Review on diagnosis and molecular characterization of Toxoplasma gondii in humans and animals

@#Toxoplasma gondii is an obligate intracellular protozoon which causes toxoplasmosis, an important zoonotic disease that is endemic worldwide. Common sources of T. gondii infection in humans are food or water contaminated with oocysts and raw or undercooked meat with cysts. In animals, common sources of infection include feed, water, or litter contaminated with oocysts. The diagnosis and molecular characterization of T. gondii infection in humans and animals is crucial due to public and veterinary health importance. Various traditional and serological methods have been used in clinical practice for toxoplasmosis diagnosis, but interpreting the results remains a challenge. Several molecular techniques have also been used for the detection and genetic characterization of T. gondii, but primarily in research settings. In this paper, we review the techniques that are currently used for the diagnosis and genetic characterization of T. gondii in humans and animals, along with their advantages and disadvantages. The techniques reviewed have laid the groundwork for the future development of more effective and precise detection and characterization of T. gondii. These advances will contribute to a better understanding of epidemiology, prevention and control of toxoplasmosis. Thus, this review would be of particular interest to clinical physicians, veterinarians and researchers.

Assessment Of Drug Utilization Among Pediatric Patients In Private Clinic And Public Hospital Of Bangladesh

Objective: Aim of the study was to assess drug utilization among pediatric patients in both private practice and hospital settings in Rajshahi city, Bangladesh. Methods: This observational study was conducted during a period of two months (March to April) in 2017. Prescriptions were randomly collected from patients and recorded in a predesigned questionnaire form. The data analysis was carried out by using a statistical software package GraphPad Prism. Results: The study involved a total of 185 patients, of which 62.70% were male and 37.30% were female. The patient’s age ranges from 1 mo-12 y and highest number of patients visited physicians belong to group 1 mo-1 y (47.57%). Most commonly occurring disease conditions were pneumonia (24%), the leading cause of hospitalizations among the children's age group of 1 mo-1 y. The results indicated that physician’s handwriting was not clear and legible in 50 (27.03%) prescriptions. A total of 468 drugs were prescribed with an average of 2.53 per prescription. However, none of the drugs were prescribed by generic name. The most commonly prescribed drugs were antibiotics 173 (93.5%). About 78% patients were exposed to antibiotics, of which single antibiotic was prescribed in 116 (62.70%) and two antibiotics in 23 (12.43%) prescriptions. Among the drugs, NSAIDS 65 (35.14%), anti-histamine 57 (30.81%), anti-asthmatic 49 (26.49%) drugs were assigned in prescriptions followed by vitamin and minerals 51 (27.57%). Steroids 57 (30.81%) and hypnotics 26 (14.05%) were also accounted in many prescriptions. Interestingly, antibiotics were indiscriminately prescribed in private practices without any bacteriological examinations, whereas in hospital settings, most of the treatment was initiated after culture and sensitivity tests. Conclusion: Children were highly exposed to antibiotics, steroids and hypnotics in both private practice and hospital settings.  So Medical practitioners should be aware of current guidelines for prescriptions of antibiotics and drugs in child.

Ice-on-Eyes Test in the Diagnosis of Myasthenia Gravis.

Myasthenia gravis is the most frequent autoimmune neuromuscular transmission disorder with incidence of 2-20 patients per million. Its pathophysiology is autoimmune, with acetylcholine receptor auto antibodies damaging the post-synaptic fold at the muscle membrane. The diagnostic confirmation of myasthenia gravis is often challenging. Ice-oneyes test can be used to diagnose this disease for its simplicity, safety and cost-effectiveness. Here we report a case of myasthenia gravis in Enam Medical College Hospital, Savar, Dhaka where ice-on-eyes test was done with improvement of ptosis of the patient. Aim of this case report is to make aware our physicians to apply this simple bed side test instead of common traditional edrophonium (tensilon test) test for confirmation of the diagnosis of ocular myasthenia gravis.

Interventional Pain Management in Rheumatological Diseases: A Three Years Physiatric Experience in a Tertiary Medical College Hospital in Bangladesh

BACKGROUND: Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. METHODS: A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. RESULTS: The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. CONCLUSIONS: All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.

Herpes zoster ophthalmicus in an otherwise healthy 7 years child.

A 07 years otherwise healthy child, non vaccinated for chickenpox and with a history of chickenpox infection at 02 years of age presented with red colored lesions in right upper lid, right side of forehead, vertex and right side of nose and defective vision in right eye in Mymensingh Medical College Hospital, 20 days after the appearance of blister in the same region. On examination granulation tissue was present on the same area. There was no hair and skin over that area. Lesion was strictly limited to right side of midline. Eyelashes of right upper lid were absent and there was defective closure of eyelids. Best corrected visual acuity of right eye was 3/60 and of left eye was 6/6. There was ciliary congestion of right eye with haziness of cornea at interpalpebral region of right eye. Corneal sensitivity was reduced and there was uniform fluorescein staining at central part of cornea. Mild flare and cells were present in anterior chamber. Fundus examination revealed no abnormality. He was treated with systemic acyclovir, antibiotics, topical acyclovir, antibiotic and atropine. Corneal ulcer and skin lesions were healed, but the patient developed cicatricial ectropion of right upper lid and best corrected visual acuity of right eye was reduced to 6/60 due to corneal opacity. So early diagnosis and treatment of herpes zoster ophthalmicus is mandatory to prevent sight threatening complications.

A giant vesical calculus.

Massive or giant vesical calculus is a rare entity in the recent urological practice. Males are affected more than the females. Vesical calculi are usually secondary to bladder outlet obstruction. These patients present with recurrent urinary tract infection, haematuria or with retention of urine. We report a young male patient who presented with defaecatory problems along with other urinary symptoms. The patient having an average built, non diabetic but hypertensive. The stone could be palpated by physical examination. His urea levels were within normal limits but urine examination shows infection. USG reveals bilateral hydronephrosis with multiple stones in both kidneys along with a giant vesical calculus. After controlling urinary infection and hypertention he underwent an open cystolithotomy. During operation digital rectal help was needed to remove the stone as it was adherent with bladder mucosa. Post operative period was uneventful. His urinary output was quite normal and had no defaecatory problems. Patient left the hospital 10 days after operation.

Post operative throat complications after general anesthesia, a comparison between laryngeal mask airway and endotracheal tube

To determine the incidence of post operative throat complications such as pain dvsphagia, hoarseness of voice, dryness of throat and cough, after general anesthesia, and to compare between laryngeal mask airway and endotracheal tube. Prospective, double blinded, comparative, randomized observational study. Department of Anesthesiology and Surgical Intensive Care Unit, Civil Hospital Karachi, over a period of one year. 150 randomly selected A.S.A I and A.S.A II patients receiving general anesthesia were divided into two groups, 75 patients in each group. One group receiving general anesthesia through endotracheal tube and other group through laryngeal mask airway. This study was based on two proformas 1. Intra operative proforma. 2. Post operative proforma. This study has shown that the incidence of post operative throat complications after general anesthesia are 51/150 [34%] i.e 35/75 [46.6%] with endotracheal tube and 16/75 [21.3%] with laryngeal mask airway. General Anesthesia with laryngeal mask airway is associated with lesser number of throat complications as compared to endotracheal tube

Comparison between the time required to obtain maximum recovery point [10] after intravenous induction of general anesthesia with injection midazolam and injection thiopentone sodium in day case urological procedures

The objective of this study was to determine whether injection Midazolam could produce similar anesthesia, characterized by short duration of actions and clear headed and rapid recovery. Midazolam was compared with Thiopentone Sodium during day case short urological procedures. This was a prospective, single blinded, comparative, randomized, observational study. It was conducted in the Department of Anesthesiology and Surgical I.C.U, Civil Hospital Karachi and Dow Medical College, over a period of one year. Hundred randomly selected A.S.A I and A.S.A II patients receiving general anesthesia, were divided into two groups. 50 patients in each group, group I receiving injection Midazolam and the other, group II receiving injection Thiopentone Sodium, as IV induction agents, all patients received injection Pentazocine 0.3mg /kg and Injection Suxamethonium 1-1.5 mg/kg and anesthesia maintain with 02 + N2O+Halothane. At the end of surgical procedure all anesthetic agents were discontinued. Patients were extubated when they responded to verbal commands. Recovery from anesthesia was assessed by an evaluator who was unaware of the IV induction agents used for each patient. This study was based on two proforma I]. Intra operative proforma II] Recovery Room proforma. In group I [Midazolam group] after 5 and 10 minutes, no patient received 10 recovery points, after 20 minutes 6 patients received 10 recovery points and after 30 minutes 26 patients received 10 recovery points and those who didn't score 10 points after 30 minutes were 18 patients. In group II [Thiopentone Sodium group] after 5 minutes 1 patient, after 10 minutes 2 patients, after 20 minutes 22 patients, after 30 minutes 23 patients received 10 recovery points, patients who didn't score 10 points after 30 minutes were just 2. After induction with injection Thiopentone Sodium recovery is more rapid as compared to the induction with injection Midazolam, so injection Thiopentone Sodium is the better of the two drugs under comparison for day case urological procedures

Application of the capture-recapture method for estimating number of mobile male sex workers in a port city of Bangladesh.

Male sex workers (MSWs) and sex trades are not new in Bangladesh. Current HIV interventions for MSWs need to be expanded in the major cities, but the number of MSWs needs to be scientifically estimated. Although two-sample capture-recapture surveys are suitable for closed populations, this method was here applied to indirectly estimate the number of mobile MSWs in a conservative social setting, a port city of Bangladesh. Use of the method resulted in an estimation of 248 MSWs (95% confidence interval, 246-250) who picked up clients only at open and known contact venues. This estimate does not, however, reflect the total number as MSWs who worked in unknown hidden venues and could not be reached. Experience suggests that the two-sample capture-recapture method is a simple technique for reliably estimating an unrecognized population. The limitation of this method can be minimized by shortening the time gap between surveys, creating an enabling environment to encounter harassment of MSWs, and offering safety to peer-staff.