Clinicopathological Study of Enterocutaneous Fistula in Mymensingh Medical College Hospital

Enterocutaneous fistulae are a major catastrophe to the patients and surgeons and it still has high incidence of morbidity and mortality and their management remains a big challenge. Enterocutaneous fistula presents the surgeon with challenges of metabolic disorders and extensive sepsis. Total management of an intestinal fistula requires skill in nutritional support, stoma therapy, elimination of sepsis, well timed and well carried out surgery. Postoperative enterocutaneous fistulae account for approximately 80% of enterocutaneous fistulae. The majority of the intestinal fistula (75-85%) is iatrogenic occurring in the postoperative period following anastomotic dehiscence. They arise following emergency abdominal surgery for intestinal obstruction, inflammatory bowel disease or cancers. Protein calorie malnutrition alters the patients immune response, inflammatory reactions and tissue regenerations, all of which are essential for wound repair. The present study is an effort to highlight the incidence of enterocutaneous fistula after emergency and elective resection and anastomosis of gut with discussion over recent trends and developments in its management and compare with other studies. Objectives of the study are to determine the various clinicopathological features and management protocol of enterocutaneous fistula. There are recent advances in nutritional support. This descriptive type of cross-sectional study was carried out in the Department of Surgery, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh from October 2010 to September 2011. Total 42 cases of enterocutaneous fistulae were selected purposively. Enterocutaneous fistulae are more common in patients of low economic condition. Enterocutaneous fistulae are more common after emergency abdominal surgery. Spontaneous closure occurred in 17(40.48%) cases and surgery needed in 25(59.52%) cases. Of them 20(80.00%) were healed and 5(20.00%) were expired. In spite of improvement in the management protocol of enterocutaneous fistula, there is still high unacceptable morbidity and mortality rate. Total parenteral nutrition (TPN) is not available and very costly, and health care facilities are also limited in our country. Patients with enterocutaneous fistula require fluid, electrolytes and nutritional support. Anaemia, dehydration, electrolytes imbalance should be corrected prior to abdominal surgery if possible. Surgical treatment for enterocutaneous fistula should be performed only after failure of conservative treatment of more than 12 weeks.

Maternal Iodine Status Reflects the Iodine Status of their Breast-Fed Infants

Background: Bangladesh is an iodine deficient region and the government of Bangladesh, with assistance of UNICEF had initiated a universal salt iodinization program to provide iodized salt by the middle of 1994. Breast milk is the only source of iodine for exclusively breast-fed infants. Iodine deficiency and iodine excess both have bad impact on infant’s health. Objectives: To assess the iodine status of lactating mothers and their breast-fed infants and to evaluate whether maternal iodine status reflects the iodine status of their breast-fed infants. Material and methods: This observational analytical study was carried out in the department of biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka with active cooperation of Kumudini Women’s Medical College Hospital, Mirzapur, Tangail involving fifty lactating mothers and their exclusively breast-fed infants. Early morning urine and breast milk samples were collected in dry and clean plastic containers free from any chemical contamination. Urinary iodine was used as an indicator for assessing iodine status. All statistical analysis was done by using SPSS (Statistical Program for Social Science) 12 version software package for windows. Results: The median (range) urinary iodine concentration of lactating mothers and their breast-fed infants were 225.25 ?g/L (61.50-530.00) and 225.75?g/L (100.50-526.00). 96% (48) mothers had no biochemical iodine deficiency (UIE ?100?g/L), only 4% (2) mothers had mild biochemical iodine deficiency (UIE, 50-99?g/L). There was no biochemical iodine deficiency of breast-fed infants. The median breast-milk iodine concentration was 157?g/L which was more than three times of recommended minimum concentration (50?g/L). Iodine in breast milk of lactating mothers was positively correlated with their urinary iodine excretion (P<0.01). Infant’s urinary iodine was positively correlated with iodine concentration in breast milk (P<0.01) and also positively correlated with urinary iodine of lactating mothers (P < 0.01). Conclusion: Lactating mothers and their breast-fed infants in this study were iodine sufficient. Iodine status of exclusively breast-fed infants can be determined by the iodine status of their mothers. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20283 Pulse Vol.6 January-December 2013 p.6-11

Effect Of Supplementation Of Organic Acids On Laying Performance, Body Fatness And Egg Quality Of Hens

The study was conducted to determine the effect of organic acids supplementation on body weight changes, feed intake, feed efficiency, egg production, egg weight and egg quality in laying hens at age between 67 and 74 weeks. A total of 48 Shaver 579 laying hens of 67 weeks age were allotted into 4 groups, each containing 12 hens. The hens were fed basal diet (17% CP and 2800 kcal ME/kg diet) supplemented with 0 (T1), 260 (T2), 520 (T3) and 780 ppm (T4) of organic acid mixture (fumaric acid and salt of butyric, propionic and lactic acids). The results revealed no effect of organic acids supplementation on body weight change and feed intake but improvement of egg production and feed conversion were observed. Organic acids supplementation significantly increased egg production by about 2.26, 8.0 and 9.84% on 260, 520 and 780 ppm respectively when compared with the untreated group (P<0.05). Feed conversion showed a significant (P<0.05) improvement in laying hen groups which fed on the basal diet supplemented with organic acids at 260, 520 and 780 ppm by about 1.85, 8.48 and 7.74% respectively when compared with the control. On the other hand, dietary organic acid had no effect on the average egg weight, while showed a lower percentage of large (P<0.05) and extra large egg (P<0.01) size compared with control group. Body composition parameters were not affected (P>0.05) by dietary treatments. Inclusion of organic acids improved egg shell thickness (P<0.05) while significantly reduced albumen index (P<0.05). Incorporation of organic acids attributed to significant increase per cent albumen (P<0.01) and significant decrease in yolk per cent (P<0.05). It can be concluded that organic acid supplementation of laying hens diet may improve persistency of lay and feed conversion. From economical point of view, it is concluded that organic acid addition (520 ppm) may result an economic benefit of layer production at older age. DOI: http://dx.doi.org/10.3329/bjas.v37i2.9884 BJAS 2008; 37(2): 74-81