Utility of Median-to-Ulnar Sensory Comparative Nerve Conduction Study to Increase Diagnostic Accuracy in Mild Carpal Tunnel Syndrome

Electro-physiological diagnosis of mild Carpal Tunnel Syndrome (CTS) based on traditional median motor and sensory studies are often inconclusive. Therefore, we wanted to investigate the utility of Median-to-Ulnar Sensory Conduction studies in diagnosis of mild CTS. Data from Nerve conduction study (NCS) of 82 cases with symptoms suggestive of CTS from September 2017 to October 2020 attending electrophysiology department of Mount Adora Hospital, Sylhet, Bangladesh was selected for study. About 54(66.0%) out of 82 symptomatic patients were diagnosed as CTS by the conventional method, and 28(34.0%) patients required further investigation as their test report were found to be inconclusive. combining methods showed 70(85.37%) were found to be positive and 12(14.63%) were negative in comparison study. Thus, it can be concluded that those patients found to be negative in conventional methods; comparison method is an option for diagnostic confirmation.

Role of Nuclear Morphometry in the Cytologic Evaluation of Benign and Malignant Thyroid Lesions

Thyroid lesions are very common problem in Bangladesh. To categorize the type of lesion, FNAC is a reliable, minimally invasive and cost-effective diagnostic modality. In routine cytology, precise categorization into benign and malignant is highly subjective. So, additional methods are needed to improve the accuracy of cytological diagnosis. Computerized semi-automatic nuclear morphometry is an objective and reproducible tool for quantitative evaluation of nuclear features which may help to differentiate between benign and malignant thyroid lesions in cytology. Objective of the study was to apply morphometry with regard to nuclear size parameters, shape parameters and nuclear chromasia with derivation of suitable cutoff values to differentiate benign and malignant lesions of thyroid gland. This cross-sectional study was done in total 55 cases at the Department of Pathology, Bangabandhu Sheikh Mujib Medical University, Bangladesh from March 2018 to February 2020. Morphometry was done on images containing diagnostic cells captured from cytological smears with open source ImageJ morphometric software. In this study, all the nuclear size parameters and one nuclear shape parameter was found significant in differentiating benign and malignant lesions. No significant difference was observed in analysis of chromasia parameter. The cut-off values derived between all benign and malignant lesions for mean value of nuclear area, maximum feret diameter, perimeter and aspect ratio were 40.20μm², 8.46μm, 6.68μm, 28.28μm and 1.35 respectively with sensitivity of 86%, 95%, 81%, 90% and specificity of 97%, 93%, 97% and 97% respectively. The Nuclear morphometry may be used as an adjunctive tool to routine thyroid cytology.

Comparison of Serum Zinc in Children of Wilson Disease and Non-Wilsonian Volunteers in Bangladesh

Wilson disease (WD) is an autosomal recessive disorder of copper metabolism with diverse clinical manifestations. Zinc (Zn) has been used for treatment of WD. Recent studies showed low serum zinc level in patients suffering from WD than the normal. This cross-sectional analytical study has been designed to compare the serum zinc level between paediatric patients suffering from WD but yet not started treatment and children who have normal ALT level. This study was carried out at the Department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh from July 2018 to June 2019. Total 51 children were included in this study. Among them 27 were diagnosed case of WD aged between three to eighteen years and 24 children of same ages who were suffering from other than liver disease having normal ALT were included as volunteers. The patients of WD were divided into four groups according to their presentation as acute hepatitis, chronic liver disease (CLD), acute liver failure & neuropsychiatric manifestation. Informed written consent was obtained from all patients and volunteers for participation in this study. Along with other physical findings and laboratory investigations 3 ml of venous blood were collected for estimation of serum zinc level. After estimation of serum zinc level results were analyzed statistically. The difference in serum zinc levels were compared between the groups. Serum zinc level was significantly lower in Wilson disease patients (43.8±19.7μg/dl; range: 13-83) compared to volunteers group (67.8±11.8μg/dl; range: 47-97) p<0.001. Among the diseased group, serum zinc level were significantly lower in 18 CLD (38.4±17.4μg/dl) and in 4 acute liver failure (33.1±3.7μg/dl) compared to 4 acute hepatitis (71.8±4.3μg/dl) (p=0.001) and (p<0.001) respectively. Mean serum zinc level was low in 4 Wilsonian acute liver failure (33.1±3.7μg/dl), which was significant compared to those (23) who presented as Wilson disease non acute liver failure (45.7±20.8μg/dl) (p=0.013). Serum zinc level was significantly lower in Wilson disease children compared to the volunteers. Zinc level was also found significantly low in Wilson disease presented as CLD and acute liver failure in comparison to Wilson disease presented as acute hepatitis.

Relationship between Renal Function and Bone Mineral Density in Postmenopausal Women

Renal insufficiency is a risk factor for osteoporosis and can increase risk of fracture. It may be a result of an age-related decline in renal function or chronic kidney disease. In patients with CKD, accurate diagnosis of osteoporosis or CKD-MBD is important for determining the most appropriate treatment. This was a cross sectional study was done at Institute of nuclear medicine and Allied Sciences, BSMMU, Dhaka from 1st January 2014 to 31st December 2014. Study population was total 69 postmenopausal women age over 50 years. Women with Bilateral hip replacement or bilateral hip pins or screws, metallic rods in spine, Carrying out BMD scan within the week after other radiological investigation using contrast media e.g. Barium meals or enema, IVPs were excluded from study. Clinical variables were- age (years), height (cm), weight (kg), BMI. Laboratory variables were- serum creatinine and BMD (Dexa). Estimated GFR was determined by using the serum Creatinine by MDRD formula. Renal function test and Bone mineral density (BMD) were done in all of these patients. Majority (43.4%) of the patients were in 6th decade. The mean weight was found 57.4±11.2kg. Majority 41(59.4%) patients belonged to T score at hip (-1 to -2.5) and their mean T score at hip was found (-1.1±1.1). Osteopenia and osteoporosis were found in 59.4% and 4.3% respectively according to BMD. High serum creatinine level was found in 10.1% cases. Renal function impairment was found in 79.6% of patient. Majority (50.7%) patients had mild decrease of eGFR (60-89 ml/min/1.73m²), There was Pearson's correlation (r=0.156; p=0.200) but not significant was found between age with T score at hip of the patients. Positive Pearson's correlation (r=0.112; p=0.361) was found but not significant between age and serum creatinine level. A significant negative Pearson's correlation (r= -0.274; p=0.023) was found between T score at hip and serum creatinine level of the patients. A significant negative Spearman correlation (r=-0.278; p=0.021) was found between BMD and serum creatinine of the patients. A significant positive Spearman correlation (r=0.580; p=0.001) was found between BMD and estimated GFR of the patients. This study was undertaken to evaluate the relationship between renal function and bone mineral density in postmenopausal women. Majority of the postmenopausal women were in 6th decade and most of them were overweight and obese. Renal function impairment was found in 79.6% of patient. Osteoporosis was found in 04.3% and 20.3% cases according to T score at hip and T score at lumber spine respectively. Significant negative Pearson's correlation was found between T score at hip and serum creatinine level of the patients. Significant negative Spearman correlation was found between BMD and serum creatinine of the patients. Significant positive Spearman correlation was found between BMD and estimated GFR of the patients.

Early Impact of Cardiopulmonary Bypass on Renal Function after Valve Replacement Surgery

Renal dysfunction following cardiopulmonary bypass is well recognized. The pathophysiology of renal injury is multifactorial and culmination of the interplay of several pathophysiological mechanism. Cardiac surgery requiring cardiopulmonary bypass (CPB) is being carried out on an extended patient population of different age groups and undergoing complex surgical procedure, and thus it places them at an increased risk of renal impairment. Valve replacement surgery is a major and complex surgical procedure requiring CPB. This study was therefore designed to observe the impact of CPB and short term outcome on patients with reduced estimated Glomerular Filtration Rate (eGFR) (60-89ml/min/1.73m²) after valve replacement surgery. This cross-sectional study was conducted in the Department of Cardiac Surgery, National Institute of Cardio Vascular Diseases (NICVD) during the period of January 2015 to August 2016. After fulfillment of enrollment criteria 100 patients were studied for the purpose of the study and they were grouped in two, patients with normal eGFR (≥90ml/min/1.73m²) in Group A and patients with reduced eGFR (60-89ml/min/1.73m²) in Group B. A total of 100 patients, 50 in each group were studied for renal function alteration after valve replacement surgery under cardiopulmonary bypass. The incidence of Acute Kidney Injury (AKI) was higher in Group B. Chi-square test was done and p value was 0.011 which is statistically significant. Postoperative blood loss (ml/hr) (p=0.038), duration of Intensive Care Unit (ICU) stay (in hours) (p=0.009), postoperative hospital stay (days) (p=0.014) was significantly higher and postoperative Urine Output (ml/hr) (p=0.001) was significantly lower in patients with reduced eGFR (60-89ml/min/1.73m²) in Group B. Deterioration of renal function is more in patient with eGFR (60-89ml/min/1.73m²) after valve replacement surgery under cardiopulmonary bypass in comparison with patients with eGFR (≥90ml/min/1.73m²).

Assessment of Nutritional Status of Children with Chronic Kidney Disease in a Tertiary Care Level Hospital, Dhaka, Bangladesh

Malnutrition is recognized to be a serious and common complication of chronic kidney disease (CKD) and is associated with increased morbidity and mortality in children. Early identification and swift intervention is the key in the management of malnutrition in CKD. The objective of the study was to determine the prevalence of malnutrition in children with CKD, to see the prevalence of malnutrition according to different anthropometric indices, to see the prevalence of malnutrition in different stages of CKD, to compare the nutritional status of children with CKD according to chronological age and height age. This analytical cross sectional study was done in the Department of Pediatric Nephrology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2014 to May 2015. Thirty children were enrolled in the study by purposive sampling. Nutritional assessment was done from dietary assessment by 72 hours recall and anthropometric measurements. Anthropometric indices were expressed in Z-scores and percentiles according to both chronological age and height age. Numeric data was analyzed by ANOVA and categorical data was tested by chi-square test. Difference between proportions was tested by Z-test of proportion. P value (<0.05) was considered significant. Data shows that the mean age of the studied population was 10.99±3.5 years with a male predominance. Eighteen (60.0%) children were on hemodialysis and rests on conservative management. Average calorie intake was 74.31±9.34% of estimated energy requirement (EER). The prevalence of malnutrition was 70.0% (95% CI: 53.6-86.4) according to height Z-score (HAZ), 66.7% (95% CI: 45.8-80.2) for weight Z-score (WAZ) and mid upper arm circumference (MUAC) Z-score, according to BMI percentile it was 56.7% (95% CI: 39-74.4), for mid arm muscle circumference (MAMC) the prevalence was 53.3% (95% CI: 35.5-71.1), according to arm muscle area (AMA) and arm fat area (AFA) the prevalence was 50.0% (95% CI: 38.1-67.9) and for triceps skin fold thickness (TST) it was 43.3% (95% CI: 25.5-61). Height was the most affected parameter and triceps skin fold thickness was the least affected parameter. When anthropometric indices were adjusted for height age, the prevalence was 36.7% according to BMI and TST, 30.0% according to AFA, 13.3% according to MUAC, 10.0% each for MAMC and AMA and 3.3% for WAZ. The difference in the prevalence of malnutrition according to this two approach was statistically significant in all parameters accept BMI, TST and AFA. Malnutrition was more associated with advanced stage of CKD. Low calorie intake was associated with low BMI and low serum albumin level. Serum albumin level was low in the present study population. In conclusion, prevalence of malnutrition is very high in children with CKD.

Clinical Presentation, Management and In-Hospital Outcome of COVID-19 among Non-Healthcare Personnel and Healthcare Personnel in a Tertiary Cardiac Care Hospital

The huge numbers of non-healthcare personnel (non-HCP) who get infected by corona virus disease 2019 (COVID-19) not only paralyze health care systems but also put health care personnel (HCP) at potential risk globally. Objective of the study was to compare the Healthcare personnel (HCP) and non-HCP COVID-19 cases. This prospective observational study was carried out in National Heart Foundation Hospital and Research Institute of Bangladesh from March 08, 2020 to July 20, 2020. During this study period all admitted non-HCP who subsequently was diagnosed as COVID-19 positive by rRT-PCR and HCP of this hospital, who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace and become COVID-19 positive, were included. Out of 320 infected patients, 181(56.6%) patients were non-HCP and 139(43.4%) were HCP. Non-HCP were older than HCP (Mean age: 52.95±13.82 years vs. 34.08±11.11 years; p=0.001). Non-HCP were predominantly male and HCP were predominantly female (73.5% vs. 41% & 26.5% vs. 59%; p=0.001). Non-HCP had more risk factors and co-morbidities than HCP (p=0.001). Typical symptoms of COVID-19 such as fever and cough were prevalent in HCP. More aggressive treatment was required for non-HCP. Non-HCP had more severe disease and higher case fatality rate (9.4% vs. 0.7%; p=0.001) than HCP. Disease severity (OR 0.03, 95% CI 0.01-0.15) and DM (OR 0.09, 95% CI 0.01-0.94) were the independent predictor of mortality. Non-HCP was older in age, predominantly male and had more co-morbidities than HCP. Typical symptoms of COVID-19 were prevalent in HCP. Non-HCP had more severe disease and higher case fatality rate than HCP.

Proportion of Diagnosed and Undiagnosed Cases of Diabetes Mellitus Among Above 40 Years Old Population in a Selected Rural Area in Jamalpur, Bangladesh

Diabetes Mellitus (DM) represents one of the biggest challenges in our country affecting hundred millions of people worldwide, both in developed countries and in developing ones. The objectives of the study were to assess the proportion of diagnosed and undiagnosed cases of diabetes mellitus among above 40 years old population in a selected rural area in Jamalpur, Bangladesh. A descriptive type of cross sectional study was conducted from September 2018 to December 2018. The respondents of the study were taken purposively. Using semi-structured questionnaire data were derived from face to face interview. The data were analyzed by using statistical for social science package (SPSS) 25.0 version for data entry and analysis. 53.4% of the respondents were aged between 40-50 years and 60.6% were female, 98.3% were Muslim, 57.2% were housewife. The study revealed that nearly half of the respondents (44.9%) had no formal education, 27.1% had primary, 14.8% had secondary, 8.9% had graduate and above and 4.2% had higher secondary education. 43.6% of the respondents' monthly family income had <10000 BDT. 27.5% had family history of diabetes. 33.5% of the respondents had body weight of 51-60 kg and 20.8% were overweight and only 2.1% were obese. Active respondents were 35.6%, 28.8% were moderately active, 24.6% were mildly active and 11% were sedentary in their life style. Majority of the respondents (72.5%) did not perform regular exercise. Excessive sweet or sugar regularly has taken 32.6% of the respondents. About diabetes knew 91.5% of the respondents and only 8.5% did not know about diabetes. Majority of the respondents (72.9%) did not know how diabetes & its complications can be prevented. This study found that 54.1% of the respondents continued oral drugs/insulin regularly for treatment of diabetes mellitus. Most of the respondents (88.1%) did not monitor blood glucose level regularly. 97.5% of the respondents did not attend any diabetes awareness program. The prevalence of diabetes was 22.88%. The proportion of diagnosed diabetic cases was 15.7% and the proportion of undiagnosed diabetic was 7.2% according to their fasting blood sugar. A relatively high proportion of diabetic cases were observed in that rural Bangladeshi population. The study found that about one third of the diabetic cases were undiagnosed and untreated which was significant and alarming. The study showed that the association between education of the respondents and status of diabetes was statistically strongly significant (p<0.001). The study revealed that there was strong association between family history of diabetes of the respondents and status of diabetes (p=0.006).

Relationship of BMI and Fasting Serum Glucose with Hypertension

Hypertension is an important worldwide public-health challenge because of its high frequency and concomitant risks of cardiovascular and kidney disease. It is recognized as a major contributor to the disease burden globally. Aim of the study was to evaluate body mass index and fasting serum glucose level in male hypertensive patients in order to compare these parameters with male normotensive subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh from July 2018 to June 2019. Total 200 male subjects, age range was from 30-65 years were included in this study. Among them, 100 hypertensive subjects were taken as study group (Group II) and 100 ages matched normotensive male subjects were taken as control group (Group I). Quantitative data were expressed as mean (±SD) and statistical significance of difference among the group was calculated by unpaired student's 't' test. In this study we found that body mass index was significantly (p<0.001) increased in study group (29.52±2.46) in comparison with control group (22.91±1.04). Fasting serum glucose level was also significantly (p<0.001) increased in study group (6.35±0.47) in comparison with control group (4.52±0.50). Based on the study carried out it is concluded that there is definite relationship of body mass index and fasting serum glucose level with hypertension. Therefore, basic measurement of weight and height to determine the body mass index and fasting serum glucose level as routine assessment during hospital visitation with appropriate lifestyle modification would help in controlling hypertension as well as its devastating consequences.

Body Mass Index and Serum Thyroid Stimulating Hormone in Third Trimester of Pregnancy

Pregnancy is a natural physiological state with hormonal and metabolic changes that helps the growth and survival of the fetus. Adequate body mass index (BMI) in pregnancy is important for securing, protecting and promoting the health of women and newborns. High or low maternal body mass index is associated with adverse outcome. Thyroid physiology plays a major role in pregnancy and thyroid disorders constitute one of the most common endocrine disorders in pregnancy. To assess the levels of body mass index and serum thyroid stimulating hormone (TSH) in third trimester of pregnancy in order to compare these parameters with non-pregnant women of same age range. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh from January 2019 to December 2019. A total number of 140 subjects, age range between 20-35 years were included in this study. Among them, 70 healthy subjects were taken as control group (Group I) and 70 pregnant women of third trimester were taken as study group (Group II). The results were calculated and analyzed by using SPSS. Quantitative data were expressed as mean (±SE) and statistical significance of difference among the group was calculated by unpaired student's 't' test. In this study we found that BMI was 27.87±1.9kg/m² and serum TSH level was 2.27±1.18μIU/ml in study group. Both (BMI & TSH) are significantly increased in study groups in comparison with control group. Therefore, by this study we recommended that routine estimation of these parameters is important for prevention of complication related to pregnancy.

Giant Villous Adenoma: A Rare Case of Colorectal Adenoma that Mimic Colorectal Cancer

Colorectal cancer being the 4th most common cause of cancer death in which most arise from a preexisting adenomatous polyp. Among the various adenomas Giant villous adenoma (GVA) is less common. We came across a 65 years female with intermittent per rectal mucus discharge for last 10 years and intermittent fresh, painless, scanty per rectal bleeding along with weakness and fatigue for last 5 years. No members of her family had been suffering from colorectal malignancy. DRE revealed irregular gritty feelings of rectal mucosa starting 2cm from anal verge and the examining fingertip was blood tinged mixed with mucus. On proctoscopic examination the accessible rectum was studded with thousands of polyps with granular appearance, with variable sizes and there was mucus mixed blood within the rectum. Colonoscopy reveals- polypoid lesion starting 2cm from anal verge and extends up to 2cm with granular and velvety appearance. Biopsy was done 2 times for suspicious lesion and histopathology reveals tubulovillous adenoma with dysplasia. However as clinical suspicion of an adenocarcinoma was strong but histopathological report of colonoscopic biopsy was contradictory, intersphincteric ultra-low anterior resection with coloanal anastomosis with covering ileostomy was done. Resected specimen was sent for histopathological study and it reveals- villous adenoma with low grade dysplasia. Two months later reversal of ileostomy was done and now the patient is under regular follow up and now she is asymptomatic.

Isolation and molecular identification of Lumpy Skin Disease (LSD) virus from infected cattle in Bangladesh

Lumpy Skin Disease (LSD) is a new disease of cattle in Bangladesh. It is endemic in Africa but through the last few years disease beings to spread to other countries of the world. The disease was widely spreaded in the many other countries in Asia and some parts of Europe. In Bangladesh, the disease was first time detected in April 2019, in southern part and then continued to spread all over the country.The disease caused enormous economic losses causing cutaneous and internal lesions, affecting milk production, hide quality and in some cases death of infected animal. LSD suspected samples were collected from different areas of the country during the period from July 2019 to January 2020. In this study, a total of 36 clinically suspected LSD samples of skin crustnodules, pus and ocular discharge were collected. Samples were examined by the published PCR protocol for LSD virus, GPV and SPV. Around 78% samples were found positive for LSD virus in PCR test. LSD virus was also identified from pus and ocular discharge of infected cattle. The virus can grow in the lamb testicular cell and clinically the disease is characterized by distinctive nodular lesions mostly on the skin of the affected animals.The results indicated that the LSD virus is circulating in the outbreak are as and is an emerging transboundary cattle disease in Bangladesh. Bang. J. Livs. Res. Vol. 26 (1&2), 2019: P. 15-20

Coronary Artery Revascularization with the Left Internal Mammary Artery (LIMA) to Diagonal (D) & Left Anterior Descending (LAD) Sequential and LIMA-LIMA "Y" Graft, Our Experiences at National Heart Foundation Hospital and Research Institute

The Left internal mammary artery (LIMA) is considered the conduit of choice for the surgical treatment (CABG, coronary artery bypass grafting) of Coronary artery disease (CAD) due to its superior long term potency than the other conduits. Sequential anastomosis with the LIMA in CABG increases the number of arterial graft and more completeness the arterial revascularization. To increase the number of arterial graft and improved long term potency, an alternative technique is sequential anastomosis of LIMA to Diagonal (D) & left anterior descending artery (LAD) and LIMA-LIMA "Y" Graft play a vital role in patients with tight proximal lesion. Perioperative data were prospectively collected from all patients with isolated CAD with tight proximal LAD lesion, who underwent off-pump CABG from November 2013 to October 2015 at a single Centre. A total of 321 patients had LIMA to D & LAD sequential and LIMA-LIMA "Y" grafts pattern with severe proximal LAD lesion. The mean age was 54.7±8.4 years, male & female ratio was 29.7:7.5. Left main involvement was in 25% & triple vessel disease was 89% with LVEF 53.6±8.6%. Sequential LIMA to diagonal (side to side) & LAD (end to side) done in all 294 cases and LIMA-LIMA"Y" grafts in 27 cases. Thirty days mortality was 0.935% (3 patients). Postoperative myocardial infarction (MI) occurred in 2 patients (0.623%). Two sequential LIMA graft failed and both the diagonal & LAD bypassed coronary arteries were very narrow, about 1mm in diameter. All the patients underwent postoperative NYHA class evaluation at 3-6 months follow up & found normal and none of the patients suffered for angina. Revascularization with skeletonized sequential LIMA anastomosis to D, LAD & LIMA-LIMA "Y" graft is a safe, feasible with improve overall long-term potency and reproducible alternative in the presence of severe proximal LAD lesion to the complete revascularization of the anterior& lateral myocardial wall. Long term follow-up with coronary angiogram is essential to recommend this technique as standard one.

Frequency and Risk Factors of Diabetic Retinopathy among Patients with Type 2 Diabetes Mellitus: A Single-Center Study from Bangladesh

Diabetic retinopathy (DR) is the most frequent microvascular complication of diabetes mellitus (DM). DR remains a leading cause of blindness, currently accounting for 4.8% of the world's 37 million blindness cases. DR is one of the critical preventable causes of blindness. In Bangladesh, the number of studies reporting the prevalence and risk factors of DR in type 2 DM (T2DM) is limited. We conducted this cross-sectional study in a tertiary hospital in Bangladesh from March 2017 to August 2019 among 200 patients with T2DM for the presence and severity of DR by using color fundus photography in a dilated pupil. The diagnosis and grading of DR were made using the Early Treatment of Diabetic Retinopathy Study (ETDRS) Chart. Out of 200 subjects with T2DM, 35.5% had DR; the frequencies of NPDR and PDR were 19.0% and 16.5%, respectively. The mean age, diabetes duration, FPG, HbA1c, TG, TC, LDL-C, and serum creatinine were statistically higher, and eGFR was lower in the study subjects with DR than those without DR; BMI and HDL-C were indifferent in the two groups. The frequencies of males, subjects having monthly income of 10,000 Bangladeshi Taka (BDT) or more, smokers, hypertensives, and subjects having uncontrolled diabetes (HbA1c ≥7%), were higher in the DR group than the no DR group. Higher age (≥50 years), higher monthly income (≥10,000 BDT), urban residence, smoking, uncontrolled diabetes, and high LDL-C (≥100mg/dL) were found to be independent risk factors of DR in the study subjects. A large-scale nationwide study is needed to find out the actual prevalence of DR in Bangladesh.

The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh

BACKGROUND

We aimed to estimate the effect of the community-based health insurance (CBHI) scheme on the magnitude of out-of-pocket (OOP) payments for the healthcare of the informal workers and their dependents. The CBHI scheme was piloted through a cooperative of informal workers, which covered seven unions in Chandpur Sadar Upazila, Bangladesh.

METHODS

A quasi-experimental study was conducted using a case-comparison design. In total 1292 (646 insured and 646 uninsured) households were surveyed. Propensity score matching was done to minimize the observed baseline differences in the characteristics between the insured and uninsured groups. A two-part regression model was applied using both the probability of OOP spending and magnitude of such spending for healthcare in assessing the association with enrolment status in the CBHI scheme while controlling for other covariates.

RESULTS

The OOP payment was 6.4% (p < 0.001) lower for medically trained provider (MTP) utilization among the insured compared with the uninsured. However, no significant difference was found in the OOP payments for healthcare utilization from all kind of providers, including the non-trained ones.

CONCLUSIONS

The CBHI scheme could reduce OOP payments while providing better quality healthcare through the increased use of MTPs, which consequently could push the country towards universal health coverage.

Clinical Profile and Immediate Outcome of Children Admitted With Acute Glomerulonephritis in Pediatrics Department of A Tertiary Level Hospital

Acute post-streptococcal glomerulonephritis (APSGN) is the commonest cause of acute glomerulonephritis (AGN), which usually present with gross hematuria, mild edema, oliguria, hypertension and varying degree of renal insufficiency. It is more common among the population of school going age where poverty, overcrowding and poor hygienic conditions are prevailing. This cross sectional observational study was aimed to know the socio-demographic variables, clinical profile and immediate outcome of AGN in hospitalized children and was conducted in the Pediatric department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from November 2014 to April 2015. A detailed history was taken from the parents in each case with a written questionnaire. A written consent was also taken from the guardian of the including patients and also permission was taken from the ethical committee of MMCH. Thorough clinical examination and available relevant investigations were done in all patients. Progresses of the patient were monitored by daily clinical examinations and also by investigations. Data were analyzed by statistical package for social science (SPSS) windows version 18. Results were verified by doing standard test for significance. Among total 60 cases male was 58.3% & female was 41.7%. The common age group of presentation was between 7-12 years (73%), peak age of incidence was 7-9 years. Most of them came from low socioeconomic status (83.3%), 63.3% from rural area with average 5-6 member's family size. Most of the parents were illiterate. History of (H/O) skin infection was present in 35(58.3%) patients, 15(25%) had H/O sore throat, 15% did not give any H/O infection before presentation. Average duration of gap between infection and appearance of clinical feature was 7-14 days in 73.40%and 15-21 days was in 45.7% in case of sore throat & skin infection respectively. Almost all (95%) patients presented with puffiness of face, others presented with scanty micturition, gross hematuria, respiratory distress, fever, convulsion and altered sensorium. Edema (75%), hypertension (88.3%), pallor (38%), tachypnea (25%), tachycardia (26.7%) were the important clinical findings. Microscopic hematuria was present among 96.66% patients; low complement level was found in 85% cases. There is significant association between low socioeconomic statuses with more hospital stay. Only one patient died due to heart failure and 98.3% patient had complete recovery. Results of this study conclude that most of the patients came from rural illiterate family with low socioeconomic background. Skin infection is the commonest cause of acute glomerulonephritis. Edema, scanty micturation, hematuria and hypertension are the common mode of presentation. Heart failure and hypertensive encephalopathy are the common complication of AGN. Immediate prognosis of AGN was excellent.

Antimicrobial Resistance Pattern and Genetic Characteristics of ESBL and Carbapenemase-producing Escherichia coli at a Tertiary Care Hospital in Bangladesh

Uropathogenic Escherichia coli is frequently resistant to different antibiotic leading to a critical condition of the patients. The purpose of the present study was to see antibiotic resistance pattern and genetic characteristics of ESBL and Carbapenemase-producing Escherichia coli. This cross sectional study was conducted in the Department of Microbiology at Mymensingh Medical College, Mymensingh, Bangladesh from October 2014 to December 2015. Patients presented with clinically diagnosed urinary tract infection at any age with both sexes who attended in the OPD of Mymensingh Medical College Hospital and the Doctors Diagnostic Centre in Mymensingh, Bangladesh was selected as study population. Non duplicate clinical isolates from urine were collected in full aseptic precaution for culture of bacteria. Escherichia coli were confirmed by PCR Stargetingadk. Antimicrobial susceptibility was measured by broth microdilution test. Minimum inhibitory concentrations against 18 antimicrobial agents were measured. Beta-lactamase genes were detected by multiplex PCR. For all the isolates showing resistance to imipenem and/or meropenem, presence of carbapenemase genes was confirmed by multiplex/uniplex PCR using primers. A total of 233 non-duplicate clinical isolates of Escherichia coli were collected from patients of which dominant phylogenetic group was B2 which was 78(33.5%) isolates of which 71 isolates were B2a and 7 isolates were B2b. Furthermore, Group A was in 29.6% isolates and Group D was in 26.6% isolates. E. coli showed significantly higher resistance rates to piperacillin, cephalosporins, and some other antimicrobials. Meropenem-resistance was detected in 8.2% of E. coli. The detection rate of blaTEM was 41.6% in E. coli. Carbapenemase genes were detected in 9(3.9%) isolates of E. coli and identified as genes encoding NDM-1, -5, and 7 and OXA-181. All the blaNDM-positive E. coli isolates carried also blaCTX-M-15, except for a group B1 isolate. E. coli is significantly higher resistance rates to piperacillin, cephalosporins, and some other antimicrobials and possesses different ESBL and carbapenemase genes.

Study of Vitamin D Deficiency among the Apparently Healthy Population in Jashore, Bangladesh

Globally Vitamin D deficiency is a burning issue for the last two decades. Though the very high prevalence of hypovitaminosis D is worldwide even in the South-East Asia but there is very limited data in Bangladesh. This observational study was designed to assess the status of Vitamin D deficiency among the clinically apparent healthy population in the district of Jessore, Bangladesh from January 2017 to June 2017. Both the male and female clinically healthy participants between the age of 10 and 70 years residing more than 3 years in Jashore were included in this study, while those having renal or liver failure or any other chronic diseases and using drugs that could potentially interfere the metabolism of vitamin D were excluded from the study. Here we leveled serum 25(OH)D concentration of ≤20ngm/dl as deficient, >20-30ngm/dl graded as insufficient and >30ngm/dl graded as sufficient. Among 160 participants 43.1% (n=69) were male and 56.9% (n=91) were female. And 102(63.7%) participants had deficient vitamin D, 50(31.3%) had insufficient vitamin D and only 8(5%) had sufficient vitamin D. The mean serum 25(OH)D levels in our study was 18.60±6.59ngm/dl. The mean serum 25(OH)D level in case of male participants was 19.72±7.10ngm/dl whereas in female the corresponding figure was 17.74±6.07gm/dl and no significant difference observed among the man and women (p=0.059). Sun exposure play a vital role in the vitamin D deficiency and we observed only 1-2 hours/day sun exposure was sufficient for normal vitamin D level (p=0.001). In case of women who used veil had significantly lower level of vitamin D (p=<0.001) due to lack of adequate sun exposure. Urban participants who also had significant low level of vitamin D due to the same reason (p=0.009). There was no deficiency observed in farmers and only 5(3.1%) had insufficient vitamin D. No significant difference observed in deficiency of vitamin D among the different age, sex, education level, skin complexion or BMI. But the obese participants had significant (p=0.041) lower vitamin D level. It was concluded with the high rate of vitamin D deficiency in this small scale study conducting in a district of Bangladesh demands a nationwide survey of vitamin D.

Outcome of Transcanalicular Endolaser and External Dacryocystorhinostomy in Chronic Dacryocystitis

Nasolacrimal duct obstruction due to chronic dacryocystitis is the most common cause of epiphora. Dacryocystorhinostomy (DCR) is the treatment of choice for chronic dacryocystitis. This can be carried out by external, endoscopic and endolaser surgical approach. Though external DCR is still a gold standard and most popular method, the latest procedure of less traumatic DCR is transcanalicular approach. The study was done to evaluate the outcome of Transcanalicular Endolaser DCR regarding epiphora and surgery related complications by measuring anatomical success rate (patency assessed by irrigation), functional success rate (symptom free) and complication rate and to compare with External DCR (Ext-DCR). This prospective interventional study was conducted from October 2011 to September 2012 in Ophthalmology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Total 62 patients included in the study as per inclusion and exclusion criteria of them 31 for TCEL-DCR and 31 for Ext-DCR. But during follow-up one patient was dropped from each group and finally outcome of 30 patients analyzed in each group. Mean age of the patients TCEL-DCR was 38.3±11.54 and of Ext-DCR was 38.4±14.01. In both groups females were the most sufferer (female: male = 1.5: 1). Functional and anatomical success rate of TCEL-DCR showed 93.3% and 83.3% after 3 months; 83.3% and 76.7% after 6 months respectively. Statistically non-significant difference was observed about success rate in comparison between groups. Per-operative complications were pain excessive bleeding. In TCEL-DCR pain complained 13.3% and excessive bleeding occurred in 3.3%. Where as in Ext-DCR pain complained 16.7% and excessive bleeding occurred in 20%; difference was statistically significant (p=0.001). Post-operative complications were bleeding and scar formation. Bleeding occurred in TCEL-DCR 6.67% and in Ext-DCR 10%. So, TCEL-DCR could be an alternative option for the treatment of chronic dacryocystitis especially for those patients who are conscious about scar formation and afraid about Ext-DCR technique.

Outcome of Surgical Repair of Post-Infarction Ventricular Septal Rupture: A Single Center Observational Study

To review the experience of surgical repair of post-infarction ventricular septal rupture (VSR) and analyze the associated outcomes in National Heart Foundation Hospital & Research Institute (NHFH & RI). This retrospective review was performed on 19 consecutive cases who had undergone surgical repair of post-infarction VSR between 2009 and 2017. Continuous variables were summarized as mean plus/minus the standard deviation or median. Categorical variables were expressed as percentage of the sample. Comparison between in-hospital survivors versus non-survivors was performed by Student's t-test and chi-square or Fisher's exact test for continuous and categorical variables respectively. A value of p<0.05 was considered statistically significant. Mean age of survivor and non-survivors were 53.53±9.2 and 56.33±1.5 years consecutively. Anterior VSR 14(73.6%) was more common than posterior VSR 5(26.4%). All patients had significant coronary lesions; the frequency of 1-, 2-, and 3-vessel disease was 22.2%, 27.7% and 50.0% consecutively. The left anterior descending coronary artery was the infarct-related artery in all patients with anterior VSR. Mean cardiopulmonary bypass time was 157±58.6 minutes and 249±78.3 minutes in survivor and non-survivor groups consecutively (p=0.018). Operative mortality within 30 days was 21%. Low output syndrome (LOS), multiple organ failure (MOF), septicemia, tracheostomy and prolonged intensive care unit (ICU) stay were the major factor for survivals. Surgical repair of post-infarction VSR carries a high operative mortality. But, stable hemodynamic at the time of VSR diagnosis is a significant predictor of survival and concomitant coronary artery bypass grafting (CABG) improves early survival.

Modified Blatchford Score for Risk Stratification in Adult Patient with Nonvariceal Upper Gastrointestinal Haemorrhage and Their Short Term Hospital Outcome

Upper gastrointestinal hemorrhage (UGIH) is one of the most common and life-threatening gastrointestinal emergency. There are several risk scores for risk stratification in UGIB patients. The Modified Blatchford score, which relies only on clinical and laboratory parameters, is practical in the emergency setting The Modified Blatchford scoring system also known as Glasgow Blatchford Scoring (GBS) have been developed to stratify risk of non variceal upper gastrointestinal hemorrhage or need of medical or surgical intervention, endoscopic therapy. Objective of this study is to see risk stratification by The Modified Blatchford score and short term hospital outcome in non variceal upper GI hemorrhage patients. The observational study was carried out over a period of 6 months from October, 2014 to March, 2015 in Department of Department of Medicine, Gastroenterology and Surgery Mymensingh Medical College Hospital, Mymensingh. A total of 120 patients with non variceal UGIH were taken for the study during study period. Categorical variables were reported as percentage and Means and proportions were carried out using the Chi-square test (X2-test) of different variables by SPSS software version-18.0. Patients related variables age, sex; and main outcome variables the Modified Blatchford scoring system, Risk stratification, and short term hospital outcome were observed. Age frequency among total cases were 66(55%) <60 years, 50(41.67%) from 60-79 years and 4(3.3%) 80 years or above and sex distribution were 84(70%) were male and 36(30%) were female patients. Blatchford score of patients 1(0.83%) had score 0, 1(0.83%) had score 1, 2(1.67%) had score 2, 2(1.67%) had score 3, 2(1.67%) had score 4, 3(2.5%) had score 5, 12(10%) had score 6; 15(12.5%) had score 7, 16(13.33%) had score 8, 17(14.17%) had score 9, 16(13.33%) had score 10, 15(12.5%) had score 11, 10(8.33%) had score 12, 4(3.33% ) had score 13, 1(0.83%) had score 14, 2(1.67%) had score 15 and 1(0.83%) had score 16. Risk stratification showed 54(45%) had low risk (Mean GBS score 6.19±1.79), 66(55%) had high risk (Mean GBS score 11.03±1.83) Outcome of the patients were observed that 1(0.83%) died, 54(45%) was discharged without any medical or surgical intervention, and 65(54.17%) patients' needs medical or surgical intervention such as blood transfusion and endoscopy. Among total 120 patients with upper GI hemorrhage I have found that GBS score of three or less than three is predictive of low risk of adverse outcomes and can be discharged without any intervention.

A Young Boy with L-asparaginase-Induced Seizure

L-Asparaginase is a critical component in the treatment of acute lymphoblastic leukemia in children. It is known to cause coagulation abnormalities, thrombosis and hemorrhage in the central nervous system in addition to vasculitis and hypersensitivity reactions. This syndrome generally occurs after a few weeks of therapy and may occur after L-asparaginase therapy is completed. Seizures are uncommon symptoms. We report a case of seizure associated with L-asparaginase therapy but no evidence of hemorrhagic or thrombotic cerebrovascular events, completed in the department of Hematology of Bangabandhu Sheikh Mujib Medical University during March & April 2016.

Quantitative trait loci mapping of the stigma exertion rate and spikelet number per panicle in rice (Oryza sativa L.)

The stigma exertion rate is a polygenic inherited trait that is important for increased seed yield in hybrid rice breeding. To identify quantitative trait loci (QTL) associated with high stigma exertion rate, we conducted QTL mapping using 134 recombinant inbred lines derived from XieqingzaoB and Zhonghui9308, which have high and low stigma exertion rates, respectively. A total of eight QTLs (qSES6, qSSE11, qDSE1a, qDSE1b, qDSE10, qDSE11, qTSE1, and qTSE11) for single stigma exertion, double stigma exertion, and total stigma exertion were detected. The locations of qSSE11 and qTSE11 have not been previously reported, and the qDSE11 allele from parent XQZB exhibited a positive additive effect. In addition, three QTLs (qSNP1, qSNP3a, and qSNP3b), for spikelet number per panicle were identified. Of note, one QTL (qSNP1) was detected in two different environments (Hainan and Zhejiang). To evaluate the advantage of exerted stigma for cross-pollination, single, dual, and total stigma exertion should be considered separately for future genetic improvement in the production of rice hybrid seeds. In addition, this study provides information for fine mapping, gene cloning, and marker assisted selection, with emphasis on the latter.

Response of Dapsone in Refractory Chronic Immune Thrombocytopenia

This was a prospective study. A total number of 19 patients with chronic ITP with platelet count <50×10⁸/L, treated with dapsone at a dose of 100 mg/day for nine months and followed up to 12 months were included in this study. Among them 13 patients (76.5%) were responded well shortly to dapsone which persisted during Dapsone therapy. Response rate of Dapsone was declining after Dapsone therapy. Response persisted in 6 patients (35.3%) after stoppage of dapsone up to last follow up at 1 year. Mean platelets count during Dapsone therapy was 168.35×10⁸/L. Shorter duration of thrombocypenic patients were responded well. Except one all patients experienced mild to moderate anaemia. Mean fall of Haemoglobin was 1.4gm/dl during dapsone therapy observed which come back to normal shortly after stoppage of dapsone. Only 2 patients were suffered from moderate anaemia. Dapsone syndrome and methemoglobinamia caused permanent discontinuation of therapy in 2 patients (10.5%) which was revert back to normal shortly after stoppage of drug. This study demonstrates that dapsone is an effective, inexpensive and well tolerated treatment for chronic, refractory ITP.

Initial Experience with Endoscopic Ultrasound

Since its introduction in early 1990s, endoscopic ultrasound (EUS) has become integral to the diagnosis and staging of various luminal, extraluminal gastrointestinal (GI) and certain non-GI lesions. There is no data on EUS experience in Bangladesh. The aim of this paper is to evaluate the initial recent experience and clinical impact of EUS. All EUS procedures data were recorded prospectively from July 2013 to December 2014. These included patients' demographics, referral details, provisional diagnosis, management plan before and after EUS & indications of procedures. EUS-FNA data recorded included details regarding site, number of passes and histological diagnosis. Two hundred & four EUS procedures were carried out over one and half years. Male female ratio was 1.4:1, mean age was 46.4 ± 20 years. Of these procedures 148 (72.5%) were referrals from physicians and 56 (27.5%) were from surgeons. Most common indications were pancreatobiliary pathologies, esophageal & gastric pathologies. Pancreatobiliary lesions (n = 165, 80.9%) included patients with (A) Benign pathologies: Microliths in Gall baldder (n = 6), Gall stones (n = 12), Biliary ascarrisis (n = 22), Choledocholithiasis (n = 42), Acute Pancreatitis (n = 9), Chronic Pancreatitis (n = 15), Pancreatic pseudocysts(n = 4) (B) Malignant Pathologies : GB Carcinoma (n = 4), Cholangiocarcinoma (n = 29), Ca- pancreas (n = 9), Periampullary carcinoma (n = 12). Esophageal lesion was 9.3% (n = 19) of total procedures. Forty seven percent (n = 9) of EUS procedures on esophagus were for staging of esophageal malignancy, 10. 5% (n = 2) for restaging or recurrence after chemoradiation and 21% (n = 4) for submucosal lesions. Fifteen EUS procedures were carried out for gastric lesions, seven were for staging of gastric carcinoma, four were for assessment of submucosal lesions (e.g. GIST, lipoma or external compression), 02 for assessment of polyps and two for gastric ulcers.In clinical impact & outcome study, changes in diagnosis, management, avoidance of investigations and usefulness of EUS were evaluated. Diagnosis was changed in 34.4% (64/186) & management was changed in 45%(92/204). Additional investigation was avoided in 57.8% (118/204). This is the first report of Bangladesh experience of EUS to date. EUS is safe, accurate, cost effective & very useful tool for diagnosis and management of G.I. disorders.

Bartter Syndrome with Normal Aldosterone Level: An Unusual Presentation

Bartter syndrome (BS) is a hereditary disease, with an autosomal recessive or autosomal dominant mode of transmission. It is characterized by salt wasting hypochloraemic, hypokalaemic metabolic alkalosis and hyperreninaemia with normal blood pressure. The primary defect is in the thick ascending limb of loop of Henle (TAL). Herein, we report a case that had typical features of BS like severe dehydration, severe hypokalaemia, metabolic alkalosis and failure to thrive but had normal aldosterone level which is very uncommon.

Prevalence and Symptom Correlation of Lactose Intolerance in the North East Part of Bangladesh

This study was designed to see the prevalence of lactose intolerance and symptom correlation following oral lactose challenge in healthy volunteers in the north east part of Bangladesh. Symptoms of abdominal pain, nausea, borborygmi, flatulence, diarrhea and others were noted for 24 hours and blood glucose was estimated at 0 hour and 30 minutes after 50 gm oral lactose load to healthy volunteers. Failure to rise blood glucose level ≥1.1 mmol/l at 30 minutes after lactose intake from fasting level was taken as lactose malabsorption (LM) i.e., lactose intolerance. Sensitivity and specificity of different symptoms were then found out. A total of 171 volunteers (male 123, female 48) with a mean age 34.08 years participated in this study. Lactose intolerance was found among 82.5% (n=141, M=100, F=41) subjects. Symptoms mostly experience by the lactose malabsorbers were diarrhea 93(66.0%), borborygmi 80(56.7%), abdominal pain 31(22.0%) and flatulence 32(22.7%). LM prevalence was found to increase with increasing number of symptoms up to 3 symptoms. A week positive correlation (r=0.205, P=0.007) was found between the number of symptoms and proportion of subjects having positive lactose tolerance test. Lactose intolerance among healthy adults of North East part of our country is as common as in other Asian countries including China and Malaysia. But LM is higher than that of Europeans and south Indians. Diarrhea and borborygmi were mostly associated with LM.

Evaluation of Physicochemical Deterioration and Lipid Oxidation of Beef Muscle Affected by Freeze-thaw Cycles

This study was performed to explore the deterioration of physicochemical quality of beef hind limb during frozen storage at -20℃, affected by repeated freeze-thaw cycles. The effects of three successive freeze-thaw cycles on beef hind limb were investigated comparing with unfrozen beef muscle for 80 d by keeping at -20±1℃. The freeze-thaw cycles were subjected to three thawing methods and carried out to select the best one on the basis of deterioration of physicochemical properties of beef. As the number of repeated freeze-thaw cycles increased, drip loss decreased and water holding capacity (WHC) increased (p<0.05) till two cycles and then decreased. Cooking loss increased in cycle one and three but decreased in cycle two. Moreover, drip loss, WHC and cooking loss affected (p<0.05) by thawing methods within the cycles. However, pH value decreased (p<0.05), but peroxide value (p<0.05), free fatty acids value (p<0.05) and TBARS value increased (p<0.05) significantly as the number of repeated freeze-thaw cycles increased. Moreover, significant (p<0.05) interactive effects were found among the thawing methods and repeated cycles. As a result, freeze-thaw cycles affected the physicochemical quality of beef muscle, causing the degradation of its quality.

Chronic Gastritis and its Association with H. Pylori Infection

This cross sectional study was designed to see association of chronic gastritis including its type with H. pylori infection. Consecutive patients undergoing endoscopic examination having histopathological evidence of chronic gastritis were enrolled in the study and was done in Sylhet MAG Osmani Medical College from July 2011 to June 2012. Biopsies were taken from antrum, body and fundus in all patients. Histopathological examinations were done using H-E stain and for detection of H. pylori, rapid urease test, anti-H.pylori antibody test and histopathological test with modified Giemsa stain were done. Patients having results positive in at least two methods were considered infected by H. pylori. Total 80 dyspeptic patients having chronic gastritis were evaluated. Out of them 67(83.8%) had H. pylori infection and 13(16.2%) were H. pylori negative. Among all patients 57(71.2%) had pangastritis and 23(28.8%) had antral gastritis with female and male predominance respectively. H. pylori infection was present in 49(86.0%) cases of pangastritis and 18(78.3%) cases of antral gastritis. H. pylori infection was a little higher among males (34, 50.7%) females (33, 49.3%). H. pylori infection is the predominant cause of chronic gastritis and pangastritis is the major type.

Study on Serum Albumin in Third Trimester of Pregnancy

Various hormones can cause marked changes in pregnant woman's appearance. Decreased level of serum albumin occurs in third trimester of pregnancy, which may be associated with increased maternal and infant mortality and morbidity. So, this study was carried out to evaluate and assess the level of serum albumin in third trimester of pregnancy. This cross-sectional study was carried out in the Department of Physiology Mymensingh Medical College, Mymensingh. This study enrolled 100 pregnant women of third trimester of pregnancy and 100 aged matched non-pregnant women from Mymensingh district. In this study serum albumin level in study group were 33.41 ± 4.62gm/l and in control group were 37.09 ± 4.21 gm/l, which was statistically decreased. The lower level of serum albumin in third trimester of pregnancy is the major concern of development of physiological edema during pregnancy and may be associated with pre-eclampsia.

Sixty years old man with primary cutaneous lymphoma

Cutaneous lymphomas are uncommon skin tumors. Which may be primary or secondary and T-cell or B-cell according to cell type the former type being less frequent. The term "primary cutaneous lymphoma" refers to cutaneous lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. In this report, we describe a 60-year-old man with primary cutaneous lymphoma, who presented with multiple painless reddish nodular skin lesion on the different sites of his body and there was no evidence of systemic involvement.

Musculoskeletal disorder (MSD) among agricultural workers

Farming is a large and main industry in Bangladesh. Large numbers of people are directly involved in farming and have very unique exposure compare to other sectors. Musculoskeletal problems among farmer population are not infrequent. This study was carried out among 200 farmers in one selected district. The study revealed that musculoskeletal problems were common among the farmers working in a traditional way. All the respondents were male. The age of all respondents lie between 20-60 years. Among them 22.5% farmers were illiterate, about 45.5% below Class V. About half (42%) of the respondents had reported pain in different parts of the body at least one or more times during working in land. And about two third (65.5%) of the farmers had history of joint pain and stiffness in last 12 month. Most of the farmers who suffered from musculoskeletal symptoms were 41-60 years. Specially who worked more then 20 years (82.6%) and average 6 hours per day (66.7%). The occurrence of musculoskeletal problems in various part of the body included Knee pain - 48.1%, Back pain (back ache) - 22.9%, Waist pain (low back ache) - 13.3%, Neck pain - 18.3% and shoulder pain - 10.7%. Length of work in year and daily average working hours were found significant association with musculoskeletal pain. It was found that musculoskeletal pain were more common among the farmers when they worked in squatting position (52%) and specially during weeding of plants (31%). Among them only 22% also engaged in other business. Most of the farmers complained dull aching pain (40.6%), only 2.3% noticed severe acute pain, but about 86% farmers' temporary stop their work for pain and 80% get relief after discontinue of work. About 75% respondents visited doctors for their pain which was statistically significant (p=0.001). It was found that the rates of musculoskeletal complaints are more among those individuals who worked relatively bad ergonomic condition, such as body position probably play an important role.

Effect of Repeated Freeze-Thaw Cycles on Beef Quality and Safety

The objectives of this study were to know the effect of repeated freeze-thaw cycles of beef on the sensory, physicochemical quality and microbiological assessment. The effects of three successive freeze-thaw cycles on beef forelimb were investigated comparing with unfrozen fresh beef for 75 d by keeping at -20±1℃. The freeze-thaw cycles were subjected to three thawing methods and carried out to know the best one. As the number of freeze-thaw cycles increased color and odor declined significantly before cook within the cycles and tenderness, overall acceptability also declined among the cycles after cook by thawing methods. The thawing loss increased and dripping loss decreased significantly (p<0.05). Water holding capacity (WHC) increased (p<0.05) until two cycles and then decreased. Cooking loss increased in cycle 1 and 3, but decreased in cycle 2. pH decreased significantly (p<0.05) among the cycles. Moreover, drip loss, cooking loss and WHC were affected (p<0.05) by thawing methods within the cycles. 2-Thiobarbituric acid (TBARS) value increased (p<0.05) gradually within the cycles and among the cycles by thawing methods. Total viable bacteria, total coliform and total yeast-mould count decreased significantly (p<0.05) within and among the cycles in comparison to the initial count in repeated freeze-thaw cycles. As a result, repeated freeze-thaw cycles affected the sensory, physicochemical and microbiological qua- lity of beef, causing the deterioration of beef quality, but improved the microbiological quality. Although repeated freeze-thaw cycles did not affect much on beef quality and safety but it may be concluded that repeated freeze and thaw should be minimized in terms of beef color for commercial value and WHC and tenderness/juiciness for eating quality.

Long versus standard initial prednisolone therapy in children with idiopathic nephrotic syndrome

The efficacy of longer initial course of prednisolone with standard regimen was compared in children with idiopathic nephrotic syndrome (INS). It was a randomized controlled trial in which patients with INS who responded to initial course of prednisolone, either long or standard regimen were included and followed for one year after completion of treatment of first attack. The long regimen consisted of prednisolone 60mg/m²/day for six weeks followed by 40mg/m² every alternate day single morning dose for further six weeks. The standard regimen consisted of prednisolone 60mg/m²/day for four weeks followed by 40mg/m² every alternate day single morning dose for further four weeks. There were 93 children who fulfilled the criteria of the study, 47 from long group and 46 from standard group though ultimately 72 completed the study (41 from long and 31 from standard group). The primary outcome measure was relapse within next one year. Relapse within one year was noted in 73.2% of long and 64.5% of standard group. The odds ratio for relapse within one year was 0.80 (95% confidence interval 0.22, 2.05). This did not reach statistical significance (p=0.696). Adverse effects of prednisolone between two groups were also not statistically significant (p>0.05). Prolongation of prednisolone therapy for initial episode of steroid-sensitive INS does not have a beneficial effect on the outcome in next one year.

Use of local anesthesia in transrectal ultrasound guided prostatic biopsy

Transrectal ultrasound (TRUS) guided biopsy of the prostate is the gold standard for detecting prostate cancer. Intraprostatic administration of local anesthesia significantly decreases pain during prostatic biopsy. Transrectal ultrasound guided intraprostatic lidocaine administration along with intrarectally lidocaine gel is a new local anesthesia technique for prostatic biopsy. It was a randomized prospective, comparative, interventional type of the study. A total of 60 patients of age over 55 years included in the study among them 30 patients with transrectal lidocaine gel was in Group I and 30 patients with intraprostatic lidocaine injection with intra rectal gel were in Group II. The mean age was almost identically distributed between the two groups (p=0.668). About 47% of patients in Group I exhibited hard prostate on digital rectal examination (DRE), 33.3% single nodule and 20% multinodule compared to 33.3% of patients in Group II had hard prostate, 26.7% single nodule and 40% multinodule (p=0.236). The mean serum prostate specific antigen (PSA) was significantly higher in Group II than that in Group I (36.7±9.2 vs. 7.5±5.8ng/ml; p=0.007). The mean pain intensity during biopsy was almost two times higher in Group I than in Group II (p<0.001). The present study concludes that the intraprostatic lidocaine injection along with intra rectal lidocaine gel is less painful method and can be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.

Ultrasonographic evaluation of breast mass

Breast cancer is the second most common cause of cancer-related mortality among women. The aim of the present study is to investigate the diagnostic accuracy of ultrasonography in correlation with histopathology in suspected patients of breast mass. In this cross-sectional study, ultrasonography and histopathology was done on 50 clinically suspected patients of breast mass in the Department of Radiology and Imaging Mymensingh Medical College Hospital, Mymensingh from 1st April 2008 to 30th March 2009 for the period of one year. Women of all ages were included in the study. Findings of USG and histopathology were correlated. In diagnosis of malignant mass by USG, 32(64%) of cases were diagnosed as malignant and 18(36%) cases as other than malignant. Here 31(86.1%) of sonographically diagnosed malignant lesions were also proved as malignant lesion by histopathologically and 1(7.1%) other than malignant. Out of 18 sonographically diagnosed cases of other than malignant lesions 13(92.9%) were proved histopathologically and 5(13.9%) did not match with sonographic findings as other than normal. USG, in diagnosis of malignant lesion, sensitivity was 86.1%, specificity 92.9%, positive predictive value (PPV) (96.6%), negative predictive value 72.2% and accuracy was 88.0% and comparable to other study. In the conclusion this study permits to conclude that ultrasonography has significant sensitivity, specificity, accuracy, positive predictive value and negative predictive value in the diagnosis of both benign and malignant breast mass.

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.

Auto-analyzer based screening of microcytic hypochromic ratio to differentiate thalassaemia and non thalassemic microcytosis

DOI: http://dx.doi.org/10.3329/bmrcb.v39i3.20317 Bangladesh Med Res Counc Bull 2013; 39: 146-147

Short-term outcome of magnesium sulfate infusion in perinatal asphyxia

This randomized, single blind, controlled, clinical trial was done to see the effect of magnesium sulfate infusion in perinatal asphyxia. This study was conducted in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital from January, 2010 to October, 2010. Total 50 term neonates having postnatal age less than 12 hours with history of perinatal asphyxia and had history of hypoxic ischemic encephalopathy (moderate or severe) were included in this study. Patients were assigned randomly to receive either 3 doses of magnesium sulfate infusion at 250mg/kg per dose (0.5ml/kg per dose) 24 hours apart (experimental group) or 3 doses of normal saline infusion 24 hours apart (placebo-controlled group). Both groups also received supportive care according to the unit protocol for perinatal asphyxia. Baseline characteristics of 50 neonates had no differences in gestational age, birth weight, gender, mode and place of delivery, parity, ANC, liquor colour and hypoxic-ischemic encephalopathy (HIE) staging and mean age of intervention between the experimental and controlled groups. The mean serum magnesium at admission was 1.6±0.3mg/dl and 1.8±0.4mg/dl and after 48 hours was 3.9±0.6mg/dl and 1.9±0.2mg/dl in experimental group and in controlled group respectively. There was no significant difference or alteration in colour, heart rate, respiration, capillary filling time/blood pressure and oxygen saturation between the experimental and control groups. At discharge, 26% (5 of 19) of infants in the experimental group had neurological abnormalities, compared with 61% (11 of 18) of infants in the control group. At discharge experimental group were received more (78% vs. 44%) oral feedings by sucking compared with the controlled group. There is no significant difference in Electroencephalographic (EEG) abnormalities between groups. Good short-term outcomes at discharge were seen more (60% vs. 32%) in the experimental group, compared with the placebo-controlled group. The overall mortality rate in our study was 26%. Postnatal magnesium sulfate infusion is effective in improving short-term outcomes in neonate with perinatal asphyxia.

Performance Of Bari Mango (Mangifera indica L.) Varieties In Chittagong Region

Five mango varieties developed by Bangladesh Agricultural Research Institute (BARI) were evaluated at ARS, Pahartali, Chittagong during January to June 2012 to find out the suitable variety. The earliest flowering as well as harvesting were observed in BARI Aam-1 and the latest in BARI Aam-8. Number of fruits per tree varied from 51 to 117. Maximum number of fruits (117) per tree was obtained from BARI Aam-8, while minimum fruits (51) from BARI Aam-4 (Hybrid). The heaviest fruit (373.0 g) was obtained from BARI Aam-4 (Hybrid), while the lightest fruit (172.6 g) was in BARI Aam-3. Maximum yield per plant was found in BARI Aam-8 (33.59 kg) followed by BARI Aam-4 (19.02 kg), whereas it was lowest in BARI Aam-1(14.42 kg). The highest edible portion (78.66 %) was recorded in BARI Aam-4, while the lowest (65.99%) was obtained from BARI Aam-1. The highest TSS content (21.36%) was recorded in BARI Aam-3, whereas the lowest TSS content (16.51%) was observed in BARI Aam-2. Bangladesh J. Agril. Res. 38(2): 203-209, June 2013 DOI: http://dx.doi.org/10.3329/bjar.v38i2.15883

Acute renal failure following wasp sting

Wasp stings can result in multi system involvement ranging from intravascular hemolysis, rhabdomyolysis, acute renal failure cardiac involvement, hepatic dysfunction and occasionally thrombocytopenia and coagulopathy. We report here a case of eight year old boy presented with history of wasp sting followed by scanty micturation, generalized swelling and respiratory distress. After admission renal replacement therapy along with oral Prednisolone was started as serum creatinine level was gradually increasing. Kidney biopsy reveled Acute Interstitial Nephritis (AIN). Diagnosis was made of acute renal failure due to AIN following wasp stings.

Effect Of Ga3 And Row Ratio On Floral Traits Of Component Lines Of BRRI Hybrid Dhan2

Component lines (A and R lines) of BRRI hybrid dhan2 were assessed under treatment of GA3 application and row ratio on days to 5% and 50% flowering, duration of opening of floret, angle of open floret, filament length, anther length, stigma length, panicle exsertion rate, stigma exsertion rate and outcrossing rate. The CMS line viz; BRRI 10A have been found to be usable female parents for hybrid rice seed production due to their stigma length, stigma exsertion rate, duration of blooming, anther length and filament length. The different between genotypic and phenotypic variation was not remarkable for most of the characters studied indicating negligible environmental influence on the traits. The maximum duration of opening of floret (158.10 min) and angle of floret opening (28.870) were obtained with the application of 350 g GA3 ha-1. The improvement in the floral traits with increased GA3 level might be due to increased availability of GA3 which enhanced floral traits. The CMS line can be used as potential female parent in hybrid rice seed production of BRRI hybrid dhan2. Bangladesh J. Agril. Res. 38(1): 155-163, March 2013 DOI: http://dx.doi.org/10.3329/bjar.v38i1.15202

Environmental Impact Assessment of Fish Diseases on Fish Production

The present research work was conducted from July 2008 to June 2009 to investigate intensity of infestation of parasites in freshwater fishes and the impact of fish diseases on fish production in northern region of Bangladesh. Possibility of out break of diseases due to deterioration of environmental factors of water bodies was included in this study. The diseases identified were ulcer diseases, EUS (Epizootic Ulcerative Syndrome), Ichthyophthiriasis, Trichodiniasis, Chilodoneliasis, Myxoboliasis, Dactylogyrosis, Gyrodactylosis, Argulosis, Pernicious anaemia, Red spot disease, Red Pest of freshwater eel, Mouth fungus, Branchiomysis, Abdominal dropsy and whirling disease. The infestation more occurred in young fishes than in adult fishes. The overall water qualities of water bodies fluctuated from July 2008 to June 2009. Physicochemical parameters have more or less significant combined effect on the deterioration of water quality as well as fish diseases. Gills were the most affected sites and parasites damaged gill filaments by rupturing blood capillaries, causing necrosis, coagulation and hemorrhage. The present study revealed the prevalence of different organisms in fishes, which are potential pathogen for them. Fishes were infested by parasites and other pathogens. From overall study it was observed that the parasites, bacteria and fungus were most important pathogen for outbreak of diseases. It was also observed that there was a direct relation between disease outbreak among fishes and environmental factors. Low alkalinity reduces the buffer capacity of water and badly affects the pond ecosystem, which in turn cause stress to the fish and become more susceptible to diseases. In case of low aquatic environmental temperature fish reduces metabolic activities, which in turn makes the fish more susceptible during the winter period towards parasitic infection. DOI: http://dx.doi.org/10.3329/jsf.v9i1-2.14655 J. Sci. Foundation, 9(1&2): 125-131, June-December 2011

Single layer gastro-intestinal anastomosis in gastric cancer surgery

Gastrojejunostomy is one of the most important procedures in gastric cancer surgery. Anastomosis between different parts of the stomach and the intestine is a basic technical component in all gastrointestinal procedure. This study evaluated complications of gastrojejunostomy in gastric cancer surgery with two methods: single-layer and double-layer anastomosis. This study was carried out in the Department of Surgery in Mymensingh Medical College Hospital from January 1st 2010 to June 30th 2012. Fifty patients with carcinoma stomach who needed gastrojejunostomy were included in this study. These patients with average age of 43.22 years were divided in two groups (25 in each group); single-layer and double-layer anastomosis. In single-layer anastomosis gastrojejunostomy was performed in interrupted method with absorbable suture (3/0 vicryl). Double-layer anastomosis was carried out with continuous suture (2/0 silk, 2/0 catgut). Possible post-operative complications like anastomotic leakage, pelvic abscess, abdominal sepsis, anastomotic stenosis and wound infection were evaluated. In the single-layer group, 2 patient (4%) developed anastomotic leakage, wound infection and only 1 patient (2%) developed abdominal sepsis, pelvic abscess and anastomotic bleeding. No patient developed anastomotic stricture. In double-layer group, no patient developed anastomotic leakage but wound infection only in 1 patient (2%). Gastrojejunostomy with single-layer hand-sewn suture technique is safe without serious complications in comparison to double-layer suture technique. More-over operation time is less and cost is less in single-layer method.

Prevalence and risk factors for gastro-esophageal reflux disease in the North-Eastern part of Bangladesh

Despite a common disorder population-based data on gastro-esophageal reflux disease (GERD) in Bangladesh is lacking. This epidemiological study was designed to determine the prevalence of GERD and its association with lifestyle factors. This population-based cross-sectional study was done by door to door interview of randomly selected persons in both urban and rural areas of North Eastern part of Bangladesh by using a validated questionnaire. A cutoff point 3 was chosen as a valid and reliable scale to confirm GERD. Statistical analysis was done by SPSS-12 version and the level of significance was set at P?0.05. A total of 2000 persons with an age range of 15 to 85 years were interviewed; 1000 subjects from urban area and 1000 from rural area. Among the study subjects 1064 were male and 936 were female. A total of 110 persons (5.5%) were found to have GERD symptoms and among them 47 were men and 67 were women. The monthly, weekly and daily prevalence of heart-burn and or acid regurgitation was 5.5%, 5.25% and 2.5% respectively. Female sex, increased age and lower level of education were significantly associated with GERD symptoms. Prevalence was found more among city dwellers (approximately 6.0% versus 4.8%), married (6.23%, n=86), widowed/widowers (16.83%, n=17) and day labourer (8.78%). Level of education inversely influenced the prevalence. No significant association of GERD was found with body mass index (BMI) and smoking. Prevalence of GERD in North-Eastern part of Bangladesh was lower than that of western world. Prevalence was found higher in urban population, women, married, widowed/widowers and in poor and illiterate persons. BMI and smoking had no significant association with GERD. DOI: http://dx.doi.org/10.3329/bmrcb.v38i3.14338 Bangladesh Med Res Counc Bull 2012; 38(3): 108-113 (December)

Mortality rate and clinical features of highly pathogenic avian influenza in naturally infected chickens in Bangladesh

A retrospective study was performed to assess the mortality rates and clinical signs in commercial and backyard chickens naturally infected with the highly pathogenic avian influenza (HPAI) H5N1 virus in Bangladesh. All of the 33 commercial and 25 backyard farms, recorded during the first wave of HPAI outbreaks (January to November 2007) in Bangladesh, were enrolled in this study. The farm profile data, stock information and major clinical signs recognised by the farmers and/or farm attendants, were collected through a prototype questionnaire. The investigating veterinarians' retrospective appraisals of the clinical signs were recorded by interview. After the clinical onset, the incidence rates of mortality in breeder, commercial broiler, commercial layer and backyard chickens were, respectively: 0.0215, 0.0341, 0.0179 and 0.0703 per chicken-day at risk. The four major clinical signs observed were cyanotic combs and wattles, oedema of the head and face, drowsiness and huddling and ecchymotic discoloration of the leg shanks. The first sign (cyanotic combs and wattles) was equally observed in chickens from commercial and backyard farms (p = 0.44) but the second (oedema of the head and face) was more common in backyard farms (p = 0.03).

Prevalence and Pregnancy Outcome of Gestational Diabetes Mellitus Among Bangladeshi Urban Pregnant Women

Objective: To assess the prevalence of gestational diabetes mellitus (GDM) among the pregnant women of Dhaka city and to find out the consequences or effects of GDM on pregnancy outcome. Materials and methods: This was a descriptive type of cross sectional study followed by cohort type of study, conducted in different hospitals in Dhaka city. Initially 960 pregnant women of 24th to 28th weeks were selected purposively; plasma glucose was measured at fasting and two hours after taking 75g oral glucose load. Modified method of Carpenter and Coustan criteria was followed to diagnose GDM. For each GDM case diagnosed, one non-GDM pregnant women was taken as control after matching age and parity. Both groups were followed up to 4 wks after delivery to find out maternal and neonatal mortality and morbidities. Results: Out of 960 pregnant women 72 were GDM positive (7.5%).There was no maternal mortality but morbidities like hydramnions (p<0.001)), pre-eclampsia (p<0.001)), urinary tract infection (p<0.05), puerperial sepsis (p<0.05)) and surgical interventions (p<0.001) were more prevalent in GDM compared to non-GDM groups. The prevalence of antipartum haemorrhage, post partum haemorrhage, and eclampsia did not vary between the groups. There was one still birth, one perinatal mortality (due to respiratory distress syndrome) and one congenital anomaly observed in neonates of GDM mothers. More pre-term (p<0.01), post-term (p<0.01), low birth weight (p<0.001) and macrosomic (p<0.001) babies were found among the babies of GDM mothers than non-GDM mothers. More babies also suffered from neonatal jaundice (p<0.05) and respiratory distress syndrome (p<0.05) in GDM groups than non GDM groups. Conclusion: The prevalence of GDM in urban Bangladeshi population is about 7.5%. Maternal morbidities like hydramnios, pre-eclampsia, infections and operative interventions were observed more in GDM mothers. Pre-term, post-term and LBW babies alone with perinatal morbidities like respiratory distress syndrome, macrosomia and neonatal jaundice were more common in babies of GDM mothers. DOI: http://dx.doi.org/10.3329/jom.v13i2.12749 J Medicine 2012; 13 : 147-151

Status of blood pressure among individuals consuming saline water

Climate change is taking its toll in the form of saline water intrusion into the mainland of Bangladesh, which is one of the lowest-altitude countries in the world. The study was carried out with the objective to assess the blood pressure status associated with salinity in saline prone selected areas of Bagherhat and Tangail districts from March 2008 - June 2008 of rural Bangladesh. Two hundred and ninety subjects were selected purposively from both the districts. About 70% of the respondents were males and below forty years of age. More than two thirds of the respondents were illiterate; belong to 4-5 member family, with monthly family income of less than Tk. 4000 per month. Only one third of the respondents were smokers. More than two thirds of the respondents from salinity area had salinity level of 2-3%. Among them majority were drinking saline water for 6-10 years and 26% were drinking for more than ten years. About 20% of the non saline respondents' systolic blood pressure was 110-120 mm of Hg and 26% of saline area had systolic blood pressure >135-140 mm of Hg. Mean systolic BP among salinity area was more than that for non salinity area. About 19% of the non saline respondents' diastolic blood pressure was ≤ 85 mm of Hg. About one third had ≥ 90 mm of Hg, among them 31% were from saline area. Mean diastolic BP among salinity area was more than non salinity area. There was no history of heart disease, and less than 1% was diabetic among them. About two thirds had mean arterial pressure <70 mm of Hg, among them majority were from non saline area. About one third had >70 mm of Hg, among them majority were from saline area. The study concluded that systolic and diastolic blood pressures of saline group were significantly higher than that of the non saline group.