Beyond the regulatory radar: knowledge and practices of rural medical practitioners in Bangladesh

BACKGROUND

Informal and unregulated rural medical practitioners (RMPs) provide healthcare services to about two-thirds of people in Bangladesh, although their service is assumed to be substandard by qualified providers. As the RMPs are embedded in the local community and provide low-cost services, their practice pattern demands investigation to identify the shortfalls and design effective strategies to ameliorate the service.

METHODS

We conducted a cross-sectional study in 2015-16 using a convenient sample from all 64 districts of Bangladesh. Personnel practising modern medicine, without any recognized training, or with recognized training but practising outside their defined roles, and without any regulatory oversight were invited to take part in the study. Appropriateness of the diagnosis and the rationality of antibiotic and other drug use were measured as per the Integrated Management of Childhood Illness guideline.

RESULTS

We invited 1004 RMPs, of whom 877 consented. Among them, 656 (74.8%) RMPs owned a drugstore, 706 (78.2%) had formal education below higher secondary level, and 844 (96.2%) had informal training outside regulatory oversight during or after induction into the profession. The most common diseases encountered by them were common cold, pneumonia, and diarrhoea. 583 (66.5%) RMPs did not dispense any antibiotic for common cold symptoms. 59 (6.7%) and 64 (7.3%) of them could identify all main symptoms of pneumonia and diarrhoea, respectively. In pneumonia, 28 (3.2%) RMPs dispensed amoxicillin as first-line treatment, 819 (93.4%) dispensed different antibiotics including ceftriaxone, 721 (82.2%) dispensed salbutamol, and 278 (31.7%) dispensed steroid. In diarrhoea, 824 (94.0%) RMPs dispensed antibiotic, 937 (95.4%) dispensed ORS, 709 (80.8%) dispensed antiprotozoal, and 15 (1.7%) refrained from dispensing antibiotic and antiprotozoal together.

CONCLUSIONS

Inappropriate diagnoses, irrational use of antibiotics and other drugs, and polypharmacy were observed in the practising pattern of RMPs. The government and other stakeholders should acknowledge them as crucial partners in the healthcare sector and consider ways to incorporate them into curative and preventive care.

Effectiveness of "Physician Prompt Clinical Decision Criteria" in Weaning Outcome Prediction for Neurocritical Patients

Endotracheal intubation and invasive mechanical ventilation are fundamental components for the resuscitation of neurocritically ill patients to achieve various goals which include ensuring the protection of the airway, participating in tissue oxygen delivery and indirectly modulating cerebral vascular reactivity. The neurocritical patients demand special attention to their systemic involvement regarding weaning. Physician prompt clinical decision criteria (PPC) can play a better role in weaning of such patients. The aim of this study was to evaluate the effectiveness of 'Physician prompt clinical decision criteria' for successful weaning in neurocritical patients. This prospective observational study was conducted in the ICU, Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from March 2018 to April 2020. In total 100 neurocritical patients who fulfilled the inclusion criteria were taken as samples by informed written consent. The outcome was observed as successful weaning or as failed weaning. Finally, the existence of Standard extubation criteria (SEC) was compared with Physician prompt clinical decision criteria (PPC). Weaning was succeeded in 80.0% of patients and failed in 20.0% according to the Standard extubation criteria (SEC) while weaning was succeeded in 85.7% of patients and failed in 14.28% according to the Physician prompt clinical decision criteria (PPC). There were some differences in results but no significant differences were observed statistically between the groups in predicting the weaning outcome. Physician prompt clinical decision criteria were found to be 75.0% sensitive and specificity was 50.0%. Positive predictive value for Physician prompt clinical decision criteria was 85.70% with a Positive likelihood ratio for these criteria was 1.5 times. So, according to the study findings, accuracy of Physician prompt clinical decision criteria was 70.0%. According to the findings of this current study we can conclude that Physician prompt clinical decision criteria are an effective weaning readiness predictor in neurocritical patients.

Physical, Psychological and Social Impact of COVID-19 Pandemic on Healthcare Workers at a COVID Designated Bangladeshi Public Hospital

The world has been devastated facing the outbreak of a novel infectious disease known as Corona virus disease (COVID-19). This has been declared as a pandemic by the World Health Organization. The frontline health care workers, who are directly involved in the diagnosis, treatment and care of patients with COVID-19, are taking significant personal risks on their own health and those of their family members. Objectives of the study include establishing the physical, psychological and social impact experience by the healthcare workers serving in public hospitals of Bangladesh. This prospective cross-sectional observational study was carried out at Kuwait Bangladesh Friendship Government Hospital, the first Covid-19 designated hospital of Bangladesh between the 1st June and the 31st August, 2020. A total of 294 doctors, nurses, ward boys and ailed healthcare workers were included in this study via purposive sampling. The study found statistically significant (p value 0.024) difference of medical co-morbidities between Covid-19 positive and Covid-19 negative groups of health care professionals. Significant association was found between duration of work and presence during aerosol generating procedure with COVID infectivity of the study subjects. 72.8% respondents experienced public fear of contracting the virus from them and 69.0% noticed negative attitude of the society towards them. Eighty five percent (85.0%) did not get any community support during this pandemic crisis. The health care professionals engaged in COVID-19 treatment have been taking significant personal risk on their life in terms of physical, psychological and social perspective. Providing safeguard to the health care workers are integral components of public health measures for addressing the COVID-19 pandemic. Special interventions to promote their physical wellbeing and arrangement of adequate psychological training need to be immediately implemented to cope up this critical situation.

Partnerships in the introduction of new routine vaccines in Bangladesh: evidence from a prospective process evaluation

OBJECTIVE

To assess the contribution of partners in the introduction of two new vaccines concurrently: pneumococcal 10-valent conjugate vaccine (PCV-10) and inactivated polio vaccine (IPV) into the routine Expanded Programme on Immunization (EPI) in Bangladesh.

DESIGN

We conducted a prospective process evaluation that included the theory of change development, root cause analysis and in-depth investigation. As part of process tracking, we reviewed relevant documents, observed trainers' and vaccinators' training and key stakeholder meetings. We analysed the data thematically.

SETTING

We purposively selected eight Upazila (subdistrict) and one city corporation covering nine districts and seven administrative divisions of Bangladesh.

PARTICIPANTS

Nineteen national key informants were interviewed and 16 frontline health workers were invited to the group discussions considering their involvement in the vaccine introduction process.

RESULTS

The EPI experienced several challenges during the joint introduction of PCV-10 and IPV, such as frequent changes in the vaccine introduction schedule, delays in budget allocation, vaccine supply shortage and higher wastage rates of IPV. EPI addressed these challenges in collaboration with its partners, that is, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF), who provided technical assistance to develop a training curriculum and communication materials and enhanced demand generation at the community level. In addition, the WHO conducted a country readiness assessment for PCV-10, and UNICEF supported vaccine shipment. Other government ministries, City Corporations and municipalities also supported the EPI.

CONCLUSIONS

The partnership among the EPI stakeholders effectively addressed various operational challenges during the joint introduction of PCV-10 and IPV helped strengthen Bangladesh's immunisation systems. These accomplishments are attributed to several factors that should be supported and strengthened for future vaccine introductions in Bangladesh and other low and-middle countries.

Effect of Application of Platelet-Rich Plasma on Bone Regeneration after Removal of Jaw Cysts

Platelets are involved in regeneration at sites of bony defect, apart from their function in coagulation. An autologous preparation platelet-rich plasma gel applied to sites of bony defects after surgical treatment of jaw cyst. This case-control study was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU) in the department of Oral and Maxillofacial Surgery from September 2017 to August 2018. Total 30 patients were chosen having jaw cyst. They were divided into 2 groups; Group A and Group B, where Group A got the platelet rich plasma, after removal of the cystic lesion; and Group B got the normal usual treatment. Platelet rich plasma gel was prepared using a standardized technique and applied to the surgical site of the Group A. The differences of radiographic changes between the two groups at 6th, 12th, 18th and 24th weeks after surgery were analyzed. Study showed significant changes in early bone regeneration in group A at 12th and 18th weeks post operatively. Platelet rich plasma induces early bone regeneration and it has proven successful outcome.

Multidisciplinary Team Effort Results in Better Outcomes in Critically Ill Obstetric Patients Admitted in ICU

Management of critically ill obstetric patients is a great challenge for the ICU team. The safety of both mother and fetus are of real concerns. Teamwork is essential for better outcome in obstetric patients in the ICU. A 26 years old female was admitted in Dhaka Medical College Hospital, Dhaka, Bangladesh on 18 August 2019 with 7 months pregnancy with brain tumor (later diagnosed as Gliosarcoma) and was managed surgically by left temporal craniotomy with excision of the tumor. The patient was shifted to the ICU due to repeated convulsions and need mechanical ventilator support. Later on, she was suffering from sepsis with pseudomonas in blood culture, grade IV pressure ulcer and electrolyte imbalance and needed tracheostomy for airway management. On 34th weeks of her pregnancy she developed antepartum hemorrhage with respiratory distress. Emergency LUCS was done and she delivered a LBW baby who was managed in NICU. Mother was managed in the ICU and later on both mother and child were discharge with good conditions. Multidisciplinary team work is vital for better management of critically ill obstetric patients.

Microbiological status of some street iftar items collected from chalk bazar in Dhaka city, Bangladesh

In Dhaka, the capital of Bangladesh and one of the most densely populated cities of the world, different categories of street foods are widely consumed by all classes of people, especially for iftar during the holy month of Ramadan. The objective of this research was to assess the microbiological quality of street iftar food items collected from a street in Chalk Bazar locality of Dhaka along with the antibiogram profile of the bacterial isolates. A total of 74 samples belong to ten different categories of street food items and 8 different types of street vended juices were collected aseptically. The bacteria were isolated by using different culture media. The antibiotic susceptibility of the bacterial isolates was determined by the disc diffusion method. In case of street food total viable bacteria (on average of 6 log10 CFU/g). On the other hand, an extended number of total viable bacteria were encountered in all juices samples which also on an average of 6 log10 CFU/mL. Fungi, Pseudomonas spp. and Staphylococcus spp. were found in the majority of the samples irrespective of the categories. Few samples were contaminated with Escherichia coli and Klebsiella spp. Most of the cultivated bacterial strains exhibited resistance against commonly used antibiotics, while several isolates were noted to be multi-drug resistant. The present study revealed a huge array of microbial load which indicates a high risk to public health. Presence of antibiotic-resistant bacteria heightened the risk by many folds and urges the need for frequent surveillance.

Correlation of Mean Platelet Volume with ST Segment Resolution after Thrombolytic Therapy in Patients with ST Elevation Myocardial Infarction

Acute occlusive thrombosis of the coronary artery is the principal cause of myocardial infarction where platelets play an important role. Large size platelets, easily measured by mean platelets volume (MPV) are thrombogenic and commonly seen after ST-segment elevation myocardial infarction (STEMI). ST segment resolution has been shown as a simple non-invasive marker that reflects both epicardial and myocardial reperfusion following thrombolysis. The present study intended to investigate whether MPV on admission correlated with ST segment resolution following thrombolysis in STEMI patient. This cross-sectional analytical study was conducted in the department of cardiology, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh from December, 2016 to June, 2018. Total 284 patients with first attack of STEMI were included after considering inclusion and exclusion criteria. Sample population was divided into two groups, Group I - Patients with successful ST segment resolution (≥50%). Group II - Patients with impaired ST segment resolution (<50%). MPV on admission was estimated during estimation of Complete Blood Count (CBC) by Automated Haematology Analyzer & compared between two groups. Successful ST segment resolution (≥50%) was seen in 67% of patients after thrombolysis. Admission MPV was higher in patients with impaired ST segment resolution (<50%) group than patients with ≥50% ST-segment resolution group (12.42±0.89fl vs.10.35±0.77fl respectively, p=0.001). Statistically significant strong negative correlation between MPV and ST segment resolution percentage (r = -0.742, p=0.001) suggesting that the higher the level of MPV, the lower the ST segment resolution percentage in first attack of STEMI patients. Multivariate regression analysis found MPV level on admission as an independent predictor of ST segment resolution. The study concluded that high MPV on admission correlate with impaired ST segment resolution following thrombolysis in STEMI patients.

Relation of Obesity with Breast Cancer among the Patients Attending at National Institute of Cancer Research & Hospital

Breast cancer among women is gradually increasing in Bangladesh day by day. A number of breast cancer related etiological factors identified as age, reproductive factors, menarche, menopausal status, life style, hormone replacement therapy, genetics and alcohol intake. Obesity is an important factor for developing breast cancer in different countries. Obesity is one of the modifiable factors. The aim of the study was to find out the factors which might be associated with obesity among female breast cancer patients in Bangladesh. It was a case-control study conducted at the Department of Medical Oncology, National Institute of Cancer Research & Hospital (NICRH), Dhaka, Bangladesh from August 2014 to July 2015. Ninety one case and equal numbers of age matched controls were included in the study. The mean age of the case was 42.99 (±9.24) years and that of the control was 44.11±8.97 years. Majority of patients i.e. 59.3% (n=54) in case group was in pre-menopausal state where as 52.7% (n=48) of respondents in control group were in menopausal state. Increased waist to hip ratio (>0.85) was associated with increased risk of breast cancer (OR: 8.1). This was also true for increased BMI of ≥25kg/m² (OR: 4.57), increased waist circumference (OR: 3.52) and ever OCP use (OR: 2.11). However, para >3, education and moderate to heavy work were found to be protective against breast cancer (OR: <1). In clinical setting waist-to-hip ratio, body mass index (BMI) and waist circumference (WC) can be used effectively to identify women with an increased risk of breast cancer.

3D Echocardiography Is More Efficient In Detail Assessment of Calcification in Chronic Rheumatic Mitral Stenosis

Rheumatic heart disease is in the declining phase, with the increase of urbanization and increment of availability of healthcare facility. However still it causes a substantial number of morbidity and mortality in South Asia. The prevalence of Rheumatic Fever and Rheumatic heart disease in Bangladesh is still high, 0.6 and 0.3 per thousand populations respectively. In the rheumatic process mitral is the frequently involved valve, mostly in the form of mitral stenosis. Choice of a treatment modality and its success largely depend on the accurate assessment of severity of disease especially the extent and distribution of calcification. Echocardiography has a key role in the determination of the severity of mitral stenosis as well as assessment of details calcification. Conventionally 2 dimensional and Doppler echocardiography is used. Now a days, 3D echocardiography offers better cardiac imaging for detail evaluation. The heart being a complex structure, the 3D evaluation would certainly offer better imaging for the accurate assessment of the mitral stenosis, especially details of presence & distribution calcification. This cross-sectional observational study was done from May 2012 to October 2012 in University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Data were collected with informed written consent, from 50 subjects who underwent transthoracic 2D and 3D Echocardiography for the assessment of rheumatic mitral valve with special emphasis on accurate assessment of severity, extent and distribution of calcification. Precise measurement of MV area is essential in the assessment of severity, which is found comparable by both 2DE (0.98±0.24cm²) and 3DE (0.92±0.23cm²). But in identifying calcification and accurate assessment of severity, more importantly commissural involvement is better detected by 3DE (p=0.002). This has extreme importance in therapeutic decision making in the treatment of chronic rheumatic MS. So, to formulate an efficient management plan, three-dimensional echocardiography has promising prospects in detecting severity & extent of rheumatic calcification.

Prevalence of Diabetic Nephropathy in Patients Attending the Endocrine Department of Mymensingh Medical College Hospital

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Due to severe morbidity and mortality of DN and limited effective therapies, research has mainly focused on prevention of this debilitating illness by modification of risk factors. Aims of this study were to find out the prevalence of diabetic nephropathy, its factors and to correlate the functional status of the kidney. This cross-sectional study was conducted in the Department of Endocrinology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 1st January 2013 to 30th June 2013. A total 105 patients having clinical diagnosis of Diabetes mellitus were enrolled in this study. Data were collected by interview of the patients, clinical examination and laboratory investigation. Data was analyzed using the Chi-square test for Categorical variables and unpaired Student's 't' test for differences in means for continuous variables. P value <0.05 was considered significant. With DN (30.5%) patients 21.1% had micro-albuminuria and 9.5% had macro-albuminuria. The mean age for the DN patient was 47.9±14.7 years and male female ratio was 1:1. BMI was found significantly low in patients with DN (p<0.05). Prolonged duration of diabetes (>5 years) and uncontrolled diabetes were found as significant risk factors associated with DN. Other risk factors were hypertension, family history of hypertension, family history of diabetes mellitus and irregular treatment of diabetes mellitus. Mean serum creatinine, mean estimated glomerular filtration rate (GFR) and mean blood sugar level was 1.3±0.6mg/dl, 69.4±26.7ml and 15.6±7.1mmol/L respectively in DN patients. Relation was significant for higher serum creatinine and lower eGFR values (p<0.05). Prevalence of diabetic nephropathy was 30.5%. Long standing diabetes (>5 years) and uncontrolled diabetes were the important risk factors for the development of diabetic nephropathy. Diabetic nephropathy is associated with higher serum creatinine and lower eGFR values.

Outcome of Ilizarov External Fixator for the Treatment of Gap Non-uniting Mid Shaft Tibia-fibula Fractures: Our Experience

Many patients come with open fracture tibia-fibula initially managed by surgical toileting and the application of indigenous uniaxial external fixator in our country. Many of them lead to non-uniting fracture or sometimes signs of union absent within 4 months from the time of initial fracture and become infected also. This quasi experimental study included 40 skeletally matured patients was conducted from 05 February 2014 to 05 February 2018 in the department of Orthopedics, Mymensingh Medical College Hospital, Mymensigh, Bangladesh. The purpose of this study was to evaluate the efficacy of Ilizarov external fixator for treatment of infected gap non-uniting mid shaft tibia-fibula fracture which was initially open fracture Gustilo II to Gustilo III B. Uniaxial external fixators were replaced by to Ilizarov external fixators which multiaxial. Here male 30(75%), female 10(25%) with mean 28 years of age were analyzed in this study based on the inclusion criteria. Twenty eight (70%) fractures had right tibia-fibula while 12(30%) fracture had involved left tibia-fibula. Twelve (30%) patients had a grade II, grade III A- 18(45%), grade IIIB- 10(25%) open fracture tibia-fibula according to the Gustilo and Anderson classification. Initial mode of injury RTA was 28(70%), fall from height 8(20%), physical assault 4(10%). Mean interval between initial trauma and Ilizarov external fixator application was 4.4 months (ranges 4.2-4.8 months).Union or signs of union achieved in all cases in an average time of 17.12 weeks (range 14-20 weeks). The Ilizarov fixator was kept for an average period of 195 days (range 180-210 days). Minimal follow-up was 9 months after complete frame removal (average: 12 months, range: 9-18 months). Based on ASAMI scoring system, bony and functional results were assessed. The bony results were excellent in 24(60%), good in 12(30%), fair in 4(10%) and the Functional results were excellent in 18(45%), good in 16(40%), fair in 4(10%) and poor in 2(5%). In 16(40%) patients 20 wires had pin tract infection in this series. Most pin-tract infections healed well with regular dressing and oral antibiotics but in 8(20%) patients 8 affected loose wires were exchanged. Limb length discrepancy was 1.5cm in 18(45%) patients and 2.0cm in 22(55%) patients. The small sample sizes and short duration of follow-up were the study limitations. We need a life boat or life jacket during journey. As Orthopeadic Surgeon we are always in danger and Ilizarov method is the life boat technology in orthopedic surgery. It restores bone biology without disturbing the medullary cavity. To avoid repeated surgical intervention and to reduce the cost of treatment, we suggest that gap non-uniting infected tibia-fibula fracture which was primarily open should be fixed by Ilizarov external fixator than continuing treatment with indigenous uniaxial external fixator.

Lipid Profile Status in Natural and Surgical Menopausal Women: A Comparative Study

This cross sectional, study was carried out in the department of Obstetrics and Gynaecology in Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from October 2015 to September 2016. The objective of the study was to evaluate dyslipidaemia between natural and surgical menopausal women. Patients who attended the menopausal clinic of Mymensingh Medical College Hospital, Mymensingh were included in the study. For this purpose 91 patient were divided into study (n=46) and comparison (n=45) groups. Serum total cholesterol (TC), serum triglyceride (TG), Serum high density lipoprotein cholesterol (HDL-cholesterol) were estimated by colorometric method and serum low density lipoprotein cholesterol (LDL-cholesterol) was calculated by using Friedwald's formula. Age range of menopausal women was 45 to 60 years. The mean age with SD was in study group 50.26±2.57 years and control group 49.02±3.13 years. It was observed that women with surgical menopause had higher mean plasma level of total cholesterol with standard deviation 192.84±52.43mg/dl while that of mean and standard deviation of natural menopause 192.26±27.56mg/dl i.e. Mean difference was statistically insignificant (p>0.05). Mean plasma levels of Triglyceride (TG) with standard deviation (215.87±67.73mg/dl) higher in surgical menopause as compared with natural menopause (147.33±65.17mg/dl) which was statistically significant (p<0.001). There was significant rise of mean with standard deviation of HDL cholesterol in natural menopause was (44.42±8.14mg/dl) as compared to surgical menopause (34.61±8.55mg/dl) and the mean difference was statistically highly significant (p<0.001). Mean with standard deviation of plasma LDL cholesterol (122.02±49.16mg/dl) rise in surgical menopause as compared to physiological menopause (118.06±20.56mg/dl) and was statistically insignificant (p>0.05). Serum total cholesterol, serum triglyceride (TG) and serum low density lipoprotein (LDL) was found significant higher level in surgical menopause. And only serum high density lipoprotein (HDL) was found significantly higher level in physiological menopause. So, surgical menopausal women were marked dyslipidaemia.

Platelet Count as a Severity of Chronic Obstructive Pulmonary Disease

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

Quantification of viable granulosa cells in murine ovarian follicles

Ovarian follicle growth and oocyte maturation depend on the viability of granulosa cells (GC). We quantified GC in whole mouse follicles. Single follicles were isolated from adult mouse ovaries and stained with DAPI or Live-Dead stain before fixation. An objective image analysis protocol for counting fluorescent labeled GC was developed that used Image J software to measure GC cytoplasmic and nuclear areas. These data were compared to the number of GC obtained by disaggregating 96 follicles with enzymes to produce a suspension of GC, which then was stained with trypan blue and assessed using a hemocytometer. We found a linear relation between GC/follicle and follicle diameter. Viability of GC/follicle ranged from 40 ± 11 to 72 ± 7%. The coefficient of variation for image analysis of DAPI stained GC by different assessors was 4%, but the number of GC obtained from image analysis was approximately 50% less than from disaggregated follicles. The number of GC in intact mouse follicles was greater than the number reported earlier for fixed ovarian sections. We found that the number of GC was less in fluorescence labeled follicles; it is possible that the three-dimensional structure of the intact follicles obscured the fluorescent signal. Direct quantification of viable GC isolated from follicles appears to be the most accurate method.

Hunting Bats for Human Consumption in Bangladesh

Bats are important wildlife to their ecologic system, but they are also a zoonotic disease reservoir. Close bat-human interaction can lead to pathogen spillover. We conducted a qualitative study in two districts of Bangladesh and interviewed 30 bat hunters who hunt bats primarily for consumption, to understand the process and their reasons for hunting bats and their perceptions about bats and bat-borne disease. Most hunters catch bats during winter nights, using a net. Bat meat is used for household consumption, and the surplus is sold to cover household expenditures. They prepare the bat meat at home to sell it in their own and in neighboring communities. They also sell live bats to traditional healers. They report that the bat population has declined compared with 5 or 10 years ago, a decline they attribute to hunting and deforestation. Many have heard of a disease from bat-contaminated date palm sap but do not believe that bats can spread such disease to humans. Close bat-human interaction reported in this study pose a risk of pathogen spillover. Conservation initiatives have the potential to reduce such interaction and so both reduce disease risk and support the ecology.

Antithyroid Antibody Status in Non-Pregnant Adult Bangladeshi Patients with Subclinical Hypothyroidism

Sub clinical hypothyroidism (SCH) is common in clinical practice. Autoimmunity is thought to be the most important cause of SCH. In this cross-sectional study, we investigated 120 SCH patients and 100 healthy controls attending the Endocrinology Outpatient Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2014 to April 2015 for anti-thyroid antibodies (anti-TPO and anti-Tg). Measurement of serum TSH, FT4, anti-TPO, and anti-Tg antibodies were done by using the chemiluminescent sequential immunometric assay. SCH patients had a higher mean age; the frequencies of female subjects, those having family history of thyroid disease or other autoimmune diseases, and goiter were higher in SCH group than in the control group. Forty-five percent (45%) of SCH patients were positive for anti-thyroid antibodies (23.3% for both anti-TPO and anti-Tg, 16.7% for only anti-TPO, and 5% positive for only anti-Tg) in comparison to only 10% anti-thyroid antibody positive controls (none for both antibodies, 8% for only anti-TPO, and 2% positive for only anti-Tg). The SCH subjects in the lower age group, females and with a TSH >10μIU/mL had the higher frequency of thyroid autoimmunity. Female gender, high socioeconomic condition, the presence of other autoimmune diseases, the presence of goiter and TSH >10μIU/mL were associated with higher odds of anti-thyroid antibody positivity in the SCH group, though none were statistically significant. The frequency of anti-thyroid antibody was higher in SCH and was more prevalent among the females, younger patients and those having a goiter, other autoimmune diseases, and TSH >10μIU/mL.

Detection of Retinopathy of Prematurity (ROP) in very Low Birth Weight Babies and Outcome of Management

The purpose of the present study was to early detection and management of retinopathy of prematurity (ROP). This observational descriptive/ interventional study was carried out to evaluate 96 babies brought by their parents to BIRDEM General Hospital during the period of January 2016 to June 2016 who fulfilled the inclusion and exclusion criteria. Screening of ROP was performed in all 96 babies after taking informed written consent. After screening of ROP, the babies who had ROP, staging was done and treatment was given as per requirement. Descriptive data in the study were shown by cross table and compared by student paired 't' test and Chi-square test. The study included total 96 babies of preterm low birth weight. Among them 64(66.66%) babies had no ROP, where 32(33.33%) babies had different stages of ROP. In these 32 babies, 18 babies didn't need any treatment, only 14 babies needed treatment according to their requirement (14 babies had 28 eyes, where 16 eyes needed Inj. Anti VEGF and laser and 11 eyes needed only laser and one eye had Stage V ROP, so observed that eye). Early detection of ROP and proper management not only restore the anatomical and functional outcome of the retina, but also restore the vision, prevent childhood blindness and decrease morbidity.

Prevalence and Predictors of Depression among Patients with Type 2 Diabetes: A Multicenter Cross-sectional Study from Bangladesh

Depression is a common comorbidity of type 2 diabetes mellitus (T2DM) which adversely affects diabetes management and outcome. Identifying and treating comorbid depression may improve diabetes care. This cross-sectional study was conducted in several tertiary hospitals throughout Bangladesh from July 2017 to April 2018. Nine hundred (900) adult patients with T2DM aging ≥25 years having diabetes for at least 6 months and equal numbers of non-diabetic otherwise healthy controls were recruited from the outpatient departments of these centers. Depression was assessed in all consenting patients and controls by administering the Bangla (local language) version of the PRIME-MD Patient Health Questionnaire (PHQ-9); participants obtaining a score of 5 or more were labeled to have depression. Depression was present in 60.3% of T2DM patients and in 29.4% of controls. Statistically significant difference was found in age, marital status, occupation, body mass index (BMI), waist circumference, systolic blood pressure (BP), diastolic BP and PHQ-9 score between diabetic and non-diabetic subjects (<0.001). T2DM subjects had 4.71-fold higher odds of depression in comparison to the controls (95% CI: 3.76-5.90; p<0.001). Age ≥50 years, unmarried status, years of schooling ≤10 years, underweight, abdominal obesity, and hypertension appeared to be the significant predictors of depression in the study subjects. In T2DM subjects, diabetes in the family members, the presence of other comorbidities, diabetic complications, diabetes duration >5 years, insulin use, using insulin syringe for injection, albuminuria and CKD were the important predictors of depression. Our study found higher prevalence and risk of depression in T2DM patients than their non-diabetic counterparts. T2DM patients should be screened for depression in order to achieve and maintain the treatment goals.

Anti-Phospholipid Antibody Syndrome with Subdural Hematoma: A Case Report

A 33-year-old man with anti-phospholipid antibody syndrome associated with Budd Chiari syndrome and subdural hematoma. He developed venous thrombosis in his hepatic vein (stenting done) when laboratory studies demonstrated prolongation of activated partial thromboplastin time (APTT). Subdural hematoma demonstrated with Computed tomography (CT) of brain. Laboratory studies revealed thrombocytopenia, prolonged bleeding time and APTT, positive antinuclear antibody and positive test results for both lupus anticoagulant and an anti-cardiolipin antibody, namely antiphospholipid antibodies. Based on these findings, we consider that the tendency of this bleeding may have been due to antiphospholipid antibodies, attacking the platelet membranes and that the bridging veins in the subdural space may be the site at which the bleeding tendency easily appears. Antiphospholipid antibody syndrome accompanied by hemorrhagic complications had rarely been reported. We suggest that special attention should be given to hemorrhagic complications in patients with antiphospholipid antibody syndrome associated with fragility of the vessels and/or platelet dysfunction and on anticoagulant (warfarin).Pulse Vol.10 January-December 2017 p.25-28

Rapid and non-invasive multivariate approach for the quality control of raw milk from mountain areas based on proton transfer reaction mass spectrometry data

RATIONALE

A rapid and non-invasive method for the control of milk by proton transfer reaction mass spectrometry was developed. The approach has the potential to verify the geographic origin and altitude of dairy farms, provided that the cows have been extensively grazed with forage that reflects the botanical composition of the mountain environment.

METHODS

Over a 1-month period, a total of 116 samples were analysed by proton transfer reaction mass spectrometry (PTRMS). A multivariate control chart based on the Hotelling T² statistic was built with PTRMS data and, for comparison, with the chemical parameters obtained by infrared spectroscopy (FTIR, MilkoScan).

RESULTS

The headspace analysis of the samples led to characteristic volatile profiles. Farms located in different mountain areas were discriminated by the protonated molecules m/z 45 (acetaldehyde), 59 (acetone), 73 (2-butanone) and 89 (butyric acid, ethyl acetate, pentanol). Milk samples were also discriminated according to the altitude of the farms according to m/z 45, 59, 63 (dimethyl sulfide), 73 (propionic acid, methyl acetate) and 81 (terpenes).

CONCLUSIONS

A multivariate control chart based on PTRMS data was used for the quality control of milk. Milk samples from farms located at different mountain areas and altitudes were successfully discriminated.

Proteinase-activated receptor-2 blockade inhibits changes seen in a chronic murine asthma model

BACKGROUND

Proteinase-Activated Receptor-2 (PAR₂ ) is a G protein-coupled receptor activated by serine proteinases. We have shown that PAR₂ activation in the airways is involved in the development of allergic inflammation and airway hyperresponsiveness (AHR) in acute murine models. We hypothesized that functional inhibition of PAR₂ prevents allergic inflammation, AHR and airway remodeling in chronic allergic airway inflammation models.

MATERIAL AND METHODS

We developed and used a 12 week model of cockroach extract (CE)-mediated AHR, airway inflammation and remodeling in BALB/c mice.

RESULTS

Mice sensitized and challenged with CE for 12 weeks exhibit AHR, increased numbers of eosinophils in bronchoalveolar lavage (BAL) and increased collagen content in the lung tissue compared to saline controls. Administration of an anti-PAR₂ antibody, SAM-11, after the initial development of airway inflammation significantly inhibited all these parameters.

CONCLUSIONS

Our data demonstrate that PAR₂ signaling plays a key role in CE-induced AHR and airway inflammation/remodeling in long term models of allergic airway inflammation. Targeting PAR₂ activation may be a successful therapeutic strategy for allergic asthma.

An Evaluation of the Result of Fenestration and Discectomy for the Treatment of Prolapsed Lumber Intervertrebal Disc (PLID)

The aim of this study is to asses the result of fenestration and discectomy for the treatment of PLID. This Prospective quasi experimental study was conducted on 29 Patient of PLID with different ages at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from July 2014 to June 2016. Post Operative outcome was assessed through Modified Macnab Criteria & Visual Analogue Score (VAS). The mean age of patient were 38.14±9.20 years and ranging from 24 to 55 years. The mean age of male was 37.21±9.72 years and female patient was 39.90±8.32 years. Overall subjective assessment of this study revealed that 79.2% patients had excellent functional outcome, 13.8% good and 6.9% fair and there was no poor functional outcome a according to modified Macnab criteria.

A Controlled Trial to Reduce the Risk of Human Nipah Virus Exposure in Bangladesh

Human Nipah virus (NiV) infection, often fatal in Bangladesh, is primarily transmitted by drinking raw date palm sap contaminated by Pteropus bats. We assessed the impact of a behavior change communication intervention on reducing consumption of potentially NiV-contaminated raw sap. During the 2012-2014 sap harvesting seasons, we implemented interventions in two areas and compared results with a control area. In one area, we disseminated a "do not drink raw sap" message and, in the other area, encouraged only drinking sap if it had been protected from bat contamination by a barrier ("only safe sap"). Post-intervention, 40% more respondents in both intervention areas reported knowing about a disease contracted through raw sap consumption compared with control. Reported raw sap consumption decreased in all areas. The reductions in the intervention areas were not significantly greater compared to the control. Respondents directly exposed to the "only safe sap" message were more likely to report consuming raw sap from a protected source than those with no exposure (25 vs. 15%, OR 2.0, 95% CI 1.5-2.6, P < 0.001). While the intervention increased knowledge in both intervention areas, the "only safe sap" intervention reduced exposure to potentially NiV-contaminated sap and should be considered for future dissemination.

Factors Influencing the Prevalence of Stunting Among Children Aged Below Five Years in Bangladesh

Background:

Poor nutrition during childhood impedes physical and mental development of children, which propagate the vicious cycle of intergenerational under nutrition. This paper is aimed at understanding the determinants of stunting among children aged 0 to 59 months in Bangladesh.

Methods:

The study used Bangladesh Demographic and Health Survey 2011 data and a multistage stratified cluster-sampling design. Anthropometric data (for height and weight) were collected and analysis was limited to 7647 children. Multiple binary logistic regression analysis was performed to assess the association of stunting with potential socioeconomic and demographic factors.

Results:

The prevalence of stunting has been found to be about 41% among children aged less than 60 months and higher in rural setting than in urban areas (43% vs 36%). Adjusted model revealed that several factors were influencing stunting. The children living in moderately food-insecure households had higher odds of becoming stunted (odds ratio [OR] = 1.27, 95% confidence interval [CI]: 1.05-1.54, P = .01) compared to the children living in food-secure households. The derived ORs of stunting for children delivered at institutions facilitated particularly by public (OR = 0.80, 95% CI: 0.67-0.96; P = .02) or private (OR = 0.81, 95% CI: 0.67-0.97; P = .02) sectors were less than for children delivered at home. Similarly, wealth index, exposure of mother to the mass media, age of child, size of child at birth, and parents’ education were significantly associated with stunting.

Conclusions:

Moreover, the demographic characteristics and other indicators appeared to have significant influence in the prevalence of stunting. Public health programs are needed to avert the risk factors of stunting among children in Bangladesh.

A large-scale behavior change intervention to prevent Nipah transmission in Bangladesh: components and costs

Background

Nipah virus infection (NiV) is a bat-borne zoonosis transmitted to humans through consumption of NiV-contaminated raw date palm sap in Bangladesh. The objective of this analysis was to measure the cost of an NiV prevention intervention and estimate the cost of scaling it up to districts where spillover had been identified.

Methods

We implemented a behavior change communication intervention in two districts, testing different approaches to reduce the risk of NiV transmission using community mobilization, interpersonal communication, posters and TV public service announcements on local television during the 2012–2014 sap harvesting seasons. In one district, we implemented a “no raw sap” approach recommending to stop drinking raw date palm sap. In another district, we implemented an “only safe sap” approach, recommending to stop drinking raw date palm sap but offering the option of drinking safe sap. This is sap covered with a barrier, locally called bana, to interrupt bats’ access during collection. We conducted surveys among randomly selected respondents two months after the intervention to measure the proportion of people reached. We used an activity-based costing method to calculate the cost of the intervention.

Results

The implementation cost of the “no raw sap” intervention was $30,000 and the “only safe sap” intervention was $55,000. The highest cost was conducting meetings and interpersonal communication efforts. The lowest cost was broadcasting the public service announcements on local TV channels. To scale up a similar intervention in 30 districts where NiV spillover has occurred, would cost between $2.6 and $3.5 million for one season. Placing the posters would cost $96,000 and only broadcasting the public service announcement through local channels in 30 districts would cost $26,000.

Conclusions

Broadcasting a TV public service announcement is a potential low cost option to advance NiV prevention. It could be supplemented with posters and targeted interpersonal communication, in districts with a high risk of NiV spillover.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-017-2549-1) contains supplementary material, which is available to authorized users.

Perception and attitude of medical doctors in Dhaka, Bangladesh, with regard to Ayurvedic medicine

The World Health Organization (WHO) Traditional Medicine Strategy (2014–2023) aimed to help member states promote the safe and effective use of traditional medicine. While economic conditions have markedly improved in Bangladesh, the country is experiencing significant public health problems. Because of limited medical resources, there is a strong incentive to enhance complementary and alternative medicine usage in Bangladesh. Therefore, this study aimed to confirm the perceptions and attitudes of medical doctors (MDs) in Dhaka, Bangladesh, with regard to Ayurvedic medicine (AM). A total number of 159 MDs in Dhaka were interviewed by face-to-face between February and June 2015. The study revealed that 62.0% of MDs had treated patients with AM and 55.3% believed that AM should be regarded as its own specialty, whereas 39.7% of MDs believed that AM should be part of the conventional medical curriculum and 32.7% thought that AM did not seem scientific. In terms of gender, 45.3% of male MDs agreed or strongly agreed that AM only had a placebo effect. On the other hand, 65.8% of female MDs disagreed or strongly disagreed it. In terms of age, 77.0% of MDs aged 36 or elder (elder MDs) believed they were more likely to recommend AM use and 80.3% of elder MDs believed that the government should encourage more initiatives to promote AM. To enhance AM use, scientifically robust information on the efficacy, safety and scientific basis of AM should be more effectively conveyed to male MDs.

Outcome of intraoperative use of mitomycin C combined with conjunctival auto graft in recurrent pterygium

Background and objectives: Recurrent pterygium is an important ocular problem in our country. There are different modalities of treatment for recurrent pterygium. The present study was undertaken to determine the effect of intraoperative mitomycin C along with conjunctival auto graft to prevent recurrence of pterygium.Methods: Patients with recurrent pterygium attending a tertiary care hospital in Dhaka from January 2013 to June 2015 were included in the study. Cases were randomized into two groups. Group 1 had pterygium surgery with conjunctival auto graft and Group 2 had auto graft and intraoperative mitomycin C (0.02%). All cases were followed up for one year to assess recurrence of pterygium.Results: A total of 54 recurrent pterygia cases were included in the study. The age of study population was 25 to 65 years. The recurrence rate of pterygium after 12 months was 77.7% in group 1 and none in group 2. No major postoperative complication was observed.Conclusion: The study demonstrated that the use of intraoperative mitomycin C along with conjunctival auto graft had significant effect in preventing the recurrence of pterygium.IMC J Med Sci 2016; 10(2): 49-52

Effects of ovarian disaggregation on adult murine follicle yield and viability

Follicles are isolated from ovaries for numerous reasons, including IVM, but adult murine yields are <2 follicles mg−1. The aim of the present study was to optimise ovarian disaggregation and develop methods applicable to the rapid screening of follicle viability. Ovaries from adult mice (n = 7) were halved and disaggregated mechanically, or by using collagenase IV (Col-IV; 590 U mL−1) or animal origin-free collagenase IV (AOF) at 590 or 1180 U mL−1. Isolated follicles were stained with 4′,6′-diamidino-2-phenylindole (DAPI; nuclei), chloromethyl-X-rosamine (CMXRos; mitochondria) or fluorescein isothiocyanate-conjugated anti-α-tubulin antibody. Follicle diameters and staining were measured and analysed using ImageJ, and data analysed using GraphPad Prism. Col-IV disaggregation yielded the highest number of follicles (17 ± 10 follicles mg−1 ovarian tissue). All disaggregation methods released more secondary follicles (86 ± 20 per ovary; P < 0.05) than any other size cohort. Mechanical and Col-IV disaggregation yielded similar numbers of morphologically intact follicles, whereas AOF disaggregation caused more damage (P < 0.01). As the morphological disruption increased, DAPI and CMXRos staining decreased (P < 0.05), and tubulin localisation became more heterogeneous. Col-IV disaggregation gave the best yield of morphologically intact follicles containing viable granulosa cells. In conclusion, we improved adult murine follicle yields and applied molecular markers to assess follicle morphology, cellular cytoskeleton and mitochondrial function.

Functional inhibition of PAR2 alleviates allergen-induced airway hyperresponsiveness and inflammation

BACKGROUND

Proteinase-activated receptor 2 (PAR2 ) is a G protein-coupled receptor activated by trypsin-like serine proteinases. PAR2 activation has been associated with inflammation including allergic airway inflammation. We have also shown that PAR2 activation in the airways leads to allergic sensitization. The exact contribution of PAR2 in the development of eosinophilic inflammation and airway hyperresponsiveness (AHR) in sensitized individuals is not clear.

OBJECTIVE

To investigate whether functional inhibition of PAR2 during allergen challenge of allergic mice would inhibit allergen-induced AHR and inflammation in mouse models of asthma.

METHODS

Mice were sensitized and challenged with ovalbumin (OVA) or cockroach extract (CE). To investigate the role of PAR2 in the development of AHR and airway inflammation, we administered blocking anti-PAR2 antibodies, or a cell permeable peptide inhibitor of PAR2 signalling, pepducin, i.n. before allergen challenges and then assessed AHR and airway inflammation.

RESULTS

Administration of anti-PAR2 antibodies significantly inhibited OVA- and CE-induced AHR and airway inflammation. In particular, two anti-PAR2 antibodies, the monoclonal SAM-11 and polyclonal B5, inhibited AHR, airway eosinophilia, the increase of cytokines in the lung tissue and antigen-specific T cell proliferation, but had no effect on antigen-specific IgG and IgE levels. Pepducin was also effective in inhibiting AHR and airway inflammation in an OVA model of allergic airway inflammation.

CONCLUSIONS AND CLINICAL RELEVANCE

Functional blockade of PAR2 in the airways during allergen challenge improves allergen-induced AHR and inflammation in mice. Therefore, topical PAR2 blockade in the airways, through anti-PAR2 antibodies or molecules that interrupt PAR2 signalling, has the potential to be used as a therapeutic option in allergic asthma.

Awareness and knowledge of HIV/AIDS among married women in rural Bangladesh and exposure to media: a secondary data analysis of the 2011 Bangladesh Demographic and Health Survey

The aims of this study were to describe awareness and knowledge of HIV/AIDS among Bangladeshi married women in rural areas and to examine associations between exposure to mass media and their awareness and comprehensive knowledge of HIV/AIDS where mass media has been suggested to be vital sources of information. From the original dataset of the sixth Bangladesh Demographic Health Survey in 2011, the data of 11,570 rural married women aged 15-49 years old were extracted. Logistic regression analyses were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). We found that approximately two-thirds of women (63.0%) aged 15-49 years had heard about HIV/AIDS. Exposure to each type of media was significantly associated with awareness of HIV/AIDS. Comparing to those who were not exposed to each of the investigated media, the adjusted ORs of comprehensive knowledge of HIV/AIDS were significantly high for those exposed to newspapers/magazines less than once a week (1.34, 95% CI 1.09-1.65), newspapers/ magazines at least once a week (1.44, 95% CI 1.07-1.94), television at least once a week (1.41, 95% CI 1.18-1.68). It was suggested that television can be utilized to increase awareness and comprehensive knowledge of HIV/AIDS through effective programs. Although the level of exposure was still low, significant associations between exposure to newspapers/magazines and comprehensive knowledge of HIV/AIDS suggested potential of written messages to promote knowledge of HIV/AIDS.

Raw Sap Consumption Habits and Its Association with Knowledge of Nipah Virus in Two Endemic Districts in Bangladesh

Human Nipah virus (NiV) infection in Bangladesh is a fatal disease that can be transmitted from bats to humans who drink contaminated raw date palm sap collected overnight during the cold season. Our study aimed to understand date palm sap consumption habits of rural residents and factors associated with consumption. In November-December 2012 the field team interviewed adult respondents from randomly selected villages from Rajbari and Kushtia Districts in Bangladesh. We calculated the proportion of people who consumed raw sap and had heard about a disease from raw sap consumption. We assessed the factors associated with raw sap consumption by calculating prevalence ratios (PR) adjusted for village level clustering effects. Among the 1,777 respondents interviewed, half (50%) reported drinking raw sap during the previous sap collection season and 37% consumed raw sap at least once per month. Few respondents (5%) heard about NiV. Thirty-seven percent of respondents reported hearing about a disease transmitted through raw sap consumption, inclusive of a 10% who related it with milder illness like diarrhea, vomiting or indigestion rather than NiV. Respondents who harvested date palm trees in their household were more likely to drink sap than those who did not own date palm trees (79% vs. 65% PR 1.2, 95% CI 1.1–1.3, p<0.001). When sap was available, respondents who heard about a disease from raw sap consumption were just as likely to drink it as those who did not hear about a disease (69% vs. 67%, PR 1.0, 95% CI 0.9–1.1, p = 0.512). Respondents’ knowledge of NiV was low. They might not have properly understood the risk of NiV, and were likely to drink sap when it was available. Implementing strategies to increase awareness about the risks of NiV and protect sap from bats might reduce the risk of NiV transmission.

Spectrum of Early Onset and Late Onset Ventilator Associated Pneumonia (VAP) in a Tertiary Care Hospital of Bangladesh: A Prospective Cohort Study

Objective : To compare the outcome of critically ill patients developing early onset Ventilator-associated pneumonia (VAP) occurring within 96 h of ICU admission and late onset VAP occurring after 96 h of ICU admission in critically ill patients admitted in the ICU of BIRDEM General Hospital of Bangladesh.Study Design: Prospective cohort study.Material and Methods: Study data obtained over a period of 24 months (July 2012 - June 2014) in the ICU of a tertiary care hospital was prospectively analyzed. Subjects were classified by ventilator status: early onset VAP (< 96 hrs of mechanical ventilation) or late-onset VAP (?96 hrs of mechanical ventilation). Baseline demographics and bacterial etiology were analyzed according to the spectrum of status of VAP.Results: The incidence of VAP was 35.73 per 1,000 ventilator days. In our study 52% of the cases were early-onset VAP, while 48% were late-onset VAP. Acinetobacter was the commonest organism isolated from late-onset VAP (p = 0.029) while Pseudomonas was the commonest isolates obtained from early-onset VAP (p = 0.046). Klebsiella, MRSA and E. coli were almost identically distributed between groups (p > 0.05). There is significant difference of sensitivity pattern of Acinetobacter baumannii and pseudomonas aeruginosa in both early and late-onset VAP (p=0.01). The overall mortality rate in our study was 44%. The mortality was significantly higher in the late-onset VAP (62.5%) than that in the early-onset VAP (26.9%) (p=0.011).Conclusion: From this study we conclude that late-onset VAP had poor prognosis in terms of mortality as compared to the early-onset type. The higher mortality in the late-onset VAP could be attributed to older age, higher co-morbidities like diabetes mellitus, COPD and CKD. The findings are similar to findings of other international studiesBangladesh Crit Care J March 2015; 3 (1): 9-13

Treatment of a recurrent parotid fistula and sialocele by controlled internal fistula: a case report

A 17 years old male patient presented with continuous flow of clear watery discharge from his right cheek for 14 years following trauma. He had previous history of two surgical interventions but result was not satisfactory. The diagnosis was parotid fistula & sialocele based on clinical examination & investigation. To repair this fistula we entered the sialocele cavity where saliva was accumulated between the superficial fascia & parotid fascia, then one end of feeding tube (5Fr) was placed at the bottom of the cavity and another end was fixed intra-orally to create a controlled fistula. After four weeks the feeding tube removed and a channel was made through which the salivary flow comes out, up to one year follow up resulting a satisfactory outcome.

Metabolomics differentiation of canola genotypes: toward an understanding of canola allelochemicals

Allelopathy is one crop attribute that could be incorporated in an integrated weed management system as a supplement to synthetic herbicides. However, the underlying principles of crop allelopathy and secondary metabolite production are still poorly understood including in canola. In this study, an allelopathic bioassay and a metabolomic analysis were conducted to compare three non-allelopathic and three allelopathic canola genotypes. Results from the laboratory bioassay showed that there were significant differences among canola genotypes in their ability to inhibit root and shoot growth of the receiver annual ryegrass; impacts ranged from 14% (cv. Atr-409) to 76% (cv. Pak85388-502) and 0% (cv. Atr-409) to 45% (cv. Pak85388-502) inhibition respectively. The root length of canola also differed significantly between genotypes, there being a non-significant negative interaction (r = -0.71; y = 0.303x + 21.33) between the root length of donor canola and of receiver annual ryegrass. Variation in chemical composition was detected between organs (root extracts, shoot extracts) and root exudates and also between canola genotypes. Root extracts contained more secondary metabolites than shoot extracts while fewer compounds were recorded in the root exudates. Individual compound assessments identified a total of 14 secondary metabolites which were identified from the six tested genotypes. However, only Pak85388-502 and Av-opal exuded sinapyl alcohol, p-hydroxybenzoic acid and 3,5,6,7,8-pentahydroxy flavones in agar growth medium, suggesting that the synergistic effect of these compounds playing a role for canola allelopathy against annual ryegrass in vitro.

Impact of tannery effluents on the aquatic environment of the Buriganga River in Dhaka, Bangladesh

This study presents an overview of the existence and effects of six heavy metals, chromium (Cr), lead (Pb), cadmium (Cd), mercury (Hg), manganese (Mn), and aluminum (Al), in tannery effluents released to the Buriganga River in Dhaka, Bangladesh. The pollutants were found in three different sources, such as effluents from tanneries, contaminated river water and three species of fish—climbing perch ( Anabas testudineus), spotted snakehead ( Channa punctata), and Black tilapia ( Oreochromis mossambicus) caught from the river. Tannery effluents, water, and fish samples were collected from three different factories, five sample stations, and three different harvesting points, respectively. Effluents from all three factories contained significant amounts of heavy metals, especially Cr (374.19 ppm in average), whereas lesser amounts were found in the tissues of the three fish species studied. The trends in tissue elemental concentrations of fish were Cr > Pb > Al > Hg > Mn > Cd. In most cases (Cr, Cd, Mn, and Al), heavy metal concentrations were found to be greater in climbing perch than in Black tilapia and spotted snakehead. Although the river water contained high concentrations of harmful heavy metals, the fish species under study had concentrations well below the permissible Food and Agriculture Organization/World Health Organization levels for those metals and seemed to be safe for human consumption.

Proteinase-activated receptor-2 activation participates in allergic sensitization to house dust mite allergens in a murine model

BACKGROUND

Many aeroallergens contain proteinase activity and are able to induce allergic sensitization when presented to mucosal surfaces. Some of these allergens activate proteinase-activated receptor-2 (PAR2 ).

OBJECTIVE

To determine the role of PAR2 activation in a murine house dust mite (HDM) allergy model.

METHODS

We sensitized and challenged PAR2 -deficient mice with HDM, and examined allergic outcomes compared to wild-type animals. To focus on the role of PAR2 in allergic sensitization, we administered a PAR2 blocking antibody to wild-type animals during the sensitization phase and examined the outcomes immediately after sensitization or following subsequent allergen challenge.

RESULTS

We found PAR2 -deficient mice sensitized and challenged with HDM failed to develop airway inflammation, did not produce HDM-specific IgG1 and had less IL-4 mRNA in the lungs than wild-type animals. Prevention of PAR2 activation during sensitization in wild-type mice diminished the levels of Th2 mediators, including IL-4, IL-5 and IL-13, in the lungs. Blocking PAR2 during the sensitization phase also led to decreased manifestations of allergic disease, including airway hyperresponsiveness (AHR) and airway inflammation following subsequent allergen challenge. HDM-induced proliferation of splenocytes obtained from animals sensitized in the presence of PAR2 antibody was reduced relative to those that did not receive antibody. The effect of PAR2 blockade could be transferred to naïve mice through splenic CD4(+) T cells from sensitized mice.

CONCLUSIONS AND CLINICAL RELEVANCE

PAR2 activation plays a key role during the sensitization phase of our HDM allergy model, leading to increased lung cytokine production and augmented lung reactivity. PAR2 activation is a common mechanism for sensitization to a wide variety of allergens and is therefore a potential pharmacological target to prevent allergy.

Percutaneous nephrolithotomy--a versatile technique for both simple and complex renal stone

Percutaneous Nephrolithotomy is currently the preferred first line treatment for simple & complex renal calculi. The technique also being used increasingly for smaller stones that have failed ESWL. Aim of the study is to share our experience in PCNL in course of time. This study was conducted from January 2009 to December 2012, 131 patient's with 142 renal units of 5-75 yrs of age, PCNL were performed in NIKDU, BSMMU & JBFH. Stone were classified into simple (isolated renal pelvis or isolated calyceal stones) or complex (partial or complete staghorn stones, renal pelvic stone with accompanying calyceal stones). The stone size was 1.5-5cm approximately. We asses our initial puncture technique, need for multi-tract, supra 12th rib access, stone free rate, operative duration, postoperative complication, number of transfusion and hospital stay. Operative durations were 60 min -180 minutes. Puncture technique improved in course of time. 14 patients need multi-puncture and tract, all are supra 12th access. Out of 142 renal units 120 (83%) were stone free after first procedure, another 22 need and auxiliary procedure, (5 2nd look PCNL, 6 URS, 11 ESWL) to become stone free result in a 95% stone free rate. Complications occurred in 17 procedures which dealt accordingly. This study revealed PCNL is an effective, versatile safe and cosmetically acceptable procedure for all age groups in simple and complex renal stone.

Effect of Trichoderma on Seed Germination and Seedling Parameters of Chili

T. virens IMI-392430, T. pseudokoningii IMI-392431, T. harzianum IMI-392432, T. harzianum IMI-392433 and T. harzianum IMI-392434 were evaluated for their potentiality on seed germination and seedling parameters in chili both laboratory and field conditions. Chili seeds were coated with spore suspension of each test strains of Thichoderma supplemented with 2 % of starch (w/v) as an adhesive. Seed germination percentages and the vigour index were significantly affected by the application of different strains of Trichoderma. Among the five Trichoderma strains, T. harzianum IMI-3924332 gave the highest germination percentage followed by T. harzianum IMI-3924333, T. harzianum IMI-3924334, T. virens IMI-392430 and T. pseudokoningii IMI-392431 treatment both in laboratory and field conditions, respectively while control decrease these value. Chili seeds also gave the highest vigour index values with T. harzianum IMI-3924332 which confirmed to better germination. Seed treatment with T. harzianum IMI-3924332 can be useful to enhance the germination of chili seeds as well as reduce to delayed germination. Further investigations however are required to study in vivo effect of Trichoderma strains on morphological and physiological characteristics in chili plant and fruit production. DOI: http://dx.doi.org/10.3329/jsf.v8i1-2.14637 J. Sci. Foundation, 8(1&2): 141-150, June-December 2010

Molecular Characterization of Phomopsis vexans Isolates of Eggplant of Bangladesh

Forty-four isolates of Phomopsis vexans were collected from eggplant producing areas of Bangladesh during the 2008-2009 growing seasons. The polymerase chain reaction (PCR) -variable number of tandem repeats (VNTR) technique was used to develop molecular markers. The MR-20 primer amplified template DNA for all isolates studied and resulted in distinct bands. The banding patterns of P. vexans isolates were separated into five groups after results with Taq polymerase. The highest genomic DNA concentration 50 ng/?l was found in the isolates of 8, 14, 26, 27 and 38, and the lowest concentration of genomic DNA was found 12.5 ng/?l in the isolates of 1, 2, 5, 15, 17, 22, 30, 31, 33, 34, 36, 40, 41, 42 and 43. Based on the fingerprinting the 44 isolates of Phomopsis vexans were categorized into five different groups. DOI: http://dx.doi.org/10.3329/jsf.v8i1-2.14636 J. Sci. Foundation, 8(1&2): 131-140, June-December 2010

Role of Fruits on Public Health

An investigation was carried out on the role of fruits on public health. Amount of nutrition value on different fruits of Bangladesh also examined. Fruits are not only good source of vitamins and minerals but also highly nutritive with anti carcinogenic value. The role of sufficient intake of fruits can prevent many life threatening diseases of human beings like diabetics, blood pressure, heart diseases and cancer. Altogether 39 fruits, the highest water portion 96.6 g was found in black berry and Jamun, and the lowest 4.3 g were found in coconut. The highest total minerals 1.7g was measured in date palm and the lowest 0.1 g was found in orange, black berry and Jamun. The maximum fiber 6.6 mg was found in coconut and the lowest 0.2 g was found in jackfruit and water melon. The highest Calorie 662 Kcal was found in coconut and the lowest 11 Kcal was measured in black berry and Jamun. The highest protein 3.5 g was found in elephant’s foot apple and the lowest 0.2 g was found in water melon. The highest fat 62.3 g was found in coconut and the lowest 0.1 g was found in jackfruit, ber, elephant’s foot apple, orange, Bullock’s heart/Custard apple, Hogplum, Olive, Aonla, River ebony and Water chestnut. The highest Carbohydrate 33.8 g was found in date palm and the lowest 1.4 g was found in black berry and Jamun. The highest 90 mg was found in Lime and the lowest 0.01g was found in River ebony. The highest amount of Fe 7.9 mg was found in water melon and the lowest 0.2 mg was found in Pummelo. The highest amount of Carotene 8300 ?g was found in mango and the lowest 0 ?g was found in litchi, ber, elephant’s foot apple, orange, lemon, Bullock’s heart/Custard apple, coconut, banana, Aonla and water chestnut. The highest amount of vitamin B-1 0.8 mg was found in elephant’s foot apple and the lowest 0.01 mg was found in Wax apple, tamarind and Rose apple. The highest amount of vitamin B-2 0.19 mg was found in Burmese grape and the lowest B-2 0.01 mg was found in orange, coconut and olive. The highest amount of vitamin C 463 mg was found in Aonla and Stargareberry, and the lowest 1 mg was found in coconut and water melon. DOI: http://dx.doi.org/10.3329/jsf.v8i1-2.14633 J. Sci. Foundation, 8(1&2): 111-118, June-December 2010

Ecology of Sundarban, Bangladesh

Sundarban is the largest mangrove wetland in the world. It covers an area of about 1mha, of which 60% is located in Bangladesh and the remaining western portion, comprising 40%, lies in India. Mangrove ecosystems are of great ecological significance in the tropical and sub-tropical coast. They protect our coast from heavy wind, tidal waves, coastal erosion and sea water intrusion, generate substantial quantities of fishery resources and provide many useful forestry products. The Sundarban ecosystem supports rich fisheries diversity. This ecosystem support 27 families and 53 species of pelagic fish, 49 families 124 species of demersal fish, 5 families and 24 species of shrimps, 3 families and 7 species of crabs, 8 species of lobster. A total 334 plants, 165 algal, 13 special orchids, 17 fern, 87 monocotyledon and 230 dicotyledon belonging to 245 genera and 75 families from the sundarbans and adjacent area are found available. The principal tree species is Sundry (Heritiera fomes) which covers about 73% to total landmass and the second species is Gewa (Excoecaria agallocha) which covers about 16% of total forest area. The plant species include 35 legumes, 29 grasses, 19 sedges, and 18 euphorbias. Of the 50 true mangrove plant species recorded throughout the globe, the Sundarbans alone contain 35 species. The magnificent among the animals on land is Royal Bengal Tiger, Spotted deer, barking deer and wild boars are there in plenty. Besides those jungle cats, fishing cat, civet cat, monkey, bengal fox, jackle, water monitor, monitor lizard and snakes are important faunal spp. Moreover, abundant of the Sundarbans are purple heron, pond heron, cattle egret, little egret, open billed stork, smaller adjutant stork, brahmini kite, spotted dove, rose ringed parakeet, crow pheasant, wood pecker, bee eater, drongo, pide myna, jungle myna, bulbul, tailor bird, magpie robin, sparrow etc., Otherwise, recorded that wild Buffalo, 2 species of deer, javan rhinoceros extinct and presently 2 species of amphibians, 14 species of reptiles 25 species of birds and 5 species of mammals are considered as endangered species. This paper is to produce a new assessment of the mangroves ecology of Sundarbans. DOI: http://dx.doi.org/10.3329/jsf.v8i1-2.14618 J. Sci. Foundation, 8(1&2): 35-47, June-December 2010

Dust-acoustic Gardner solitons and double layers in dusty plasmas with nonthermally distributed ions of two distinct temperatures

A rigorous theoretical investigation has been performed on dust-acoustic (DA) solitary structures in an unmagnetized dusty plasma, consisting of negatively charged mobile dust grains, Boltzmann distributed electrons, and nonthermally distributed ions of two distinct temperatures. The Korteweg-de Vries (K-dV), modified K-dV (mK-dV) and Gardner equations, and their solitary waves (SWs) and double layer (DL) (in case of Gardner equation) solutions are derived by using the reductive perturbation technique. The basic features of the DA Gardner solitons (GSs) and DLs are studied analytically as well as numerically. It has been observed that the GSs significantly differ from K-dV and mK-dV solitons, and only positive potential DLs exist in the system. It is also studied that two-temperature nonthermal ions significantly modify the nature and basic properties of the DA SWs. The present investigation can be very effective for understanding and studying the nonlinear characteristics of the DA waves in laboratory and space dusty plasmas.