Assessment of urinary interleukin-18 in the early post-burn period to predict acute kidney injury of various degrees of burn patients

Background:Early detection of acute kidney injury (AKI) in burn-injured patients can help modify the treatment to prevent progression of acute renal failure and reduce the need for renal replacement therapy. The aim of the study was to evaluateurinary interleukin-18 in the early post-burn period to predict the AKIfor the various degrees of burn patients. Methods:This prospective observational study was conducted in the department of nephrology, Dhaka medical college in collaboration with burn and plastic surgery unit of the same medical college hospital, from July 2017 to June 2018 for a period of one year. The 48 burn patients (Age>18 years) who attended in the burn unit of Dhaka medical college, Dhaka of both sexes were enrolled in this study. Data were analyzedby using SPSS 22.0. A value of p<0.05 was considered statistically significant for all tests. Results:In this study, mean age of the burn patients was 32.41�.59 years. Male female ratio was 3.36:1. Urinary IL-18 in diagnosis of AKI showed accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 93.8%, 91.7%, 94.4%, 84.6% and 97.1% respectively. AUC for urinary IL-18 at admission was 0.968 (CI, 0.921-1.000) and AUC for serum creatinine at admission was0.937 (CI, 0.871-1.000).Conclusions:According to Kappa value, AUC and sensitivity and specificity urinary IL-18 is a good biomarker in predicting of early AKI in burn patients

Short Term Visual and Refractive Outcome following Surgical Intervention forPosterior Capsule Opacification (PCO) in Children in a Tertiary Eye Hospital

BACKGROUND: PCO occurs commonly postoperatively followingcataract extraction in children, obscuring vision as did the initialcataract. It may require a second surgical procedure when it is dense.It is expected that this results in restoration of vision and it is importantto ascertain that this is the case as well as to examine any significantchanges in refraction thereafter.M ETHODS: A retrospective observational study extractingdemographic and clinical information from case notes of patients whohad membranectomy and/or capsule polishing between October 2017and September 2018.RESULTS: 57 eyes of 51 patients were enrolled. There was a 2:1male: female ratio. Mean age at cataract surgery was 6.33 3.59yearswhilst that for PCO surgery was 9.68 3.89years. Postoperativevisual acuity (by WHO definition) was good (between 6/6 and 6/18)in 33.3%, compared to 8.8% preoperatively. Whereas presenting visualacuity was poor (<6/60) in 61.4% preoperatively, this reduced to30% postoperatively. Visual outcome was influenced by age at cataractsurgery, age at PCO surgery, interval between cataract and PCO surgeryand type of cataract. Children >8 years of age at time of PCO surgeryhad a greater proportion of good post-operative best corrected visualacuity (BCVA) (52.6%), whilst 75% of children younger than 8yearsat time of surgery turned out with poor BCVA after surgery.Developmental cataracts proportionately had the best outcome ofvisual acuity. There was a range of refractive shift of +0.25D to ­5.25D with a mean myopic shift of ­1.51D following membranectomy. CONCLUSION: There was a good proportion of children withsignificant improvement in visual acuity on the short term,and a mildmyopic shift following membranectomy.

Hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh

@#Hemoprotozoans are important pathogens of animals and humans, among which some species have zoonotic significance. The prevalence of different hemoprotozoa and Anaplasma spp. in larger mammals have been reported from different regions of the world. But, very few studies have been conducted to estimate the prevalence of hemoprotozoa in rodents and shrews of South-East Asia. The study assessed the prevalence of hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh. Blood samples (n=451) were collected from rodents and shrews between June 2011 and June 2013 and July-December 2015 from 4 land gradients of Bangladesh. Giemsa-stained blood smears revealed that 13% of animals were harboring hemoprotozoa (4.7% Babesia spp., 0.67% Plasmodium spp.), and Anaplasma spp. (7.5%). The study may serve as a guide for future hemoparasitic research of rodents and shrews.

Concurrent management of myopic choroidal neovascularization and rhegmatogenous retinal detachment with intravitreal antivascular endothelial growth factor during primary retinal detachment repair

We report concurrent management of rhegmatogenous retinal detachment and myopic choroidal neovascularization in the left eye of a 24-year-old female who presented with sudden dimness of vision due to retinal detachment and choroidal neovascularization. Intravitreal antivascular endothelial growth factor was injected during primary vitrectomy for retinal detachment. At final follow-up, the retina was attached with scarring of choroidal neovascularization. Ours is the first report of the use of intravitreal antivascular endothelial growth factor during vitrectomy for retinal detachment.

Multimodal imaging characteristics of hydroxychloroquine retinopathy

Hydroxychloroquine (HCQ) is known to cause retinal toxicity. Early detection of the toxicity is necessary to stop the drug in time. Multicolor imaging (MC) is a new noninvasive retinal imaging modality that simultaneously acquires three reflectance images of the retina using three individual lasers producing a composite image, thereby allowing analysis of changes at various levels within the retina. It is a new and promising addition to the retinal imaging armory. MC characteristics of HCQ toxicity are hitherto unreported. A 61-year-old female presented with history of HCQ intake (400 mg/day) for the last 6 years. She had retinopathy in both eyes. Multicolor composite image showed circumscribed perifoveal arcuate area of darkening, and infrared reflectance showed speckled hyperreflecetance in both eyes. MC imaging shows definite changes in HCQ toxicity, and it might emerge as a possible screening tool in future.

Nutritional Status of Children Living in an Orphanage in Dhaka city, Bangladesh

Introduction: Children living in orphanages tend to be neglected and may be malnourished. This study assessed the socio-economic background and nutritional status of children living in an orphanage in Dhaka city, Bangladesh. Methods: A cross-sectional study was conducted among the children in Sir Salimullah Muslim Orphanage, Dhaka from January to November 2014. Systematic sampling was adopted to collect data from 232 children using a semi-structured questionnaire. Anthropometric measurements of the children were taken and the WHO reference growth chart was used to determine the children’s nutritional status. Weight-for-age was categorised by mild, moderate and severe malnutrition. The Pearson Chi-square test was performed to determine the association between the extent of malnutrition and socio-demographic characteristics of the children. Results: The majority of the children (60.3%) in the orphanage were malnourished, with mild, moderate and severe malnourished being 43.1%, 16.8% and 0.4%, respectively. Malnutrition was higher among the boys than girls in the age group of 15-18 years. The orphans suffered significantly (P<0.05) from malnutrition compared to those, who had at least one parent alive. Conclusion: Malnutrition is highly prevalent among children and adolescents under residential care and needs to be addressed. In particular, early identification and intervention can improve the quality of nutritional status of the urban orphanage population. An investigation with a large sample is highly desirable to explore the severity of the problem in the national context.

Positive and Negative Symptoms in Patients of Schizophrenia: A Cross Sectional Study.

Background: Analysis of positive and negative symptoms of schizophrenia has been increasingly needed for a systematic management plan. Unfortunately, this type of study was lacking in Bangladesh. Aims: Th e study aims were to fi nd out the predominant symptom pattern and associating factors in schizophrenia. Methods: Th is was a cross sectional, analytical and descriptive study done in a tertiary care hospital with a sample size of 78. Th e SCID-I and pre designed socio demographic questionnaire was applied. Positive and negative symptoms were assessed by using the Positive and Negative Symptom Scale (PANSS). Statistical analysis was done through SPSS version 17. Results: Among 78 patients, schizophrenics with positive symptoms (57.7%) were predominant over schizophrenics with negative symptoms (42.3%). Delusion (64.1%) and blunted aff ect (55.1%) were the most frequent positive and negative symptoms respectively. Negative symptoms were signifi cantly associated with poverty, unemployment and lack of education. Limitations: Single centered cross sectional study with small sample size. Conclusions: Schizophrenic patients with positive symptoms visit clinicians more readily than those with negative symptoms.

Establishment of Blastocystis hominis in-vitro Culture Using Fecal Samples from Infants in Slum Area of Mirpur, Dhaka, Bangladesh.

Introduction: Blastocystis hominis (B. hominis) is an obligate anaerobic protozoan found in the human large intestine, and is the most common eukaryotic organism reported in human fecal samples. Method: Multiple stool samples from 460 children (53.9% male and 46.07% female) were collected and examined for the presence of Blastocystis hominis in Parasitology Laboratory of International Centre for Diarrhoeal Diseases Research, Bangladesh during the period of 9th January to 28th December, 2011. Among them, 255 were diarrheal patients (56.47% male and 43.53% female). Direct microscopy was done for each of the samples and each sample was cultured in vitro for 48 hours and observed again for the presence of the pathogen. Th e aim of the study was to develop a sustainable technique to identify the pathogen. Results: In culture, several morphological forms were observed. Th rough microscopy, various morphological forms were clearly observed. Within 5679 tested samples, 795 samples (0.14%) were positive for B. hominis. As multiple forms were observed in the same sample, the most prevalent was cyst (0.125%) whereas least prevalent was granular (0.0072%). Th e highest percentage for all the morphological forms was observed in age group 25-36 months. In direct microscopy from fresh samples, children from 37-48 months showed the highest percentage (22.9%) of infection (p=0.000). In culture, the same age group showed the most infection rate (p=0.000). Among the diff erent morphological forms observed in culture, the highest prevalence of cyst was in age group 37-48 months (p=0.000). Th e highest prevalence of vacuolar form(5.7%) was observed in the same age group (p=0.015). In contrast, the amoeboid forms were mostly observed in children of 25-36 months (p=0.002).Th e children aged in between 37 to 48 months are at the most risk of the infection. Conclusion: Th e sensitivity of direct microscopy was found only 38.46% in respect to in-vitro culture which strongly suggests that in-vitro culture is the gold standard for the diagnosis of this parasite.

Ecological risk posed by heavy metals contamination of ship breaking yards in bangladesh

Pollution of water and soils by heavy metals is an emerging problem in industrialized countries. The present study was conducted to investigate the heavy metals concentration in water and sediment samples from ship breaking sites of Sitakunda to assess the potential ecological risk posed by heavy metal using different methods. Heavy metals concentration was analyzed by Atomic Absorption Spectroscopy Concentrations of all the tested heavy metals except Cr in water samples of ship breaking site, Sitakunda were lower than recommended values. The mean concentration of Cr was found 0.51 1 +/- 0.284 mg/1. Concentrations of all the tested heavy metals except Mn in sediment samples were higher than standard limit. The concentrations of Pb, Mn, Cr, Cu and Zn in the sediment were 55.93 +/- 18.70, 20.08 +/- 4.03, 106.8 +/- 47.65, 50.09 +/- 18.31, and 70.71 +/- 19.45 mg/kg, respectively. Based on Geoaccumulation Index, Contamination factor. Sediment Quality Guidelines, the sediment of ship breaking site can be treated as unpolluted to moderately polluted with Pb, Zn, Cr and Cu but unpolluted with Mn. The Enrichment factors of Pb, Mn, Cr, Cu and Zn in the sediment were: 2.97 +/- 0.98, 0.035 +/- 0.008, 1.97 +/- 0.88, 1.99 +/- 0.73, and 1.17 +/- 0.32, respectively. The Enrichment factor [>1] in all sampling sites, suggesting source of those metals [Pb, Cr, Cu and Zn] were more likely to be anthropogenic. Based on the Potential Ecological Risk Index the ship breaking site posed to low risk to the environment. The results of present study clearly indicated that the ship breaking site was moderately polluted with heavy metals and pose low risk to the ecosystem

Pulmonary Hypertension: A Review.

Pulmonary hypertension is a relatively common disorder that leads to right heart failure if untreated. Symptoms and signs of pulmonary hypertensionare often subtle and nonspecific. As a result a significant delay between the onset of symptoms and the diagnosis of pulmonary hypertension is common. Recently improved understanding of the pathophysiology of pulmonary hypertension leads to various treatment options that enable us to treat this disorder more efficiently.

Negative PressureWound Therapy (NPWT) in open wound management: A study of 16 Cases in Orthopaedic Department of Faridpur Medical College Hospital.

Wound management is a major concern in open fracture cases. Negative Pressure Wound Therapy (NPWT) is an advanced method for managing open wounds. It is a topical treatment using sub-atmospheric pressure to increase blood flow, remove bacteria and increase growth of granulation tissue in the wound. The study was performed to evaluate the results of NPWT in patients with open fracture in lower extremity. Using Aquarium pump as an NPWT device, 16 patients were prospectly treated for open fractures in their inferior extremity. Mean patients' age range was 21 to 60 yrs. The patients under study either had suffered from trauma, fall or had post operative wound infection. Many of them had wounds with underlying tendon or bone exposure. Necrotic tissues were debrided before applying NPWT. Dressings were changed every 3rd or 4th day and treatments were continued for 07 to 28 days. Exposed tendons and bones were successfully covered with healthy granulation tissue in all cases, depth of the wounds reduced as well as surface areas. In 12 cases coverage of granulation tissue were achieved and further managed by skin grafting, 4 cases with wound infections were closed with secondary suture. No significant complications were noted regarding the treatment. NPWT was found to facilitate the rapid formation of healthy granulation tissue on open wounds in lower extremity and thus to shorten healing time and minimize secondary soft tissue defect coverage procedures.

Occurrence and Determinants of Postpartum Maternal Morbidities and Disabilities among Women in Matlab, Bangladesh.

The burden of maternal ill-health includes not only the levels of maternal mortality and complications during pregnancy and around the time of delivery but also extends to the standard postpartum period of 42 days with consequences of obstetric complications and poor management at delivery. There is a dearth of reliable data on these postpartum maternal morbidities and disabilities in developing countries, and more research is warranted to investigate these and further strengthen the existing safe motherhood programmes to respond to these conditions. This study aims at identifying the consequences of pregnancy and delivery in the postpartum period, their association with acute obstetric complications, the sociodemographic characteristics of women, mode and place of delivery, nutritional status of the mother, and outcomes of birth. From among women who delivered between 2007 and 2008 in the icddr,b service area in Matlab, we prospectively recruited all women identified with complicated births (n=295); a perinatal mortality (n=182); and caesarean-section delivery without any maternal indication (n=147). A random sample of 538 women with uncomplicated births, who delivered at home or in a facility, was taken as the control. All subjects were clinically examined at 6-9 weeks for postpartum morbidities and disabilities. Postpartum women who had suffered obstetric complications during birth and delivered in a hospital were more likely to suffer from hypertension [adjusted odds ratio (AOR)=3.44; 95% confidence interval (CI)=1.14-10.36], haemorrhoids (AOR=1.73; 95% CI=1.11-3.09), and moderate to severe anaemia (AOR=7.11; 95% CI=2.03- 4.88) than women with uncomplicated normal deliveries. Yet, women who had complicated births were less likely to have perineal tears (AOR=0.05; 95% CI=0.02-0.14) and genital prolapse (AOR=0.22; 95% CI=0.06-0.76) than those with uncomplicated normal deliveries. Genital infections were more common amongst women experiencing a perinatal death than those with uncomplicated normal births (AOR=1.92; 95% CI=1.18-3.14). Perineal tears were significantly higher (AOR=3.53; 95% CI=2.32-5.37) among those who had delivery at home than those giving birth in a hospital. Any woman may suffer a postpartum morbidity or disability. The increased likelihood of having hypertension, haemorrhoids, or anaemia among women with obstetric complications at birth needs specific intervention. A higher quality of maternal healthcare services generally might alleviate the suffering from perineal tears and prolapse amongst those with a normal uncomplicated delivery.

High-Density Lipoprotein as a Therapeutic Target: Treatment Strategies.

Coronary artery disease (CAD) is one of the most important causes of morbidity and mortality worldwide despite considerable therapeutic advances that control the risk factors. Numerous clinical trials have shown an inverse association between high density lipoprotein cholesterol levels and the risk of coronary artery disease. So, high density lipoprotein has become a new therapeutic target after low density lipoprotein in the management of risk factors of coronary artery disease. In this review, we explore existing and future treatment strategies along with their benefits and failures which will guide our management strategy. HDL raising therapies showed very promising results in many clinical trials but larger clinical trials are ongoing.

Pulmonary Hypertension in Hemodialysis Patients.

Background: Pulmonary hypertension (PH) has been reported to be high among maintenance dialysis patients. There is a paucity of data on the incidence and prevalence of pulmonary hypertension in chronic kidney disease(CKD) in Bangladeshi patients. Materials and Methods: A total 70 CKD patients (male 47,female 23), who were on conservative management and maintenance hemodialysis were studied for the presence of pulmonary hypertension. The variables studied were hypertension, diabetes, duration of dialysis and the hemoglobin, serum creatinine and serum bicarbonate levels. Results: 68.6% of the patients on maintenance hemodialysis had pulmonary hypertension compared to 8.6% of the prediadysis CKD patients. 97.1% of maintenance dialysis patients had anaemia (Hb <10gm/dl) and 42.9% of patients had metabolic acidosis. Conclusion: The incidence of pulmonary hypertension was highest in the hemodialysis group. Significant Pearson’s correlation was found between pulmonary arterial systolic pressure with the duration of hemodialysis, hemoglobin level, serum creatinine, blood sugar and serum bicarbonate level in maintenance hemodialysis patients.

Clinical Outcome and Echocardiographic Evaluation of Inferior Myocardial Infarction with Right Ventricular Involvement.

Background : Acute right ventricular myocardial infarction complicates inferior wall myocardial infarction with an incidence of 14-84%. ECG is the cornerstone in initial diagnosis as it is cost effective and done easily. Echocardiographic analysis of the right ventricular involvement can shed light on the severity of the disease. Hence we aimed to study right ventricular infarction in acute inferior wall myocardial infarction using right precordial lead as well as echocardiography. Methods: Present study is based on the analysis of 100 patients admitted to Coronary care unit of the National Institute of Cardiovascular Diseases & Hospital during July 2010 to June 2011, with acute inferior wall myocardial infarction. 12 lead ECG with thorough physical examination was done along with right precordial mapping. ST ³ 1mm in V4R was initial diagnostic of right ventricular involvement followed by echocardiographic assessment of RV and LV within 24 hours. Results: A total of 50 patients showed right ventricular involvement with V4R being the sensitive lead. Echocardiography showed mean RVEF of patients with 29.5 % ± 9.5 in comparison of 44.9%±12.2 without right ventricular involvement. Right ventricular involvement presented with bradycardia (40%) and hypotension, 80% Kussmaul’s sign, 14% with complete heart block. Mortality in right ventricular involvement was 6 times higher than without right ventricular involvement (12 %). Conclusion: Clinical signs and symptomatology are not fully diagnostic of RVI in inferior wall acute MI. ECG can diagnose (using right precordial mapping) this condition very early. Echocardiography help to assess the right ventricular function high-risk groups for aggressive management like primary PCI. Early diagnosis will help in careful monitoring and management of such cases.

Effect of Oral Zinc Supplementation on the Growth of Preterm Infants.

Objective: To compare the effect of oral zinc supplementation on growth of preterm infants. Design: Randomized controlled trial. Setting: Dhaka Shisu Hospital (Tertiary care hospital). Subjects: 100 appropriate for date preterm infants weighing between 1000 to 2500g were randomized to receive zinc and multivitamin supplement (Group I; n=50) or only multivitamin supplement (Group II). Intervention: Zinc supplementation was given 2mg/kg/ day for 6 weeks along with multivitamin in Group I and only multivitamin to Group II. Primary outcome variable: Increment of weight and length. Results: At enrollment, serum zinc (62.1±12.4μg/dL in Group I and 63.1±14.6μg/dL in Group II) and hemoglobin levels (14.9±2.4g/dL in Group I and 14.4±1.7g/dL in Group II) were almost similar in both groups. Serum zinc levels were in lower limit of normal range. After supplementation, serum zinc and hemoglobin levels were significantly higher in Group I (105±16.5μg/dL) than Group II (82.2±17.4μg/dL) (P<0.05). Weight, length and head circumference were comparable in both groups at enrollment. Significant differences in weight gain and increment in length were found in first and second follow up between two groups but OFC increments were not significant (P>0.05). Reduction of morbidity was apparent in zinc supplemented group. No serious adverse effect was noted related to supplementation therapy. Conclusion: Zinc supplementation for preterm low birth weight babies is found effective to enhance the growth in early months of life.

Study Of Serum Lipid Profile In Pre-Eclampsia And Eclampsia.

The present study was designed to evaluate the association of lipid profile in pre- eclampsia and eclampsia. This case-control study was carried out in the department of biochemistry, M.A.G. Osmani Medical College, Sylhet, during July 2005 to June 2006. Total 100 study subjects were evaluated, 40 normotensive pregnant women (mean age 24.90 ± 4.04) as normal and 60 already diagnosed preeclamptic & eclamptic women (mean age 24.17 ± 4.90) as study group. Age range was 15-45 years, gestational age 24 weeks to term were included. Patients with pre-existing hypertension were excluded. Serum lipid profile (total lipids, cholesterol, triglycerides, HDL-cholesterol and LDLcholesterol) of hundred women with Pre-eclampsia and Eclampsia (n=60), normotensive women (n=40) were monitored. The preeclampsia was associated with a significant rise in triglyceride (225.6 ± 28.93 vs 165.6 ± 17.22) and fall in HDL cholesterol concentration (42.4 ± 9.29 vs 55.7 ± 7.11), while eclamptic women showed significant fall in HDL cholesterol (41.8 ± 8.79 vs 55.7 ± 7.11) and rise in LDL cholesterol (133.4 ± 11.75 vs 115.2 ± 10.72) as compared to normal pregnant women. Lipid metabolism plays a key role in the pathophysiology of Pre-eclampsia and Eclampsia. Increased triglycerides levels along with decreased HDL-cholesterol levels and delayed triglycerides clearance and high blood pressure are associated with development of preeclampsia and eclampsia. This association may be significant in understanding the pathologic processes of preeclampsia and may help in developing strategies for prevention or early diagnosis of the disorder.

Determining Gestational Age in a Low-resource Setting: Validity of Last Menstrual Period.

The validity of three methods (last menstrual period [LPM], Ballard and Dubowitz scores) for assessment of gestational age for premature infants in a low-resource setting was assessed, using antenatal ultrasound as the gold standard. It was hypothesized that LMP and other methods would perform similarly in determining postnatal gestational age. Concordance analysis was applied to data on 355 neonates of <33 weeks gestational age enrolled in a topical skin-therapy trial in a tertiary-care children’s hospital in Bangladesh. The concordance coefficient for LMP, Ballard, and Dubowitz was 0.878, 0.914, and 0.886 respectively. LMP and Ballard underestimated gestational age by one day (±11) and 2.9 days (±7.8) respectively while Dubowitz overestimated gestational age by 3.9 days (±7.1) compared to ultrasound finding. LMP in a low-resource setting was a more reliable measure of gestational age than previously thought for estimation of postnatal gestational age of preterm infants. Ballard and Dubowitz scores are slightly more reliable but require more technical skills to perform. Additional prospective trials are warranted to examine LMP against antenatal ultrasound for primary assessment of neonatal gestational age in other low-resource settings.