Comparative Study of Serum Zinc Level in Between Preeclamptic Patients and Normal Pregnancy in Bangladesh

Globally preeclampsia is a major cause of maternal & perinatal morbidity & mortality. Zinc is an important trace element which is essential in pregnancy for fetal growth. Essentiality of zinc during pregnancy is evident. The cross sectional study was performed to estimate the comparison of serum zinc level in between preeclamptic patient and normal pregnancy. This study was conducted from July 2016 to June 2017 in the Department of Biochemistry, Mymensingh Medical College, Mymensingh, Bangladesh. Total 100 pregnant women were included as study population. Out of 100 subjects 50 were preeclamptic patients as case group and another 50 were normal pregnant women as control group. Serum zinc was determined by colorimetric method. The statistical analysis was done by SPSS windows package version 21.0. The mean±SD of case group was 59.30±5.22 and control group was 65.26±5.99mg/dl. Statistical difference was calculated by Student's unpaired 't' test. After analysis it showed that the mean±SD of serum zinc level was highly significantly (p<0.001) decreased in case group that in comparison to control group.

Assessment of Indications and Complications of Caesarean Section in A Private Medical College Hospital of Bangladesh

Caesarean section (CS) is the most frequently performed major operation in obstetrics. Its frequency is gradually increasing because of extended indications. Now-a-days, caesarean section is also being performed at patient's request in absence of a medical indication. It is necessary to assess the risk and benefits to take a judicious decision to select cases for caesarean section. The cross sectional descriptive type of observational study was carried out among purposively selected 100 pregnant women admitted to the department of Obstetrics and Gynaecology of Community Based Medical College Hospital, Mymensingh, Bangladesh during the period of August 2011 to January 2012 to identify elective and emergency indications of caesarean section, to identify the common complications to identify the risk factors associated with complications and to establish a comparison between complications of elective and emergency caesarean section. The median age group of patients being operated was 20 to 25 years and operation were carried out on patients due to various indications. Principal indications were faetal distress (26%), PROM (15%), failed progress of labour and breech presentation were 8% each, other indications were eclampsia (4%), obstructed labour (5%), scar tenderness (4%), history of previous 2 caesarian section 5%. The rate of elective caesarean section was 21% while emergency operations were done in 79% of cases. Among the 100 patients 19% patients developed complications. Among the complications wound infection was most common (37%), then post partum haemorrhage and urinary tract infection 26% and 11% respectively. Other complications were abdominal distension, Puerperal sepsis, anaemic heart failure, wound dehiscence and Wound haematoma 5% each. We should try to keep the rate of caesarean section within optimum ranges (10%) as recommended by World Health Organization.

Prevalence of Metallo-β-lactamase Producing Non-fermentative Pseudomonas Species from Clinical Isolates in Dhaka, Bangladesh

Antimicrobial drug resistance, a global concern, has been increasing unpredictably in microorganism causing human infections specially among Gram negative non-fermenting Pseudomonas spp. Carbapenems, a beta lactam antibiotics, are the most potent and effective drug usually kept reserved for treating the multi-drug resistant Psedomonas spp and other infections caused by organisms producing Extended Spectrum Beta Lactamase (ESBL) and AmpC. Clinical utility of carbapenem will reduce when resistant bacteria evolve due to production of carbapenem hydrolyzing Metallo-β-lactamase (MBL) which confers high-level resistance to all beta-lactam antibiotics except aztreonam. The various reports on the prevalence of MBLs are available from many countries but few from Bangladesh. We investigated the prevalence of MBL production in these Pseudomonads obtained from clinical sources in an uraban setting in Dhaka, Bangladesh. A total of 29,136 specimens were processed for culture from January 2011 and December 2015 from non duplicated patients attending diagnostic unit of icddr,b from different settings of Bangladesh. The specimens included urine 14,323; blood 11,378; other body fluid 2,487; sputum 535 and tracheal aspirate 413. All specimens were processed for culture following standard bacteriological methods and the Pseudomonas spp were identified following defined standard biochemical procedures. Metallo-β-lactamase (MBL) was determined by EDTA disk synergy (EDS) test. Antimicrobial susceptibility test was performed by disk diffusion method and susceptibility pattern was interpreted and reported following Clinical Laboratory Standard Institute (CLSI) guideline. From 29,136 specimens a total of 2,340(8%) were isolated and identified as Pseudomonas spp. Of the identified Pseudomonas spp, 238(57.6%) were from tracheal aspirate, 216(40.4%) from sputum, 902(36.7%) from other body fluids, 463(4.1%) from blood and 521(3.6%) from urine samples. From 2,340 Pseudomonas spp, by selective sampling, imipenem-meropenem resistant and intermediate susceptible 100 strains were tested for MBL production and 92 were found positive. Tracheal aspirate showed 38%, other body fluids 30%, Urine 17%, sputum 4% and blood 3% MBL production respectively. Irrespective of the sources of specimens, Pseudomonas spp showed 71% resistance to cefixime, 70% to ceftriaxone, 64% to gentamicin, 56% to piperecillin+tazobactam, 50% to ciprofloxacin, 49% to amikacin, 46% to netilmicin, 45% to ceftazidime, 30% to meropenem, 26% to imipenem and 19% to polymyxin B. As multi-drug resistant Pseudomonas showed high level of (92%) MBL production, so MBL detection testing facility may be a useful battery to determine MDR producing Pseudomonas from clinical isolates.

Microbiology of Chronic Suppurative Otitis Media in a Tertiary Care Hospital in Bangladesh

This cross sectional prospective study was carried out in the Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Microbiology, University of Dhaka from July 2012 to June 2013. The objectives of this study were to identify the common microorganisms involved and the antibiograms of chronic suppurative otitis media (CSOM) patients in this tertiary care hospital in Bangladesh. A total of 117 patients clinically diagnosed of CSOM were enrolled in the study. They had chronic ear discharge & had not received any topical or systemic antibiotics for the previous five days. Swabs was taken and cultured for bacteria. The standard of isolation and identification was followed. Antimicrobial susceptibility of all aerobic bacterial isolates was performed by using modified Kirby Bauer Disk diffusion method. There were 186 positive cultures for organism from 117 patients. The most common causal organisms isolated were S. aureus (47.30%) and Pseudomonas spp. (27.40%) followed by S. epidermidis (16.10%), Klebsiella spp. (8.10%) and Escherichia coli. (1.10%). Gentamicin showed the highest sensitivity (89.8%) to S. aureus whereas erythromycin showed the lowest sensitivity (14.8%) with highest resistance (67%) to S. aureus. Pseudomonas spp. showed highest sensitivity against ciprofloxacin (78.4%) and highest resistance against cloxacillin (96.1%). Novobiocin showed the highest sensitivity (100%) followed by chloram phenicol (94.1%) to S. epidermidis. Klebsiella spp. and E. coli showed highest sensitivity against chloram phenicol. This study suggests that Staphylococcus aureus and Pseudomonas are the commonest bacteria involved in CSOM in Bangladesh and Ciprofloxacin is an important tool in the management of active CSOM.

Evaluation of efficiency of nested multiplex allele-specific PCR assay for detection of multidrug resistant tuberculosis directly from sputum samples

For an effective control of tuberculosis, rapid detection of multidrug resistant tuberculosis (MDR-TB) is necessary. Therefore, we developed a modified nested multiplex allele-specific polymerase chain reaction (MAS-PCR) method that enables rapid MDR-TB detection directly from sputum samples. The efficacy of this method was evaluated using 79 sputum samples collected from suspected tuberculosis patients. The performance of nested MAS-PCR method was compared with other MDR-TB detection methods like drug susceptibility testing (DST) and DNA sequencing. As rifampicin (RIF) resistance conforms to MDR-TB in greater than 90% cases, only the presence of RIF-associated mutations in rpoB gene was determined by DNA sequencing and nested MAS-PCR to detect MDR-TB. The concordance between nested MAS-PCR and DNA sequencing results was found to be 96·3%. When compared with DST, the sensitivity and specificity of nested MAS-PCR for RIF-resistance detection were determined to be 92·9 and 100% respectively.

SIGNIFICANCE AND IMPACT OF THE STUDY

For developing- and high-TB burden countries, molecular-based tests have been recommended by the World Health Organization for rapid detection of MDR-TB. The results of this study indicate that, nested MAS-PCR assay might be a practical and relatively cost effective molecular method for rapid detection of MDR-TB from suspected sputum samples in developing countries with resource poor settings.

Epidemiology of carbapenem resistant Klebsiella pneumoniae colonization in an intensive care unit

Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged during recent years in several intensive care units. The objective of our study was to determine the incidence of CRKP and the risk factors associated with acquisition during intensive care unit (ICU) stay. This prospective cohort study was conducted between May 2007 and April 2008 in a medical-surgical ICU at a tertiary medical center. Rectal surveillance cultures were obtained from patients on admission and twice weekly. Of screened patients, 7.0% (21/299) were CRKP colonized on admission to the ICU. One hundred eighty (81%) patients were screened at least twice. Of these, 48 (27%) patients acquired CRKP during ICU stay. Of the 69 CRKP colonized patients (both imported and ICU acquired), 29% (20/69) were first identified by microbiologic cultures, while screening cultures identified 49 patients (71%). Of these, 23 (47%) subsequently developed clinical microbiological cultures. Independent risk factors for CRKP acquisition included recent surgery (OR 7.74; CI 3.42-17.45) and SOFA score on admission (OR 1.17; CI 1-1.22). In conclusion, active surveillance cultures detected a sizable proportion of CRKP colonized patients that were not identified by clinical cultures. Recent surgical procedures and patient severity were independently associated with CRKP acquisition.

Rapid detection of Haemophilus influenzae type b in Bangladeshi children with pneumonia and meningitis by PCR and analysis of antimicrobial resistance

A polymerase chain reaction (PCR) assay with primers from 'bexA' gene was compared with culture for the detection of Haemophilus influenzae type b (Hib) in clinical samples from children with pneumonia and meningitis. Of 200 sera (180 from pneumonia, 20 from non-pneumonia patients) tested by PCR (serum-PCR), Hib was detected in 15 of 16 blood culture-positive and in 6 blood culture-negative pneumonia cases. When compared with the results of blood culture, serum-PCR had sensitivity, specificity, and accuracy index of 93.7%, 96.7%, and 96.5% respectively. Of 120 cerebrospinal fluid (CSF) samples from meningitis patients tested by culture and PCR (CSF-PCR), the latter method could detect Hib in all 15 culture-positive and in 8 of 105 culture-negative cases, showing sensitivity, specificity, and accuracy index of 100%, 92.4%, and 94.4% respectively. The PCR result was available within a day. Antimicrobial susceptibility of Hib was determined by the disc-diffusion method. High rate of resistance to ampicillin (54.8%), chloramphenicol (48.4%), and co-trimoxazole (80.6%) was observed among 31 invasive Hib isolates with resistance to all 3 drugs (multiresistance) in 48.4% of the isolates. All the Hib isolates were susceptible to ceftriaxone. The study has shown that PCR is a rapid, sensitive and specific diagnostic test for Hib from clinical samples, and a combination of culture and PCR is necessary for the detection of Hib infections to the maximum extent for case management to reduce morbidity, mortality, and complications of the invasive Hib infections. A high prevalence of multiresistant Hib strains is a matter of concern.

Seroprevalence of hepatitis B, hepatitis C, CMV and HIV in multiply transfused thalassemia patients: results from a thalassemia day care center in Malaysia

Regular blood transfusions for patients with thalassemia have improved their overall survival although these transfusions carry a definite risk of the transmission of certain viruses. Infection with hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV) and human immunodeficiency virus (HIV) leads to complications which contribute to the morbidity and mortality of patients with thalassemia. We analyzed the blood samples taken from 85 transfusion dependent thalassemics receiving treatment at the day care center in Hospital Universiti Kebangsaan Malaysia and found that the seroprevalence rates for HBV, HCV and CMV were 2.4%, 22.4% and 91.8% respectively. None of the patients tested positive for HIV. Those positive for HBV and HCV will require further tests and treatment if chronic hepatitis is confirmed.

Development and evaluation of co-agglutination test to detect rotavirus antigens in stools of patients with diarrhoea

Rotavirus is the most common cause of acute diarrhoea in infants and children in both the developed and developing countries including Bangladesh. Information about rotavirus diarrhoea in Bangladesh is insufficient primarily due to the lack of diagnostic facilities due to the high cost of reagents and equipment and lack of skilled personnel. A simple, suitable and less costly technique of co-agglutination test using protein-A secreting staphylococci was developed and evaluated against a commercially available ELISA kit to detect rotavirus antigen in stools of patients with diarrhoea. Staphylococcus cowan strain 1 was grown and coated with rabbit antisera raised against RV5 and SA11 rotavirus strains. The antibody-coated staphylococci were agglutinated specifically by rotavirus present in faecal samples within one or two minutes. A total of 1332 stool specimens were tested by co-agglutination and ELISA, of which 210 (15.77%) were positive by ELISA and 276 (20.72%) by co-agglutination test. Compared to ELISA, sensitivity of co-agglutination test was 76.19%, specificity 89.66% and predictive values of a positive and a negative test were 57.97% and 95.26% respectively. The results indicate that the co-agglutination test is a simple and suitable technique for rapid screening of rotavirus infection which could be adopted in clinical practice.

Rapid identification of Vibrio cholerae serotype O1 from primary isolation plates by a coagglutination test

A coagglutination test was developed for identifying suspected colonies of Vibrio cholerae serotype O1 directly from primary isolation plates. Visible agglutination occurs when V. cholerae O1 antibody attached to cell-wall protein A of Staphylococcus aureus reacts with its homologous antigen. From 314 faecal samples from clinically suspected cases of cholera, 210 colonies from thiosulphate citrate bile salts sucrose (TCBS) agar and 222 colonies from taurocholate tellurite gelatin (TTG) agar were tested as suspect V. cholerae. In each case 204 isolates were identified as V. cholerae O1 by conventional methods and also gave positive results for V. cholerae O1 in the coagglutination test; with one partial exception, no other colonies tested gave positive results. The coagglutination test is simple and inexpensive and provides a result 24 h earlier than conventional methods.

Epidemiological study and comparison of pyrantel and levamisole in the treatment of roundworm and hookworm infestations

Stool examined for presence of nematodes from 467 school students in Dacca city showed 48% ova positive cases with 22% among them cases of mixed nematode infection. Highest prevalence of 58% was observed with roundworm and 5% was hookworm infestations. Among hookworm cases, Necator americana (68%) appears to be the predominant species. Two anthelmintics-pyrantel and levamisole achieved similar high cure rate (around 97%) and Egg reduction rate of 99% in roundworm infection. However, pyrantel was observed to be more effective in hookworm infestation (87% against 60%) particularly in Necator americana cases.