine unit. Individuals who were admitted with sudden onset generalized muscle weakness, had history of previous attack and serum potassium level <3mmol/l or >5.5mmol/l were included in this study. In this series, majority of the patients were male (66.67%). Male: female ratio was approximately 2:1. The mean age of the patients was 27.4±4.5 years. Majority (26.67%) of them were in age range of 31-40 years. About 30% of the patients experienced the first attack of paralysis at the age of 20-24 years. Majority of patients (53%) were from middle class family with occupation of private service (26.66%) and farmer (20%). Positive family history was reported in 20% of patients. Regarding the precipitating factors, majority of patients (83.3%) were related to high carbohydrate meal, 56.67% related to temperature, 41.67% to exercise. Flaccid muscle weakness with variables muscle power (MRC grade 4/5 to 2/5 in 60% and 1/5 to 0/5 in 40%) was found. Cerebellar functions, all modalities of sensations and functions of cranial nerves were intact in all patients. In this series, laboratory investigations revealed reduced serum potassium level (<3mmol/l) in 90% of patients. Serum potassium value >5.5mmol/l was found in only 3.33% of patients. Creatine kinase (MM) was raised in 23% of the patients and Thyroid stimulating hormone (TSH) level was 0.8-2mmol/l in 6% of the patients. More than half of the patients (56%) showed variable ECG changes. Impaired nerve conduction function was found in 28.00%. So, careful history taking, meticulous clinical examination and simple laboratory investigations is sufficient to make a prompt diagnosis and rapid management of patients with periodic paralysis.

Osteopetrosis

A 15 years old Bangladeshi boy presented with hepatosplenomegaly, anaemia, multiple fractures (symptomatic and asymptomatic) without jaundice was investigated. Laboratory findings revealed leukoerythroblastic blood picture with reduced haemoglobin (7.7 gm/dl). Skeletal survey showed generalized increased bone density, sclerosed medulary space, Rugger-Jersey spine and diploic space filled with dense materials. Overlapping clinical features of both intermediate autosomal recessive and adult autosomal dominant variety of osteopetrosis were found in this patient but diagnosis were made on the basis of typical radiological finding which was mostly consistent with the adult autosomal dominant variety. The patient was treated conservatively and specialist consultation was taken in managing bony abnormalities. This patient was discharged with advised of subsequent follow-up.

Status of HIV infection among the pregnant women attending in outpatient department

Human immunodeficiency virus (HIV) infection has been spreading rapidly in the developing countries and vertical transmission also taking place. This study has been done to find out the prevalence of HIV infection among the pregnant women, so that necessity of routine screening test can be identified. It is a cross sectional study. Five hundred two pregnant women were included. Three ml venous blood was taken and then HIV screening test was done by ELISA method. All reactive tests were confirmed by Western blot antibody testing. The positive cases were followed up and necessary treatment was given. Delivery was conducted in this hospital. Baby's blood was tested to see vertical transmission after 18 months. Most of the subject were educated housewife, mean age was 25 years. Six (6%) husband was overseas service holder, 12% were smoker and 1.6% had drug addiction. Eight (8%) subject had previous history of blood transfusion and 49% subject or her husband had history of surgery or got parental therapy. 2% subject gave the history of familial disharmony and 2% had multiple sex partners. HIV infection was found in 2 patients (0.4%). Both of them got infection from their husband. One husband was over seas service holder and another one was injecting drug user. For the prevention of spread, reduction of vertical transmission and providing early management to the positive patient all pregnant women should be screened for HIV routinely.