Risk factors of bronchial asthma in two contrasting settings–metropolitan and coastal areas of Bangladesh: A case control study.

Background. Seven million people are suffering from bronchial asthma in Bangladesh. But scanty data is available to explain the risk factors for asthma in Bangladesh. Methods. This population-based, age, sex, and economic status matched case-control study was conducted to identify the risk factors responsible for the development of bronchial asthma in two contrasting settings, the metropolitan capital city and coastal area of Bangladesh. A structured pre-tested questionnaire was filled up by face-to-face interviews with the patients or parents of patients with bronchial asthma and the normal controls after a respiratory physician confirmed the diagnosis on the basis of history, physical examination and spirometry. Results. Presence of allergic problems was recognised as risk factors for the development of bronchial asthma. Concomitant existence of atopic diseases, like allergic rhinitis, eczema and allergic conjunctivitis were found to be significant risk factors in both the settings. History of early childhood lung infections, like pneumonia, bronchiolitis and intake of antibiotics and paracetamol in last 12 months were also observed to be the risk factors in both the areas. Though most of the so-called allergic foods were statistically found to be a protective factor in both the settings [odds ratio (OR) 0.48, 95% confidence intervals (CI) 0.37-0.63 in city area and OR 0.80, 95% CI 0.66-0.96 in coastal area], this was considered to be an artifact. Conclusions. Several common risk factors for the development of bronchial asthma were identified in both city and coastal areas of Bangladesh. Bronchial asthma prevention campaign in Bangladesh may focus on sensitising the people on these risk factors.

Consecutive bites on two persons by the same cobra: a case report

In tropical countries like Bangladesh, persons are bitten by snakes every day and a considerable number of patients die en route to the hospital. An event of consecutive neurotoxic bites on two men by a single snake was observed in the Snake Bite Study Clinic (SBSC) of the Chittagong Medical College Hospital (CMCH). Two brothers, working in their semi-pucca restaurant, were successively bitten by the same cobra on their lower limbs. Within an hour, they were taken to the CMCH. Few minutes after admission, both developed symptoms of neurotoxicity: ptosis, nasal voice, dysphagia, broken neck sign, etc. They received polyvalent antivenom (Haffkine Bio-Pharmaceuticals Company, India) and other auxiliary treatment immediately. Within few hours, neurotoxic features were completely absent. Later, the snake was captured in the restaurant kitchen and identified as monocellate cobra (Naja kauthia) by the SBSC. The elder brother developed significant antivenom reactions and both presented necrosis and ulceration at the bite sites. In these cases, immediate arrival to the hospital and early administration of antivenom resulted in successful recoveries.(AU)

Anti-snake venom: use and adverse reaction in a snake bite study clinic in Bangladesh

Snakebites can present local or systemic envenomation, while neurotoxicity and respiratory paralysis are the main cause of death. The mainstay of management is anti-snake venom (ASV), which is highly effective, but liable to cause severe adverse reactions including anaphylaxis. The types of adverse reaction to polyvalent anti-snake venom have not been previously studied in Bangladesh. In this prospective observational study carried out between 1999 and 2001, in the Snake Bite Study Clinic of Chittagong Medical College Hospital, 35 neurotoxic-snake-bite patients who had received polyvalent anti-snake venom were included while the ones sensitized to different antitoxins and suffering from atopy were excluded. The common neurotoxic features were ptosis (100%), external ophthalmoplegia (94.2%), dysphagia (77.1%), dysphonia (68.5%) and broken neck sign (80%). The percentage of anti-snake venom reaction cases was 88.57%; pyrogenic reaction was 80.64%; and anaphylaxis was 64.51%. The common features of anaphylaxis were urticaria (80%); vomiting and wheezing (40%); and angioedema (10%). The anti-snake venom reaction was treated mainly with adrenaline for anaphylaxis and paracetamol suppository in pyrogenic reactions. The average recovery time was 4.5 hours. Due to the danger of reactions the anti-snake venom should not be withheld from a snakebite victim when indicated and appropriate guidelines should be followed for its administration.(AU)

Total Count of White Blood Cells in Adult Male Smokers.

The present study was carried out to observe the changes in total count in WBC in cigarette smokers. The study population consisted of 105 adult male smokers and non-smokers, aged 20~40 years, from different socio-economic classes. Among them, 30 apparently healthy non-smokers were taken as control . 75 apparently healthy smokers, who had the history of smoking of one or more cigarette per day, regularly for at least last one year, were taken as the study group. Smokers were again subdivided into three categories according to the number of cigarettes they consumed per day. For statistical analysis unpaired “t” test was used for comparison. Mean ± SD of Total count of WBC in non smokers and smokers were 7501.66 ± 929.4 /mm3 and 9171.3 ± 1037.7/mm3 respectively. Smokers had significantly (P <0.001) higher WBC counts than non-smokers. In addition, WBC count was found increased with intensity of smoking. The smokers who were smoking e” 20 cigarettes per day had the higher total WBC count than those who were smoking lesser. The findings of the present study suggest that cigarette smoking may cause increased the total count of WBC, which may predict high risk for some fatal diseases.

Study of Lipid Profile in Shift Workers.

Background: The present study was undertaken to evaluate the changes of serum lipid profile in apparently healthy shift workers and non shift workers to identify the possible high risk factors for developing atherosclerotic changes. Methods: Serum Total Cholesterol, Triglyceride, HDL-Cholesterol and LDL-Cholesterol levels were estimated and blood pressure was measured in apparently healthy adult shift worker and non shift worker participants. Total 60 subjects age ranged from 20-50 years were selected, of whom 30 were shift workers (Study) for at least one year and 30 were non shift workers (control). Height, weight and resting blood pressure of all the subjects were recorded before collection of blood. Blood samples were collected after over night fasting for estimation of serum lipid and lipoprotein levels and were measured by standard laboratory technique. Data were analyzed by unpaired ‘t’ test. Results: The mean serum Total Cholesterol and LDL-Cholesterol levels were significantly higher in shift workers compared to those of non shift workers. Again mean serum Triglyceride and HDL-Cholesterol levels in the shift workers did not differ significantly from that of non shift workers. These changes may be related to internal desynchronization due to disruption of circadian rhythm. Conclusion: The changes in serum lipid and lipoprotein levels with the exception of HDL-Cholesterol and Triglyceride in the subjects engaged in shift work may put them at increased risk for coronary artery disease.

Peak Expiratory flow Rate in Pregnat Women.

In the present study peak expiratory flow rate (PEFR) were estimated in pregnant women during different trimester to observe the alteration in air flow rate during pregnancy. This study was carried out in the department of Physiology of Dhaka Medical College from July 2004 to June 2005. For this purpose, total 100 women with age ranged from 25 years to 35 years without any recent history of respiratory diseases were selected and divided into 25 healthy non-pregnant women as control and 75 normal pregnant women as study group. Study group was further divided into 25 in first trimesters, 25 in second trimester and 25 in third trimesters of pregnancy. All the subjects belonged to lower socioeconomic class. The PEFR was estimated by using an automatic spirometer. The measured values and percentage of predicted values of PEFR were estimated during the 1st, 2nd, 3rd trimesters of pregnant women and non-pregnant women. Statistical analysis of data were done by un paired student’s “t” test. The PEFR was significantly lower in both 2nd and 3rd trimester pregnant women than that of nonpregnant women. Again the PEFR was significantly lower in 3rd trimester than that of 1st trimester of pregnant women. There were no statistically significant difference of PEFR between the non-pregnant and 1st trimester; between the 1st trimester and 2nd trimeste ; and between the 2nd trimester and 3rd trimester of pregnant women. It may be concluded that PEFR were progressively decreased throughout the pregnancy, most likely due to mechanical effects of progressively increased size of uterus that progressively decreases lung volumes and capacities.

Assessment of Percentage Saturation of Hemoglobin with Oxygen in Arterial Blood of Pregnant Women.

Objective: Percentage saturation of hemoglobin with oxygen in arterial blood (SaO2) was studied in pregnant women to evaluate the lung function status in pregnancy. Methods: This study was conducted in the department of physiology in Dhaka medical college during July 2004 to June 2005. For this purpose total 32 women with age ranged 25-35 years without any recent history of respiratory diseases were selected from Dhaka city. Eight (8) age matched apparently healthy women was taken as control and Twenty four (24) normal pregnant women without any complication were included in experimental group. All pregnant subjects were studied during first, second and third trimester. SaO2 was determined by “Easy Blood Gas Auto Analyzer”. SaO2 during different trimesters were compared with that of non pregnant and also among the trimesters. Statistical analysis was done by students unpaired ‘t’ test. Result: Mean ±SD SaO2 during first trimester (97.73%±0.92), second trimester (98.05%±0.54) and third trimester (98.40%±0.30) were progressively increasing and were significantly higher (p<0.05, p<0.001, p<0.001) than that of non pregnant women (96.71±0.63). But no statistically significant differences were observed among the trimesteric values. The present result indicates increased lung function in pregnant women associated with progressively increased oxygen saturation with trimester. Higher progesterone level is related to increased ventilation which is more marked in luteal phase of menstrual cycle. In pregnant women gradually rising progesterone level reaches its peak at the later part of pregnancy. Conclusion: Therefore it may be concluded from the present study that progressively increased SaO2 might be related to hyperventilation induced by high progesterone level.

A retrospective study on genito urinary Rhabdomyosarcoma.

A retrospective study was carried out on Genitourinary Rhabdomyosarcoma in the Department of Paediatric Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period January 1990 to December 1999. Total thirteen patients were treated during this period, age ranging from 1 month to 12 years. Eight patients were male and five were female (M: F = 1.6: 1). Diagnosis was made by history, thorough physical examination, digital rectal examination, ultrasonography, intravenous urography, CT scan and biopsy. All the patients were treated with chemoradiation theraphy as a first line of management and surgical excision was done for local residual tumours. Eight children (61.5%) were asymptomatic after completion of chemo-radiation therapy. Three (23.07%) patients discontinued the chemo-radiation schedule. Residual mass was present in one (7.7%) case for which partial cystectomy was done and the patient died in the 5th post operative day. Another patient (7.7%) who had pulmonary metastasis at the time of diagnosis, died during chemo-radiation therapy.

Growth performance of Bangladeshi affluent school children (5-14 years).

A cross sectional anthropometric survey of 2045 healthy children (5-14 years) of affluent society of Dhaka City was done with the aim to compare their growth with the National Centre for Health Statistics (NCHS) standard. It was found that both weight and height of boys and girls of the studied children fall between 25th to 50th percentile of NCHS standard. In case of boys, body weight deviates below 25th percentile after 12 years whereas mean height is nearly parallel to 50th percentile up to 14 years. In case of girls, the pattern of growth is same except the fall below 25th percentile at the age of 8 and 9 years and the height remains above 25th percentile up to 12 years. It can be concluded that mean growth of affluent Bangladeshi school children is comparable to NCHS standard with minor variations.