Thyroid Hormone Level in Children with Nephrotic Syndrome

Nephrotic syndrome is the most common glomerular disease affecting children. Hypothyroidism is one of the most important complications which occur due to urinary loss of protein bound thyroid hormones, such as thyroxin binding globulin, transthyretin and albumin. This cross sectional study was conducted in the Department of Pediatric, Mymensingh Medical College Hospital (MMCH), Bangladesh from February 2018 to October 2019. This study was carried out to find out the thyroid profile in children with nephrotic syndrome and compared with thyroid profile of other acute illness in children. Total 122 children aged 2-12 years, further subdivided into Group A (n=61) suffering from nephrotic syndrome (1st attack, infrequent relapse) and Group B (n=61) other disease like viral fever, pneumonia, bronchiolitis, diarrhoea, UTI. Demographic details of patients and their relevant clinical details were obtained by an interviewer administered questionnaire. Blood for free T4, TSH were taken and compared between both groups. The mean FT4 values in Group A and Group B were 16.09±22.32fmol/ml and 68.22±11.65fmol/ml respectively, whereas the TSH level was significantly higher in Group A than controls (5.42±1.04 vs. 3.53±1.44). The T4 levels in nephrotic syndrome (Group A) patients were low. Analysis was done by using SPSS 22.0 version for windows software. Continuous and catagorical parameters were compared by unpaired 't' test and Chi-Square test. A p-value of 0.05 was considered significant. Hypothyroidism was found more in younger children i.e. age less than 6 years. This study concluded that children with nephrotic syndrome have a state of hypothyroidism.

Study on Myocardial Infarction in Young Adults: Risk Factor Analysis

Coronary heart disease (CHD) imposes a significant burden on health care systems because of high morbidity and mortality. There is documented evidence that South Asian people develop CHD at a higher rate and at an early age. If the affected individual is 40 years old or below, the tragic consequences are catastrophic. Identifying risk factors could be important for health promotion. The objectives of this study were to determine the frequency of risk factors in young patients with acute myocardial infarction and thus with ischemic heart disease (IHD) aged 40 years and below in our population. It was a descriptive observational study which was carried out at Coronary Care Unit of Rajshahi Medical college Hospital, Rajshahi, Bangladesh in 61 patients from January 2011 to June 2011. All patients who fulfilled the inclusion criteria admitted to coronary care unit (CCU) with a diagnosis of Acute MI were included. Their detailed history was then taken including symptoms at presentation and their risk factors were assessed according to the Framingham Risk Scoring System with the help of history and laboratory investigations. Mean age ±SD of the patients was 36±3.7 year. Most of the patients were male. Smoking was the major risk factor (73.8%) followed by family history of IHD (44.3%). Other risk factors were dyslipidaemia (39.35%), hypertension (37.7%), obesity (11.5%) and diabetes mellitus (8.2%). Majority of the patients were adopted in sedentary lifestyle. 91.8% patient presented with chest pain. Other symptoms were dyspnoea (37.7%), palpitation (59.0%), sweating (77.0%), nausea, vomiting (50.8%) and impaired consciousness (19.7%) etc. Most frequent risk factor for acute myocardial infarction (MI) at young age is smoking followed by family history of MI and dyslipidaemia. Majority of the patients had two or more than two identifiable antecedent risk factors.

Epidemiological Criteria to Support Breeding Tactics Against the Emerging, High-Consequence Wheat Blast Disease

Plant disease epidemiology can make a significant contribution for cultivar selection by elucidating the principles of an epidemic under different levels of resistance. For emerging diseases as wheat blast (WB), epidemiological parameters can provide support for better selection of genetic resources. Field experiments were conducted at two locations in Bolivia in 2018-2019 to characterize the temporal dynamics of the disease on 10 cultivars with different levels of reaction to WB. Logistic models best (R² = 0.70-0.96) fit the disease progress curve in all cultivars followed by Gompertz (R² = 0.64-0.94), providing additional evidence of a polycyclic disease. Total area under disease progress curve (tAUDPC), final disease severity (Y_max), and logistic apparent infection rates (r_L*) were shown to be appropriate epidemiological parameters for describing resistance and cultivar selection. Cultivars that showed a high spike AUDPC (sAUDPC) showed a high leaf AUDPC (lAUDPC). tAUPDC, Y_max, and r_L* were positively correlated among them (P < 0.01) and all were negatively correlated with grain weight (P < 0.01). Based on the epidemiological parameters used, cultivars that showed resistance to WB were Urubó, San Pablo, and AN-120, which were previously reported to have effective resistance against the disease under field conditions. The information generated could help breeding programs to make technical decisions about relevant epidemiological parameters to consider prior to cultivar release.

Demography and Symptom Profile of Tetanus: A Cross-sectional Observation in an Infectious Disease Hospital of Bangladesh

Tetanus is a potentially preventable neurological infectious disorder with paucity of literature in Bangladesh. We aimed to see the demography and symptom profile of tetanus cases managed at the Infectious disease Hospital Sylhet. This hospital based cross-sectional descriptive study was conducted within the time period of January to December 2012 among 50 consecutive admitted patients in the Infectious Disease Hospital, Sylhet, Bangladesh who were diagnosed as a case of tetanus and fulfilling the inclusion criteria and exclusion criteria. Neonatal tetanus was considered as exclusion criteria and clinical diagnosis of tetanus was considered as the tetanus. Data were collected purposively with pretested predesigned questionnaire. Data were processed manually and analyzed with the help of SPSS Version 16.0. The mean±SD age was 33.00±16.8 years, ranging from 10 to 70 years. Among the 50 respondents, 72.0% were male, 50% from lower class, 34% were students and 30.0% had their educational status of primary level, 60.0% from rural social background. Trismus was found in 98.0% of the cases, rigidity in 96.0% cases, body ache in 94.0% cases, dysphagia in 92.0% cases, neck pain in 78.0% cases, dysarthria in 92.0% cases, reflex spasm in 66.0% cases, opisthotonus in 46.0% cases and urinary retention in 26.0% cases. In this study rural male people with lower socioeconomic status individuals were mostly affected with trismus, rigidity, body ache and dysphagia symptoms.

Antibacterial Effect of Curcuma longa (Turmeric) Against Staphylococcus aureus and Escherichia coli

This observational study was conducted during the period from July 2010 to June 2011 in the Department of Pharmacology in the collaboration of Department of Microbiology, Mymensingh Medical College, Mymensingh to determine the profile of antibacterial effect of Crude Turmeric paste aqueous turmeric extract, and standard antibiotic Amikacin against Staphylococcus aureus and Escherichia coli. Three separate experiments were done e.g. (Expt- I) Inhibitory effect of Crude Turmeric paste incorporated into nutrient agar (NA) media, (Expt- II) Minimum inhibitory concentration of (a) Aqueous Turmeric extract and (b) Amikacin by broth dilution technique and (Expt-III) their subculture study in nutrient agar (NA) media for confirmation of respective results of previous experiments. Inhibitory effects were observed against the growth of Staph Aureus and Esch coli at 10% and 30% respectively of Crude Turmeric paste incorporated into NA media. The broth dilution technique was followed to determine the MIC of Aqueous Turmeric extract and Amikacin. The MIC of Aqueous Turmeric extract was 800 μg/ml against Staph aureus and that against Esch coli was 2000 μg/ml and the MIC of Amikacin was 10 μg/ml for both the bacteria. The MIC of Amikacin was the lowest in comparison to MIC of Aqueous Turmeric extract for complete inhibition of growth of Staph aureus and Esch coli. The subculture study showed similar results with that of previous experiments in terms of inhibitory effects of Crude Turmeric paste and MIC of Aqueous Turmeric extract and Amikacin against all of the organisms studied.

Detection of Giardia lamblia and Cryptosporidium parvum by direct immunofluorescence assay in stool specimen

Giardia and Cryptosporidium are the pathogens which transmitted through contaminated soil and contaminated water are significant causes of diarrhea and nutritional disorders in institutional and community peoples. Children and immune compromise persons are more vulnerable for these infections. Both Giardiasis and Cryptosporidiosis were included in 2004 as WHO Neglected Disease. So this is a major public health problem in developing countries. The present study was carried out to detect the Giardia and Cryptosporidium from diarrheic or patient having loose stool by Direct Immunofluorescence assay. The study was conducted during July 20012 to February 2013 and the work was done in Mymensingh Medical College in the department of Microbiology and in Bangladesh Agricultural University in the department of Veterinary Medicine. A total of 100 loose stools were collected from school children of different area and hospital under sadar upazilla, Mymensingh. The detection of Giardia lamblia and Cryptosporidium parvum showed the individual prevalence 8% and 4% respectively. The highest cyst/oocyst count was 85,000 and 1,000/gm of stool and the lowest being 100 and 50/gm of stool for Giardiasis and Cryptosporidiosis respectively. The detection rate of Giardia and Cryptosporidium by Immunofluorescence assay was relatively higher than the previous study done in Bangladesh and this was the first report from Bangladesh over human stool specimen using Immunofluorescence assay. So, Immunofluorescence assay could be adapted for rapid and accurate detection of Giardia and Cryptosporidium.

Evaluation of TH agglutinin titres of Widal test in the diagnosis of typhoid fever

This prospective study was evaluated the role of TH agglutinins and reevaluate the diagnostic value of Widal test in the diagnosis of typhoid fever by identifying the S. typhi specific antibody. The study was carried out in the department of Microbiology, Mymensingh Medical College, Mymensingh between July 2010 and June 2011, including 200 individuals of different ages and sexes. Widal test and blood culture were performed for each of the cases and controls. Among 150 blood samples from the suspected cases, 23(15.3%) were culture positive for S. typhi and 67(44.7%) had high titres of ≥1:160 for 'O' or 'H' or both agglutinins. Out of 23 culture positive cases, 3(13%) had TO ≥:160, 5(21.7%) had significant TH ≥1:160. Based on the above findings, it was concluded that judicious interpretation of Widal test play an essential role in diagnosis of typhoid fever, especially in the resource poor countries like Bangladesh.

Prevalence and antimicrobial susceptibility pattern of ESBL producing isolates

Extended spectrum β-lactamases (ESBLs) are produced by Gram negative bacteria showing resistance to new generations of antimicrobial agents. This study was undertaken to characterize ESBL producing bacteria from 222 urinary isolates. Antimicrobial resistance was screened by disc diffusion test. The ESBL status was confirmed by double disc diffusion test (DDDT) and minimum inhibitory concentration (MIC) by agar dilution method by standard procedure. The study revealed the following distribution of ESBL producing isolates: Klebsiella spp (81.6%), Proteus spp (78.1%) E. coli (72.3%) and Pseudomonas spp (66.7%). All the isolates were sensitive to imipenem and nitrofurantoin followed by amikacin 92.9%. A relatively higher rate of resistance to gentamicin, co-trimoxazole, azithromycin and quinolones were also observed for ESBL producers. The study suggested routine detection of ESBL and avoidance of irrational use of third generation cephalosporins to reduce the emergence of multidrug resistance bacteria following an antibiotic policy.

Detection of TEM, SHV and CTX-M in Mymensingh region in Bangladesh

The development of antibiotic resistance in bacteria following introduction of antimicrobial agents has emerged as an important medical problem everywhere in the world including Bangladesh. Extended spectrum β-lactamases (ESBLs) are rapidly evolving group of β-lactamase enzymes produced by the Gram negative bacteria. This study was undertaken to characterize ESBL producing gram negative bacilli from urine, skin wound (pus and wound infection). A total of 300 gram negative bacilli were screened for resistance to third generation Cephalosporins (3GCs) by disc diffusion test. The ESBL status was confirmed by double disc diffusion test (DDDT), minimum inhibitory concentration (MIC) by agar dilution method as recommended by Clinical Laboratory Standard Institute 2010 (CLSI) and multiplex PCR for TEM, SHV and CTX-M, CTX-M-3, CTX-M-14 genes. The present study revealed a higher occurrence of multi drugs resistant ESBLs production among gram negative isolates where Klebsiella spp. were the leading bacteria 36/45 (80%), followed by Proteus spp. 40/55 (72.7%), Esch. coli 105/156 (67.3%) and others 25/35 (71.4 %). Rate of TEM, SHV and CTX-M genes present in study population were 50.46%, 18.69% and 46.72% respectively. Among the CTX-M positive genes CTX-M-3 and CTX-M-14 were 78.0% (39/50) and 80.0% (40/50) respectively. Results indicate that routine ESBL detection should be made mandatory and irrational use of third generation cephalosporins must be discouraged to reduce multi drugs resistance bacteria, to increase patients' compliance and to make an antibiotic policy.

Methicillin-resistant coagulase-negative staphylococci (MRCoNS) by disk diffusion method

The antimicrobial susceptibility of 80 coagulase-negative staphylococci (CoNS) isolates from surgical wound, pus from infected skin lesions, burn exudates and diabetic ulcer exudates of patients in Mymensingh Medical College Hospital, Bangladesh, was evaluated in order to see their pattern of antimicrobial resistance. The study was carried out in the department of Microbiology, Mymensingh Medical College during the period from July 2009 to May 2011. The 80 CoNS isolates were subjected to antimicrobial susceptibility to relevant antibiotics including oxacillin by disk diffusion method. Out of 80 CoNS isolates, the highest number were resistant to oxacillin 36(45%), followed by gentamicin 32(40%), cefuroxime 25(31%), ceftriaxone 24(30%) and ciprofloxacin 18(22%). All isolates of CoNS were sensitive to imipenem and vancomycin. As MRCoNS were found multidrug resistant, therefore, antibiotic sensitivity must be done prior to treatment in infections caused by these species.

Comparative study of immunochromatographic assay (IgM) and widal test for early diagnosis of typhoid fever

Typhoid fever is a severe systemic infection endemic in many developing countries, including Bangladesh. Present study evaluated immunochromatographic test (ICT) and Widal test in the early diagnosis of typhoid fever cases. The study was carried out in the department of Microbiology, Mymensingh Medical College, Mymensingh between July, 2010 and June, 2011, including 200 individuals of different age and sex. Of them, 150 were clinically suspected cases of typhoid fever and 50 age-sex matched controls. Among 150 blood samples from the suspected cases 106(70.7%) were positive for IgM of Salmonella typhi by ICT and 67(44.7%) were positive by Widal test. Whereas, among the 50 controls 4(8%) were positive by ICT and 6(12%) were positive by Widal test. The sensitivity, specificity, positive and negative predictive value of the ICT was found as 83.3%, 92.00%, 91.9% and 83.6% respectively. On the other hand corresponding values for Widal test were of 44.4%, 88%, 80% and 59.5% respectively. Thus, The ICT (IgM) is better alternative to Widal test for early and accurate diagnosis of typhoid fever. The ICT (IgM) is rapid, easy to perform, applicable for field use and highly sensitive and specific for detection of antibodies in patients with typhoid fever.

Enteropathogens associated with acute diarrhea in a tertiary hospital of Bangladesh

Acute diarrheal diseases are great concern throughout the world, as they are responsible for considerable morbidity and mortality, especially in developing countries. The present study was carried out during the period from January' 2011 to December' 2011 in the Department of Microbiology, Mymensingh Medical College. A total of 300 stool specimens were examined by standard laboratory methods for identification of enteropathogens. Rotavirus was detected by Polyacrylamide Gel electrophoresis (PAGE). Different diarrheagenic E. coli (DEC) were detected by Multiplex PCR following standard methods. Of the 300 stool specimens examined, Enteropathpgens were detected in 160(53.5%) cases. Rota virus was detected in 82(27.5%) cases, followed by DEC in 54(18%), Shigella spp. in 8(2.4%), Salmonella spp. in 5(1.6%), Entameoba histolytica in 4(1.5%) and Giardia lamblia in 3(1.0%) cases. Among the DEC, the Enterotoxigenic E. coli (ETEC) was most prevalent (72%, 39/54). The present study revealed a high prevalence of rotavirus and DEC as the predominant causes of diarrhea in this region.

Multiplex polymerase chain reaction for rapid identification of diarrheagenic Escherichia coli

Despite the fact that diarrhaegenic Escherichia coli (DEC) has been identified as a major etiologic agent of childhood diarrhea which represent a major public health problem in developing countries, only a few studies have been performed in Bangladesh to identify these organisms. To detect DEC in patients with acute diarrhea, a total of 300 stool specimens were tested by multiplex polymerase chain reaction (PCR). The multiplex PCR was designed for the detection of target genes of "eae" for enteropathogenic E. coli (EPEC), "stx" for enterohemorrhagic E. coli (EHEC), "ipaH" for enteroinvasive E. coli (EIEC), "aspU", "CVD432" and "aggR" for enteroaggregative E. coli (EAEC) as well as "elt" and "est" for enterotoxigenic E. coli (ETEC). Out of 300 stool specimens collected from patients with acute diarrhea, the DEC was detected in 18% (54/300) cases. The dominating strain was ETEC (13%, 39/300), followed by EAEC (5%, 15/300) and no EHEC, EIEC and EPEC could be detected. Both heat-stable toxin (ST) and heat-labile toxin (LT) genes of ETEC were detected in 66.68% (26/39) strains and only ST or LT as single gene was detected in 23.07% (9/39) or 10.25% (4/39) strains respectively. The multiplex PCR assay could be used as a rapid as well as efficient diagnostic tool for identification of DEC in the clinical laboratory settings.

Species distribution of coagulase negative staphylococci isolated from different clinical specimens

Staphylococci are Gram positive, non motile, asporogenous bacteria that characteristically divide in more than one plane to form irregular cluster. Species are classified as coagulase-positive Staphylococcus aureus and coagulase-negative staphylococci. Coagulase-negative staphylococci (CoNS) are reported to be the third causative agent of nosocomial infections and the most frequent cause of nosocomial bloodstream infections. Strains of CoNS those are resistant to methicillin referred to as Methicillin Resistant Coagulase Negative Staphylococci (MRCoNS). Now a days, MRCoNS has been increasing as a serious nosocomial pathogen having the property of multi drug resistance. The present study was conducted to see the species distribution, antibiotic resistance patterns and some virulence factors of CoNS isolated from different clinical specimens. This cross sectional descriptive study was carried out in the Department of Microbiology, Mymensingh Medical College during the period from July 2009 to May 2011. A total of 300 clinical specimens were collected for this study of which 240 were found culture positive as single isolate. Among them 110 were from surgical wound, 80 from pus of skin infections, 30 from burn ulcer exudates and 20 from diabetic ulcer exudates. A total of 80 strains of CoNS were isolated from them. Besides CoNS other isolated bacteria were S. aureus, Pseudomonas spp and Escherichia coli. The CoNS were initially detected by coagulase test. All the strains that were either slide or tube coagulase negative were further identified by different biochemical tests using a commercial kit HiStaph™ Identification Kit (HiMedia Laboratories Ltd) which comprise a set of 12 standard biochemical tests. A total of 16 species were identified. These were S. epidermidis, S. saprophyticus, S. caprae, S. haemolyticus, S. simulans, S. xylosus, S. hyicus, S. hominis, S. warneri, S. auricularis, S. lugdunensis, S. felis, S. capitis, S. chromogenes, S. carnosus and S. gallinarum. Of them S. epidermidis was the most prevalent (17%) followed by S. saprophyticus (15%), S. caprae (11%), S. haemolyticus (9%).

Non-culture diagnosis of Chlamydia trachomatis genital infection in sexually active women

Infections caused by Chlamydia trachomatis (CT) are one of the most prevalent of all sexually transmitted diseases (STD). This cross sectional study was carried out to diagnose genital CT infection on 108 (59 pregnant and 49 non-pregnant) women attending at Department of Gynaecology and Obstetrics, Mymensingh Medical College Hospital (MMCH) during the period from January 2009 to December 2009. This non- culture technique was based on detection of CT major outer membrane protein (MOMP) by Direct Fluorescence Antibody Test (DFAT) from endocervical swab. Chlamydial inclusion bodies (IB) were looked for using Iodine stain. CT antigens were detected in 45.3% (49/108) cases by DFAT; IBs were detected in 5.5% cases (06/108) by Iodine staining technique. Majority of CT positive cases (65%) were found in the younger age group (15 to 25 years). The CT infection was found 47.2 % (35/74) in symptomatic cases, 41.1% (14/34) in asymptomatic cases and 47.4% in pregnant group, 42.8% in non-pregnant group. Although high incidence of genital chlamydia infection is common both in pregnant, non-pregnant, symptomatic and asymptomatic women in Bangladesh an early and reliable diagnostic method for genital chlamydia infection in Bangladesh should be further explored.

Nested polymerase chain reaction for early diagnosis of typhoid fever

Typhoid fever, caused by Salmonella typhi, is an important cause of morbidity and mortality in many developing countries. A rapid and sensitive method for the detection of S. typhi is essential for early diagnosis. This was a study to prospectively evaluate the sensitivity and specificity of nested polymerase chain reaction (PCR) to identify the S. typhi using flagellin gene related primers. The study was carried out in the department of Microbiology, Mymensingh Medical College, Mymensingh between July, 2010 and June, 2011, including 82 individuals of different age and sex. Of them, 62 were clinically suspected cases of typhoid fever and remaining 20 were apparently healthy controls. Cultures as well as PCR of blood specimens were performed for each of the cases. Among the 62 suspected typhoid fever cases, 8(12.9%) were blood culture positive and 55(88.7%) were PCR positive for S. typhi. All culture positive cases were positive by PCR and among 54 culture negative cases, 47(87%) were positive by PCR. Neither of the healthy controls was positive by PCR or blood culture. The sensitivity, specificity, positive predictive value and negative predictive value of PCR using blood culture as gold standard were 88.7%, 100%, 100% and 74% respectively for typhoid fever. In this study, the PCR appears highly specific, very sensitive and superior to blood culture for the early diagnosis of typhoid fever.

Methicillin resistant Staphylococcus epidermidis

Staphylococcus epidermidis is an emerging nosocomial pathogen. Due to its increasing incidence in many countries of the world it is a burning issue now a day. There is marked geographic variation in prevalence of methicillin resistant Staphylococcus epidermidis. Though it as is an endogenous human skin flora, it is therefore easily transmissible in the hospital environment well as in a community. Skin of patients and health care workers, medical equipment, clothing of personnel and environment surfaces can be sources of antibiotic-resistant S. epidermidis strains. This opportunistic pathogen causing different types of infections linked to implanted medical devices especially in immunocompromised patients. Early and specific diagnosis is important to ensure a favourable outcome. So Staphylococcus epidermidis found in culture should not always be ignored as contaminant and proper medical treatment and preventive guidelines should be applied against this alarming pathogen.

Acceptability of the rainwater harvesting system to the slum dwellers of Dhaka City

Urban area like Dhaka City, in Bangladesh, has scarcity of safe drinking water which is one of the prominent basic needs for human kind. This study explored the acceptability of harvested rainwater in a densely populated city like Dhaka, using a simple and low cost technology. A total of 200 random people from four slums of water-scarce Dhaka City were surveyed to determine the dwellers' perception on rainwater and its acceptability as a source of drinking water. The questionnaire was aimed at finding the socio-economic condition and the information on family housing, sanitation, health, existing water supply condition, knowledge about rainwater, willingness to accept rainwater as a drinking source etc. A Yield before Spillage (YBS) model was developed to know the actual rainwater availability and storage conditions which were used to justify the effective tank size. Cost-benefit analysis and feasibility analysis were performed using the survey results and the research findings. The survey result and overall study found that the low cost rainwater harvesting technique was acceptable to the slum dwellers as only the potential alternative source of safe drinking water.