Infective Endocarditis by Pseudomonas Species Following Percutaneous Transluminal Mitral Commissurotomy.

Infective mitral valve endocarditis developed in a 35-year-old male patient after a percutaneous transvenous mitral commissurotomy (PTMC). The echocardiogram demonstrated vegetation in the anterior leaflet of the mitral valve and blood culture showed growth of Pseudomonas species which was sensitive to Ceftazidime, Ciprofloxacin, Cotrimoxazole and Imipenem and resistant to Amikacin, Ceftriaxone, Gentamycin and Nitilmycin. The patient underwent treatment with intravenous ceftazidime and ciprofloxacin for six weeks and patient improved significantly and got cure of the disease. Infective mitral valve endocarditis should be recognized as a potentially lethal complication after PTMC. The important measures to prevent bacteremia during PTMC and the appropriate role of antibiotics and operation are discussed

Anti H.pylori IgM in Symptomatic and Asymptomatic Population.

To evaluate the usefulness of specific IgM in the diagnosis of Helicobacter pylori infection, a cross sectional study was carried out in the Department of Microbiology, Mymensingh Medical College between July 2006 to June 2007. A total of 45 patients having upper gastrointestinal symptoms underwent endoscopy and were subsequently diagnosed as patients with gastritis, peptic ulcer (PU) and non-ulcer dyspepsia (NUD) and another 45 asymptomatic individuals aged 18-65 years, were included in the study. The serum samples of participants were tested for presence of anti-H pylori IgM by using ELISA method. The ELISA for anti H. pylori IgM provided sensitivity and specificity of 73.33%, 93.33% respectively.

Effect of Tranexamic Acid after Cardiac Surgery in Children.

Background: The antifibrinolytic drug tranexamic acid (TA) decreases blood loss in Pediatric patients under going cardiac Surgery. However its efficacy has not been extensively studied in children. Method: We examined 750 children under going cardiac surgery form 2004 to 2007 in National Institute of Cardiovascular Diseases (NICVD), 379 children in the Tranexamic Acid group (TA) and 371 included in placebo (P) group. After induction of anesthesia and prior to skin incision, patients received either tranexamic acid (10mg/kg followed by 1mg/kg/hr) and saline placebo. After admission to intensive care unit total blood loss and transfusion requirements during the first12 hours were recorded. Result: Children who were treated with tranexamic acid had 24% less total blood loss (26±7 vs 34±17 ml/kg) compared with children who received placebo (p<0.05). Additionally, the total transfusion requirements, total donor unit exposure and financial cost of blood components were less in the tranexamic acid group. Conclusion: Tranexamic acid can reduce perioperative blood loss in children undergoing cardiac surgery.

Perosteal osteosarcoma of clavicle-treated by limb salvaging surgery (total cleidectomy).

Osteosarcoma of clavicle is extremely rare. Improved survival in patients with osteosarcomas has been associated with recent advances in imaging techniques, histopathological methods, surgery and chemotherapy. In most cases the diagnosis can be made with confidence on the x-ray appearance. Other imaging studies like- radioisotope scans may show up-skip lesions, computed tomography (CT) and magnetic resonance imaging (MRI) show the extend of the tumour. Incisional biopsy or excisional biopsy is carried out after careful clinical study and proper investigations. A 30 years old cultivator with a late case of primary osteosarcoma of clavicle was treated with pre-operative and post-operative chemotherapy and was managed with surgical excision of tumor with limb sparing. The patient was clinically disease free for about 08 (eight) months. Then the patient developed recurrences and died 11 (eleven) months after operation.

Diagnosis of human rotavirus in stool specimens: comparison of different methods.

A total of 345 stool specimens of hospitalized children below 5 years of age with acute gastroenteritis were tested for the presence of rotavirus by Polyacrylamide gel electrophoresis (PAGE), a monoclonal antibody based enzyme immunoassay (EIA) and a latex agglutination test (LAT). Detection rate for PAGE and EIA were 24.9% (345/86) and 20.9% (345/70) respectively. Using PAGE as the standard, the sensitivity and specificity of EIA were 75.6% and 98.1% respectively. The sensitivity of LAT was 70.9% with 100% specificity (LAT was done in only PAGE positive specimens). LAT appeared as the simplest and economic for both bed side and field use.

Electrophoretic patterns of human rotavirus strains prevailing among hospitalized children with acute gastroenteritis.

Polyacrylamide gel electrophoresis (PAGE) and silver staining was applied to detect rotavirus dsRNA from acute diarrheic stool of 365 hospitalized children below 5 years of age. The study was conducted at Mymensingh and Sunamgonj districts, Bangladesh from January 2002 to February 2003. Among 345 stool specimens tested, 86 (24.9%) were positive by PAGE. The rate of infection was highest in 0-12 months of age and declined significantly with increasing age. Males were slightly more infected than females and infection rate was more in winter. Twelve different electropherotypes were identified, of them eight were long and four were short. RNA profiles of the analyzed specimens, 88.6% were long and 11.4% were short patterns. Two of these long patterns (2F N 1 L, 2F N 3(U) L) circulated through out the study period and a single type was predominant (2F N 1 L). Mixed electropherotypes were also detected. Electropherotyping technique can be applied routinely to study the prevalence and epidemiological features of rotavirus infection. It is an excellent method for studying genomic variation, tracing mixed infections, detecting atypical rotaviruses lacking group-antigen and characterizing virus strains in outbreaks.

Post operative diagnosis of osteopetrosis.

Osteopetrosis is a rare hereditary disease that was first described by a German Albert Schonberg in 1904. At least five types of osteopetrosis have been described. Among them osteopetrosis congenita (autosomal recessive) and osteopetrosis tarda (autosomal dominant) are most common. Here we are reporting a case of osteopetrosis tarda, who is a female of fifty years of age presented with fracture femur. Preoperatively there was no suspicion of osteopetrosis.She was only suspected while introducing an IM Nail during her fracture reduction. Diagnosis of osteopetrosis was confirmed post operatively by histopathology of medullary cavity of her femur.

Treatment of non union of humerus using G. A. Ilizarov technique.

The management of the non union of humerus is one of the most challenging problems that the surgeon confronts in his practice. The procedures traditionally used are: I.M. Nailing, interlocking, plating, transplantation of allograft. In our series, 36 cases with non union has been treated by G.A. Ilizarov technique. The age range were: 21-62 years with an average of 32 years. The initial treatment were done by DCP, rush nails & plates with screw fixation. The duration of treatment ranged from 5-11 months (average 8 months). With the application of Ilizarov fixator a good range of elbow & shoulder motion were achieved. The average follow up period was 5 years with a range of 1-8 years. Union was achieved in all the 36 cases.

Serological diagnosis of Toxoplasma gondii infection in women associated with gyneco-obstetric problems.

The latex agglutination test (Toxoreagent) was used to detect the sero-prevalence of Toxoplasma gondii in 302 Bangladeshi women who were under treatment for various gyneco-obstetric problems at the Mymensingh Medical College during January to June 1991. The over-all sero-prevalence rate was 15.89%, of which 6.25% reacted at 1:32, 33.33% at 1:64, 16.67% at 1:128, 22.92% at 1:256, 6.25% at 1:512 and 14.58% at 1:1024. The positivity rate of 18.60% recorded in women between 31 and 40 years was insignificantly (p > 0.05) higher than that of 15.44% in women between 17 and 30 years of age. Over-all 26.49% of infections resulted in abortion, 6.62 in stillbirths and 30.79% in dystocia, of which 20.0%, 30.0% and 7.53% women had positive titers to T. gondii, respectively, whereas 17.43% women with normal live births had also positive titers to T. gondii. The over-all prevalence rate of abortion in association with T. gondii infection was 5.30% which was higher than the rates of stillbirths (1.99%) and perinatal death (0.66%). It is concluded that toxoplasmosis can cause abortion, stillbirths and perinatal death in Bangladeshi women.

Preparation of a neutralizing monoclonal antibody specific to serotype 8 rotavirus strains with a super-short RNA pattern.

Extensive cross-neutralization tests have identified seven serotypes of rotavirus. Recently, it has been reported that several human strains (69M, B37 and B38) with a super-short RNA pattern carry new serotype specificity (serotype 8). By using the strain 69M as an immunizing antigen, we prepared a neutralizing monoclonal antibody (designated 69M-2D). In neutralization tests using 18 human and two animal rotavirus strains with different serotype specificities, the 69M-2D antibody was found to neutralize only serotype 8 strains. Also, in an enzyme-linked immunosorbent assay (ELISA), the antibody reacted exclusively with the serotype 8 strains. Thus, the reactivity pattern of the 69M-2D antibody was serotype 8-specific. This antibody should be useful as another reagent for serotyping rotaviruses by ELISA.

Chronic diarrhoeal diseases in adults (a preliminary report).

The relationship of chronic diarrhoeal diseases in adults on socio-economic condition, parasitic infestation and degree of anaemia have been investigated. The disease was more prevalent in poor socio-economic group of people. Most of the patients had mixed parasitic infestations. Anaemia was present in all the cases. Difference in the degree of anaemia was not significant amongst the patients having either Ascaris or hookworm infestation.